Background characteristics of women
The following table showed that the individual characteristics of pregnant women in the five years preceding each survey in 2000, 2005, 2011, and 2016 EDHS datasets. Among the respondents, most of the respondents were age 20-34 years in all surveys. Based on educational levels, the proportion of women with no education decreased from 64.5% in 2000 to 53.9% in 2016. But those with primary education increased from 21.2% in 2000 to 33.2% in 2016 over the study period and also those with secondary education and higher decreased from 14.3% in 2000 to 12.9% in 2016. The proportion of their husbands with no education has decreased from 48% in 2000 to 40.1% in 2016 of the study periods.
Concerning the residence of respondents, in the four surveys about three-quarters of the respondents lived in the rural areas. In the four-consecutive surveys, most of the respondents (>80%) had no ever terminated pregnancy over time. Based on the wantedness of pregnancy, the reporting of the women wanted then their pregnancy has increased from 56.9% in 2000 to 76% in 2016. But the women wanted later their pregnancy and wanted no more pregnancy have decreased from 21.3% in 2000 to 17.3% in 2016 and from 21.8% in 2000 to 6.7% in 2016 respectively. Moreover, the reporting proportion of women who told about pregnancy complications has increased from 27.3% in 2000 to 45.0% in 2016 (Table 1).
Table 1: Characteristics and Percentage distribution of respondents in Ethiopia
Characteristics and their categories
|
Percentage (%) distribution of the surveys
|
EDHS 2000
|
EDHS 2005
|
EDHS 2011
|
EDHS 2016
|
N=2146
|
N=2051
|
N=3368
|
N=4740
|
women’s age
|
<20 years
|
6.6
|
5.7
|
4.7
|
5.3
|
20-34 years
|
69.0
|
71.6
|
71.9
|
73.1
|
≥35 years
|
24.4
|
22.7
|
23.4
|
21.6
|
Household head
|
Male
|
82.4
|
85.1
|
81.8
|
85.4
|
Female
|
17.6
|
14.9
|
18.2
|
14.6
|
Place of residence
|
Rural
|
71.7
|
78.5
|
73.1
|
81.6
|
Urban
|
28.3
|
21.5
|
26.9
|
18.4
|
Women educational level
|
No education
|
64.5
|
62.3
|
52.9
|
53.9
|
Primary education
|
21.2
|
23.1
|
37.2
|
33.2
|
Secondary & above
|
14.3
|
14.6
|
9.9
|
12.9
|
Husband educational level
|
No education
|
48.0
|
41.5
|
37.2
|
40.1
|
Primary education
|
28.4
|
33.2
|
45.9
|
40.8
|
Secondary & above
|
23.6
|
25.3
|
16.9
|
19.1
|
Women occupation status
|
Working
|
65.9
|
35.7
|
58.5
|
49.3
|
Not working
|
34.1
|
64.3
|
41.5
|
50.7
|
Husband occupation status
|
Not working
|
0.5
|
0.9
|
0.9
|
5.8
|
Working
|
99.4
|
99.1
|
99.1
|
94.2
|
Reading newspapers
|
Yes
|
15.9
|
14.7
|
16.8
|
10.0
|
No
|
84.0
|
85.3
|
83.2
|
90.0
|
Listening to a radio
|
Yes
|
43.2
|
50.8
|
67.7
|
66.2
|
No
|
56.8
|
49.2
|
37.3
|
33.8
|
Watching television
|
Yes
|
15.4
|
21.1
|
47.6
|
25.3
|
No
|
84.6
|
78.9
|
52.4
|
74.7
|
Told about pregnancy complications
