ArticleBMJ public health2026
Social mechanisms of maternal health service use among pregnant women facing intersecting vulnerabilities in Ethiopia: a cross-sectional study.
Article in BMJ public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Maternal health services, such as antenatal care (ANC) and institutional delivery, may reduce maternal and child health burdens. However, disparities in service coverage persist across Ethiopia. Pregnant women experiencing intersecting vulnerabilities face particularly significant barriers to accessing care. Understanding how social contexts shape maternal care-seeking behaviours can provide valuable insights into supporting underserved pregnant women, offering guidance for future research and practice. This study examines the influence of social and gender norms, as well as spousal relationship dynamics, on service utilisation among this population. Methods: This study is based on cross-sectional baseline data from a parent quasi-experimental study. Screening tools were developed to identify pregnant women facing vulnerabilities in accessing maternal care. A total of 470 pregnant women participated in the survey, which assessed perceived social norms, gender norms, couple communication, decision-making, social support, ANC visits and institutional delivery experiences. Logistic and linear regression analyses were performed. Results: Our results showed that descriptive norms, injunctive norms, couple communication and joint decision-making were significantly associated with ANC visits. Descriptive and injunctive norms predicted institutional delivery. ANC visit partially mediated the relationship between social norms and institutional delivery and fully mediated the influence of couple communication on institutional delivery. Our findings also revealed interaction effects among social norms, couple communication and gender norms on health service use. Conclusions: This study revealed that health service use among underserved pregnant women is heavily influenced by social norms-the behaviours, attitudes and beliefs of people in their social networks. Interpersonal communication with husbands also played a significant role in shaping maternal service utilisation. The findings suggest that future programmes should engage and educate male partners, family members and peer pregnant women to foster a supportive social environment that encourages care-seeking behaviours among new mothers facing intersecting barriers.
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