Introduction
Globally, around 800 women died daily from preventable causes, pregnancy and childbirth.1 Worldwide, nearly 300 000 women were predicted to be died in 2010.2 Maternal and child mortality remains a major public health challenge in the developing world, and the discrepancy is high according to developed countries. The maternal mortality ratio in low-income and middle-income countries is 15 times higher than in developed countries.3 Sub-Saharan Africa had the highest maternal mortality ratio which is 64 deaths per 10 000 live births, and 900 maternal deaths occurred in Ethiopia.3 According to the 2011 Ethiopian Demographic and Health Survey (EDHS), maternal mortality rates were 6.76 per 1000 live births.4
Maternal and child mortality occur due to countries’ poor utilisation of healthcare services.4 An average of 52% of women received at least four antenatal care (ANC) services in developing regions. It was 36% in Asia, 49% in sub-Saharan Africa5 and 32% in Ethiopia.6 In addition, 77.69%, 73.95% and 67.61% of women delayed their first ANC visit in 2005, 2011 and 2016 EDHS, respectively.7 Pregnancy-induced high blood pressure, stillbirth and unsafe abortions are extremely high. Though institutional delivery is used to reduce pregnancy and birth risks, home birth in low-income countries is high and institutional delivery is 26%–32.5% in Ethiopia.8
Women’s postnatal care (PNC) service utilisation is insufficient, which is 6.9% with marked spatial heterogeneity in Ethiopia.9 Maternal and child health problems occur due to the inaccessibility of health institutions, poor women’s health-seeking behaviours, maternal and child health services inaccessibility, low media exposure, poor attitude and knowledge, and low-quality service provision.8 10 11 The geographical accessibility of healthcare services, rural women lack reliable transportation, and women are late in starting ANC service.12
In resource-limited settings, women’s access to health services is mainly affected by four principal factors such as not want to go alone, distance to health facilities, getting the money needed for treatment, and getting permission for medical care. Previous studies have proven that distance to a health facility (long distance) and the geographical position of health facilities,13 poverty, low monthly income and not having an occupation that makes women not have enough money for medical care,12 inadequate awareness and low-risk perception of women, laziness and disease severity that make women not want to go alone for medical care,14 and husbands’ and relatives’ complete decision-making culture for women’s health service access15 16 are challenges for maternal and child health service access among women.
Maternal and child healthcare services are the most effective and potential health interventions to overcome maternal and child mortality. Of these maternal and child healthcare services, the provision of ANC and PNC services,17 institutional delivery services,18 skilled birth assistance, and nutritional and breastfeeding counselling services are the main strategies of the Millennium Development Goal to reduce mortality and morbidity. Moreover, health facilities provide preventative, curative health services to prevent maternal and child deaths.9
Maternal health services would be accessible and fairly distributed,19 the quality of health service provision should be ensured20 and sufficient health professionals would available in health facilities. Plus, policy-makers understand women’s health services access problem and geographical variations of health service access to formulate strategies and interventions to solve women’s health services problems and to provide equity and quality of services provision.17 21 Therefore, this study would be an input for policy-makers to alleviate women’s health service access problems. Studies regarding women’s health service access are not adequate, and the findings of previous studies were insufficient and limited in spatial variation analysis of women’s health service access in Ethiopia. Moreover, the findings of this study would be important for women’s decision-making regarding maternal health service access, and the finding could support policy-makers, and programmers to design interventions for achieving women’s health service access. Therefore, this study aimed to assess women’s health services access, locate women’s health service access spatially and identify factors associated with women’s health service access.