|
Yes
|
27.3
|
31.7
|
20.3
|
45.0
|
No
|
72.7
|
68.3
|
79.7
|
55.0
|
Ever had terminated pregnancy
|
Yes
|
16.4
|
10.1
|
10.8
|
9.2
|
No
|
83.6
|
89.9
|
89.2
|
90.8
|
Wantedness of pregnancy
|
Wanted then
|
56.9
|
60.3
|
68.0
|
76.0
|
Wanted later
|
21.3
|
21.5
|
21.7
|
17.3
|
Wanted no more
|
21.8
|
18.2
|
10.3
|
6.7
|
Caesarean delivery
|
Yes
|
2.19
|
3.72
|
4.0
|
3.5
|
No
|
97.8
|
96.3
|
96.0
|
96.5
|
Parity
|
1
|
37.7
|
40.0
|
41.1
|
41.2
|
2-4
|
37.7
|
34.3
|
36.8
|
36.4
|
≥5
|
24.6
|
25.7
|
22.1
|
22.4
|
Family size
|
<=2
|
2.5
|
1.9
|
3.3
|
2.1
|
3-4
|
28.3
|
30.4
|
29.3
|
33.1
|
≥5
|
69.2
|
67.7
|
67.4
|
64.8
|
Number of living children
|
0
|
2.1
|
2.2
|
1.1
|
0.6
|
1-3
|
60.8
|
57.1
|
60.9
|
59.3
|
≥4
|
37.1
|
40.7
|
38.0
|
40.1
|
Ever use contraceptive
|
Yes
|
18.4
|
24.7
|
38.4
|
41.9
|
No
|
81.6
|
75.3
|
61.6
|
58.1
|
Region
|
Tigray
|
9.1
|
8.7
|
10.1
|
10.1
|
Afar
|
1.1
|
0.6
|
0.8
|
0.8
|
Amhara
|
19.3
|
23.8
|
23.7
|
23.0
|
Oromia
|
39.5
|
33.4
|
36.4
|
33.8
|
Somali
|
0.6
|
1.1
|
1.5
|
2.5
|
Benishangul-Gumuz
|
1.0
|
0.8
|
1.1
|
1.2
|
SNNPR
|
22.1
|
24.6
|
9.7
|
23.4
|
Gambla
|
0.6
|
0.4
|
0.5
|
0.3
|
Harari
|
0.4
|
0.3
|
0.3
|
0.3
|
Addis Ababa
|
5.6
|
0.5
|
5.4
|
4.0
|
Dire Dawa
|
0.7
|
0.6
|
0.5
|
0.6
|
Trends in delayed first ANC visit by selected variables
The higher decrement in the proportion of delayed first antenatal care visits was observed in the last phase (2000-2016) with a 9.5% point change decreased compared with a 0.5% point change in the first phase (2000-2005). The trends of delayed first antenatal care visit proportion showed a variation in the women’s characteristics. Among the rural residents, the highest decrement in the proportion of delayed first antenatal care visits was observed in the first phase of the study period (2000-2005) with 28.2% differences compared with 10.7% differences during (2000-2016).
Based on the region, the proportion of delayed first antenatal care visits was increased in the first phase (2000-2005) with a small 0.1% point difference in the Amhara region but decreased in the last phase (2000-2016) at 19.0% point differences. The highest proportion of delayed first antenatal care visits was observed in the Dire-Dawa (24.9%) and the least in the Somali region (1.1%). Besides, the proportion of delayed first antenatal care visits for women with primary education in the sixth phase (2000-2016) was declined by a 10.1% point difference. Concerning women having two family sizes and three up to four-family sizes in households, the proportion of delayed first antenatal care visits over the study period (2000-2016) was decreased with 32.5% and 12.8% point changes respectively (Table 2).
Table 2: Trends of Delayed first antenatal care visits among women by the selected characteristics in Ethiopia.
