The Role of Geographical Access in the Utilization of Institutional Delivery Service in Rural Jimma Horro District, Southwest Ethiopia

Abstract

Introduction: Access to skilled maternal care in a suitable setting at all births is momentous to reduce maternal mortality. The role of geographical access particularly in rural Ethiopia is not sufficiently investigated. Hence, the central intention of this study was to estimate the effect of geographic access of rural mothers on institutional delivery care use in Jimma Horro District, Southwest Ethiopia. Methods: A community-based cross-sectional survey was conducted in April 2012 in six randomly selected kebeles. Data on socio-demographic, maternal history and maternity services use were collected from 528 eligible mothers using structured questionnaire. Geo-referenced data on respondents’ houses and health institutions as well as walking tracks from each village center to the nearest health center were recorded using hand-held Global Positioning System (GPS) instrument and mapped using Arc GIS 9.3. Multivariate logistic regression analysis was performed to estimate the effect of distance on facility delivery use by controlling for range of confounders. Results: Only 8% of the mothers gave birth to their last babies in health facilities. One third of the respondents live within 5-kilometer walking distance of the nearest health center. Each kilometer increase in walking distance to the nearest health center resulted in a reduction of institutional delivery service by 22% (AOR=0.78, 95% CI: 0.64 to 0.96).Use of institutional delivery service was also significantly higher among mothers who faced obstetric complications, and those who attended four and more ANC visits. Conclusion: Geographic access to health centers plays a major role in institutional delivery care use among rural mothers. Tackling the geographical dimension of access is pivotal in elevating institutional delivery care utilization.