Characteristics
|
EDHS 2000
|
EDHS 2005
|
EDHS
2011
|
EDHS 2016
|
Percentage point difference in delayed first ANC visit
|
N=2146
|
N=2051
|
N=3368
|
N=4740
|
2000-2005
|
2005-2011
|
2011-2016
|
2000-2016
|
Mother’s age
|
|
|
|
|
|
|
|
|
<20 years
|
83.4
|
79.7
|
75.4
|
63.5
|
-3.7
|
-4.3
|
-12.0
|
-19.9
|
20-34 years
|
76.3
|
75.7
|
73.3
|
67.0
|
-0.7
|
-2.3
|
-6.3
|
-9.3
|
≥35 years
|
76.5
|
81.0
|
74.2
|
69.2
|
4.4
|
-6.8
|
-5.0
|
-7.34
|
Residence
|
|
|
|
|
|
|
|
|
Rural
|
81.6
|
53.4
|
78.9
|
71.0
|
-28.2
|
25.5
|
-7.9
|
-10.7
|
Urban
|
64.8
|
83.8
|
59.4
|
51.1
|
19.0
|
-24.4
|
-8.3
|
-13.6
|
Household head
|
|
|
|
|
|
|
|
|
Male
|
77.2
|
79.7
|
75.1
|
68.4
|
2.5
|
-4.6
|
-6.7
|
-8.8
|
Female
|
75.2
|
63.2
|
66.9
|
61.1
|
-12.0
|
3.7
|
-5.9
|
-14.2
|
Women education
|
|
|
|
|
|
|
|
|
No education
|
81.4
|
82.42
|
78.4
|
71.2
|
1.0
|
-4.0
|
-7.2
|
-10.3
|
Primary education
|
76.5
|
76.6
|
71.7
|
66.3
|
0.1
|
-4.9
|
-5.3
|
-10.1
|
Secondary educat
|
56.6
|
56.3
|
55.5
|
53.7
|
-0.3
|
-0.8
|
-1.8
|
-2.9
|
Husband education
|
|
|
|
|
|
|
|
|
No education
|
81.7
|
81.84
|
78.4
|
69.5
|
0.1
|
-3.5
|
-8.9
|
-12.3
|
Primary education
|
79.4
|
84.2
|
75.6
|
70.4
|
4.8
|
-8.6
|
-5.2
|
-9.0
|
Secondary education
|
64.2
|
61.1
|
59.5
|
59.6
|
-3.1
|
-1.7
|
0.1
|
-4.6
|
Wantedness of pregnancy
|
|
|
|
|
|
|
|
|
Wanted then
|
73.6
|
77.4
|
74.4
|
66.9
|
3.8
|
-2.9
|
-7.6
|
-6.7
|
Wanted later
|
74.1
|
77.8
|
70.6
|
66.4
|
3.6
|
-7.2
|
-4.2
|
-7.7
|
Wanted no more
|
79.1
|
76.1
|
74.5
|
74.5
|
-3.0
|
-1.6
|
0.1
|
-4.5
|
Women occupation
|
|
|
|
|
|
|
|
|
Working
|
77.5
|
75.4
|
73.6
|
64.3
|
-2.1
|
-1.7
|
-9.3
|
-13.2
|
Not working
|
75.5
|
78.3
|
73.7
|
70.2
|
2.8
|
-4.6
|
-3.5
|
-5.2
|
husband occupation
|
|
|
|
|
|
|
|
|
Working
|
76.7
|
77.7
|
75.0
|
67.9
|
0.9
|
-2.6
|
-7.1
|
-8.8
|
Not working
|
80.9
|
81.1
|
45.4
|
67.3
|
0.2
|
-35.7
|
21.8
|
-13.6
|
Reading newspapers
|
|
|
|
|
|
|
|
|
Yes
|
63.8
|
61.1
|
65.3
|
51.7
|
-2.7
|
4.1
|
-13.5
|
-12.1
|
No
|
79.3
|
80.1
|
75.3
|
69.0
|
0.8
|
-4.8
|
-6.3
|
-10.3
|
Listening to radio
|
|
|
|
|
|
|
|
|
Yes
|
71.0
|
70.4
|
72.5
|
65.2
|
-0.6
|
2.1
|
-7.3
|
-5.8
|
No
|
81.3
|
84.3
|
75.6
|
68.4
|
3.1
|
-8.8
|
-7.2
|
-12.9
|
Watching television
|
|
|
|
|
|
|
|
|
Yes
|
60.6
|
55.8
|
68.8
|
54.8
|
-4.8
|
13.0
|
-14.0
|
-5.8
|
No
|
79.8
|
83.0
|
78.0
|
71.5
|
3.2
|
-5,0
|
-6.5
|
-8.3
|
Told pregnancy complication
|
|
|
|
|
|
|
|
|
Yes
|
73.5
|
67.2
|
62.1
|
63.3
|
-6.4
|
-5.1
|
1.2
|
-10.2
|
No
|
78.2
|
81.8
|
76.2
|
70.7
|
3.6
|
-5.7
|
-5.6
|
-7.6
|
Ever terminated pregnancy
|
|
|
|
|
|
|
|
|
Yes
|
75.9
|
69.5
|
80.0
|
69.2
|
-6.4
|
10.5
|
-10.7
|
-6.7
|
No
|
77.0
|
78.1
|
72.8
|
67.1
|
1.1
|
-5.3
|
-5.7
|
-9.9
|
Caesarean delivery
|
|
|
|
|
|
|
|
|
Yes
|
57.6
|
49.0
|
63.8
|
37.2
|
-8.6
|
14.8
|
-26.6
|
-20.4
|
No
|
77.3
|
78.3
|
74.0
|
68.4
|
1.0
|
-4.3
|
-5.6
|
-8.9
|
Parity
|
|
|
|
|
|
|
|
|
1
|
76.6
|
72.0
|
69.4
|
62.8
|
-4.6
|
-2.6
|
-6.6
|
-13.8
|
2-4
|
77.4
|
79.1
|
76.1
|
66.9
|
1.7
|
-3.0
|
-9.2
|
-10.5
|
≥ 5
|
76.3
|
82.9
|
77.2
|
76.2
|
6.6
|
-5.7
|
-1.0
|
-0.1
|
Family size
|
|
|
|
|
|
|
|
|
≤2
|
65.0
|
58.8
|
69.3
|
32.4
|
-6.1
|
10.5
|
-36.8
|
-32.5
|
3-4
|
77.1
|
73.5
|
69.0
|
64.3
|
-3.4
|
-4.6
|
-4.7
|
-12.8
|
≥ 5
|
77.1
|
79.4
|
75.9
|
69.9
|
2.3
|
-3.6
|
-5.9
|
-7.2
|
Number of living children
|
|
|
|
|
|
|
|
|
0
|
71.8
|
60.8
|
70.0
|
26.9
|
-11.1
|
9.3
|
-43.2
|
-45.0
|
1-3
|
76.6
|
74.1
|
72.4
|
63.7
|
-2.4
|
-1.8
|
-8.7
|
-12.9
|
≥ 4
|
77.6
|
82.5
|
75.7
|
73.3
|
4.9
|
-6.8
|
-2.4
|
-4.3
|
Ever use contraceptive
|
|
|
|
|
|
|
|
|
Yes
|
62.2
|
67.8
|
68.1
|
63.3
|
5.6
|
0.3
|
-4.7
|
1.1
|
No
|
80.1
|
80.4
|
77.1
|
70.2
|
0.2
|
-3.3
|
-6.9
|
-10.0
|
Region
|
|
|
|
|
|
|
|
|
Tigray
|
82.2
|
80.0
|
75.8
|
63.0
|
-2.2
|
-4.2
|
-12.8
|
-19.2
|
Afar
|
80.6
|
73.6
|
68.9
|
63.2
|
-7.0
|
-4.7
|
-5.7
|
-17.4
|
Amhara
|
77.5
|
77.6
|
73.9
|
58.5
|
0.1
|
-3.7
|
-15.5
|
-19.0
|
Oromia
|
74.6
|
75.5
|
75.9
|
71.2
|
0.9
|
0.4
|
-4.7
|
-3.4
|
Somali
|
69.8
|
49.7
|
63.6
|
68.6
|
-20.1
|
13.9
|
5.0
|
-1.1
|
Benis-Gumuz
|
81.8
|
82.2
|
84.3
|
76.9
|
0.4
|
2.2
|
-7.4
|
-4.8
|
SNNPR
|
84.3
|
87,0
|
77.3
|
78.3
|
2.6
|
-9.7
|
1
|
-6.1
|
Gambla
|
67.3
|
73.1
|
57.7
|
55.9
|
5.8
|
-15.4
|
-1.7
|
-11.4
|
Harari
|
59.7
|
55.7
|
44.6
|
41.4
|
-3.9
|
-11.1
|
-3.2
|
-18.2
|
Addis Ababa
|
56.5
|
49.1
|
47.0
|
37.6
|
-7.4
|
-2.0
|
-9.4
|
-18.9
|
Dire Dawa
|
56.0
|
46.1
|
42.0
|
31.1
|
-9.9
|
-4.1
|
-10.9
|
-24.9
|
Total
|
76.8
|
77.3
|
73.6
|
67.3
|
0.5
|
-3.7
|
-6.3
|
-9.5
|
Trends in the delayed first antenatal care visit
The trends of delay first antenatal care visits over the study periods (2000-2016) were divided into different phases to observe the change in the delayed first antenatal care visits and important source for the change in the delayed first antenatal care visits. The proportion of delayed first antenatal care visits over the study period (2000-2016) has shown a decrement from 76.8% in 2000 to 67.3% in 2016. The 95% confidence interval of the proportion of delay fist antenatal care visit rose a small from 76.8 [75.1, 78.6] to 77.3 [75.4, 79.1] decline to 73.6 [72.1, 75.1] and final decrease to 67.3 [65.9, 68.6]. Therefore, the proportion of delayed first antenatal visit was significantly declined between EDHS 2000-2016 over time (Fig. 1).
Decomposition analysis
This multivariate decomposition analysis was used to examine the trends of delayed first antenatal care visit and identify factors either positively or negatively contributing to the change in the proportion of delayed first antenatal care visit.
Decomposition analysis of delayed first ANC visit in Ethiopia, 2000-2016
The decomposition of the change in the proportion of delayed first antenatal care visit by considering the selected variables is used to understand the variations in the composition of characteristics or the change in health behaviors. The overall trend from 2000 to 2016 noted that there was a significant decline in the delayed first antenatal care visit among pregnant women. The decline in the proportion of delayed first antenatal care visits over the study period has been described by the differences in the women’s characteristics and the differences in the effect of characteristics (Table 3).
Table 3: Overall decomposition analysis change in delayed first antenatal care visit among women in Ethiopia 2000-2016.
Components
|
Coeff (95% CI)
|
Pct.
|
Difference in characteristics(E)
|
-.032592(-.056518, -.008665)
|
39.1
|
Difference in coefficients(C)
|
-.05091(-.089767, -.012034)
|
60.9
|
Residual(R)
|
-.083492(-.11491, -.052073)
|
|
Table 4: Detailed decomposition analysis change in delayed first antenatal care visits among women in Ethiopia 2000-2016.
Variables
|
Difference due to characteristics (E)
|
Difference due to coefficients (C)
|
Coeff (95% CI)
|
Pct.
|
Coeff (95%CI)
|
Pct.
|
Household head
|
|
|
|
|
Male®
|
|
|
|
|
Female
|
.0002138(-.002953, .003380)
|
-.3
|
-004131(-.018035, .009773)
|
4.9
|
Residence
|
|
|
|
|
Urban®
|
|
|
|
|
Rural
|
.006818 *(.00095109, .012685)
|
-8.2
|
.0006295(-.048803, .0747)
|
-15.5
|
Reading newspapers
|
|
|
|
|
Yes®
|
|
|
|
|
No
|
-.0036942(-.008142, .0007534)
|
4.4
|
-.029002(-.18088, .12287)
|
34.7
|
Listening to a radio
|
|
|
|
|
Yes®
|
|
|
|
|
No
|
-.004351*(-.008333, -.0003689)
|
5.2
|
.018395(-.012632, .049422)
|
-22.0
|
Watching to television
|
|
|
|
|
Yes®
|
|
|
|
|
No
|
-.007204*(-.012087, -.0023201)
|
8.6
|
-.005452(-.019421, .008516)
|
6.5
|
Ever had terminated pregnancy
|
|
|
|
|
Yes®
|
|
|
|
|
No
|
-.0003671(-.004347, .003613)
|
.4
|
.002952(-.010704, .016608)
|
-3.5
|
Told about pregnancy complications
|
|
|
|
|
Yes®
|
|
|
|
|
No
|
-.0066515*(-.012924, -.0003792)
|
8.0
|
.030205(-.015242, .075651)
|
-36.2
|
Cesarean delivery
|
|
|
|
|
Yes®
|
|
|
|
|
No
|
-.0002201*(-.000355, -.0000852)
|
.3
|
-.002895(-.007066, .001276)
|
3.5
|
Wantedness of pregnancy
|
|
|
|
|
Wanted then®
|
|
|
|
|
Wanted later
|
-.0000595(-.001919, .001800)
|
.1
|
.0061642(-.010147, .022476)
|
-7.4
|
Want no more
|
-.007346(-.01921, .0045191)
|
8.8
|
.014025(-.0064513, .034501)
|
-16.8
|
Women education level
|
|
|
|
|
No education®
|
|
|
|
|
Primary education
|
-.001951(-.007301, .003407)
|
2.3
|
.0007179(-.015125, .01656)
|
-.9
|
Secondary & above education
|
.000176(-.000494, .000845)
|
-.2
|
.013158(-.0024387, .028755)
|
-15.8
|
Husband education level
|
|
|
|
|
No education®
|
|
|
|
|
Primary education
|
.003822(-.0014566, .0091)
|
-4.6
|
.009099(-.011995, .030193)
|
-10.9
|
Secondary education & above
|
-.002262(-.004877, .000354)
|
2.7
|
.022655*(.0001921, .04512)
|
-27.1
|
Parity
|
|
|
|
|
1®
|
|
|
|
|
2-4
|
5.792e-05(-.0005397, .0006556)
|
-.1
|
.002656(-.034132, .039443)
|
-3.2
|
≥ 5
|
-.0007894(-.001665, .00008664)
|
.9
|
.033711(-.002834, .070257)
|
-40.4
|
Family size
|
|
|
|
|
≤2®
|
|
|
|
|
3-4
|
.0096351*(.0027093, .016561)
|
-11.5
|
.024385(-.035153, .083923)
|
-29.2
|
≥ 5
|
-.0056901*(-.010004, -.001376)
|
6.8
|
.047305(-.098709, .19332)
|
-56.7
|
Ever contraceptive use
|
|
|
|
|
No®
|
|
|
|
|
Yes
|
-.008472(-.017782, .000837)
|
10.2
|
.008745(-.004505, .02199)
|
-10.5
|
Constant
|
|
|
-.24466(-.48512, -.0041945)
|
293
|
®: reference; *: significant at 5% level of significance; Pct: percent; Coef: coefficient
Difference due to characteristics (Endowment)
The multivariate decomposition analysis result showed that about 39% of the overall change in the delayed first antenatal care visit was due to a difference in characteristics or composition changes related to increased population access to antenatal care utilization (Table 3). Among the various important compositional factors, such as place of residence, listening to the radio, watching television, told about pregnancy complications, cesarean delivery and the number of family sizes in the household had a significant effect on the delayed first antenatal care visit (Table 4). In general, the decomposition results indicated that changes in health behavior were the principal source of change in the proportion of delayed first antenatal care visits among women between 2000 and 2016 regardless of the exposure variables.
An increase in the composition of women who reside in rural areas in the sample negatively contributes by 8.2% to the decline in the delayed first antenatal care visit. Decreasing in the composition of women who had no exposure to listening to the radio in the sample revealed that a significant positive contribution to delaying the first antenatal care visit, which contributes about 5.2% for the decline in delayed first antenatal care visit (Table 4).
A decrease in the proportion of women who were not told about pregnancy complications in the sample contributes a positive 8% for the decline of the proportion of delayed the first antenatal care visit. A decrease in the composition of women who had no experience of cesarean delivery in the sample revealed that a significant positive 0.3% contributes to the decline of delayed antenatal care visits among pregnant women (Table 4).
An increase in the composition of women who had three up to four-family sizes in the sample showed a significant negative 11.5% contributes to a decline in the proportion of delayed first antenatal care visit. While a decrease in the composition of women who had five and above family sizes in the house showed a significant positive contribution to the decline in the delayed the first antenatal care visit by contributing 6.8% (Table 4).
Difference due to effects of the coefficient (effect of characteristics)
Keeping the effect of change in compositional characteristics, about 61% of the overall change in the proportion of delayed first antenatal care visit was due to the differences in the effect of characteristics (Table 3). The husband’s education factor had a significant effect on the observed positive change in the proportion of delayed first antenatal care visit. Women whose husband's education was secondary and above showed a significant positive contribution to the observed percentage decrease in the delayed first antenatal care visit over the study period which contributed about 27.1% (Table 4).