{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T07:32:34Z","timestamp":1792481554630,"version":"4.5.0"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,4,26]],"date-time":"2025-04-26T00:00:00Z","timestamp":1745625600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2025,4,26]],"date-time":"2025-04-26T00:00:00Z","timestamp":1745625600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"DOI":"10.1186\/s12913-025-12639-3","type":"journal-article","created":{"date-parts":[[2025,4,26]],"date-time":"2025-04-26T06:20:00Z","timestamp":1745648400000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Socio-economic and geographic equity in maternal health services utilization in Ethiopia: a community-based cross-sectional study"],"prefix":"10.1186","volume":"25","author":[{"given":"Zewditu","family":"Denu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atkure","family":"Defar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Persson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seblewengel","family":"Lemma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Della","family":"Berhanu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodros","family":"Getachew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Solomon","family":"Shiferaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amare","family":"Tariku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadesse","family":"Guadu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meseret","family":"Zelalem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girum","family":"Taye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Schellenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanya","family":"Marchant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kassahun","family":"Alemu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,26]]},"reference":[{"key":"12639_CR1","first-page":"160","volume":"17","author":"GA Tessema","year":"2017","unstructured":"Tessema GA, Laurence CO, Melaku YA, et al. Trends and causes of maternal mortality in Ethiopia during 1990\u20132013: findings from the Global Burden of Diseases study 2013. BMC Public Health. 2017;17:160.","journal-title":"\u00a0BMC Public Health."},{"issue":"Suppl 2","key":"12639_CR2","doi-asserted-by":"publisher","first-page":"S5","DOI":"10.1186\/1742-4755-12-S2-S5","volume":"12 Suppl 2","author":"M Bauserman","year":"2015","unstructured":"Bauserman M, Lokangaka A, Thorsten V, Tshefu A, Goudar SS. Esamai F, et al risk factors for maternal death in low- and middle-income countries: a prospective longitudinal cohort analysis. Reprod Health. 2015;12 Suppl 2(Suppl 2):S5.","journal-title":"Reprod Health."},{"issue":"1","key":"12639_CR3","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1186\/s12905-023-02207-4","volume":"23","author":"SB Kitila","year":"2023","unstructured":"Kitila SB, Feyissa GT, Wordofa MA. Why do women walk away from maternal health services in Southwest Ethiopia? A qualitative study of caregivers\u2019 and clients\u2019 perspectives. BMC Womens Health. 2023;23(1):83. https:\/\/doi.org\/10.1186\/s12905-023-02207-4. PMID: 36823562; PMCID: PMC9950010.","journal-title":"BMC Womens Health"},{"key":"12639_CR4","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2018-000779","volume":"3","author":"LT\u00d6 Benova","year":"2018","unstructured":"Benova LT\u00d6, Moran AC, et al. Not just a number: examining coverage and content of antenatal care in low-income and middle-income countries. BMJ Glob Health. 2018;3: e000779.","journal-title":"BMJ Glob Health"},{"issue":"4","key":"12639_CR5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1371\/journal.pone.0120922","volume":"10","author":"N Alam","year":"2015","unstructured":"Alam N, Hajizadeh M, Dumont A, Fournier P. Inequalities in maternal health care utilization in sub-Saharan African countries: a multiyear and multi-country analysis. PLoS One. 2015;10(4):1\u201316.","journal-title":"PLoS One."},{"key":"12639_CR6","doi-asserted-by":"publisher","first-page":"812","DOI":"10.2471\/BLT.06.035659","volume":"85","author":"L Say","year":"2007","unstructured":"Say L, Raine R. A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context. Bull World Health Organ. 2007;85:812\u20139. https:\/\/doi.org\/10.2471\/BLT.06.035659.","journal-title":"Bull World Health Organ"},{"key":"12639_CR7","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1007\/s00038-015-0711-x","volume":"60","author":"Z Caliskan","year":"2015","unstructured":"Caliskan Z, Kilic D, Ozturk S, Atulgan E. Equity in maternal health care service utilization: a systematic review for developing countries. Int J Public Health. 2015;60:815\u201325. https:\/\/doi.org\/10.1007\/s00038-015-0711-x.","journal-title":"Int J Public Health"},{"key":"12639_CR8","unstructured":"Countdown to 2030 for Women\u2019s, Children\u2019s and Adolescent\u2019s Health. Maternal and newborn health in low- and middle-income countries: A brief assessment of mortality, coverage and policies. Prepared for the AlignMNH Opening Forum, 20\u201321 April 2021."},{"issue":"1","key":"12639_CR9","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1186\/s12939-021-01440-3","volume":"20","author":"A Luisa","year":"2021","unstructured":"Luisa A, Saad GE, Victora CG, Barros AJD. Inequalities in antenatal care coverage and quality: an analysis from 63 low and middle-income countries using the ANCq content-qualified coverage indicator. Int J Equity Health. 2021;20(1):102.","journal-title":"Int J Equity Health."},{"issue":"9","key":"12639_CR10","doi-asserted-by":"publisher","first-page":"e0134905","DOI":"10.1371\/journal.pone.0134905","volume":"10","author":"SCM Alkenbrack","year":"2015","unstructured":"Alkenbrack SCM, ZengW CT, Sharma S. Did equity of reproductive and maternal health service coverage increase during the MDG Era? an analysis of trends and determinants across 74 Low- and middle-income countries. PLoS ONE. 2015;10(9):e0134905.","journal-title":"PLoS ONE"},{"key":"12639_CR11","first-page":"229","volume":"76","author":"LM Puchalski Ritchie","year":"2016","unstructured":"Puchalski Ritchie LM, ea. Low- and middle-income countries face many common barriers to implementation of maternal health evidence products. J ClinEpidemiol. 2016;76:229\u201337.","journal-title":"J ClinEpidemiol"},{"key":"12639_CR12","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1186\/s12884-024-06536-6","volume":"24","author":"Z Abdissa","year":"2024","unstructured":"Abdissa Z, Alemu K, Lemma S, et al. Effective coverage of antenatal care services in Ethiopia: a population-based cross-sectional study. BMC Pregnancy Childbirth. 2024;24:330. https:\/\/doi.org\/10.1186\/s12884-024-06536-6.","journal-title":"BMC Pregnancy Childbirth"},{"key":"12639_CR13","volume-title":"Ethiopia Mini Demographic and Health Survey 2019: Key Indicators","author":"ICF Ephi","year":"2019","unstructured":"Ephi ICF. Ethiopia Mini Demographic and Health Survey 2019: Key IndicatorsEphi ICF. Ethiopia Mini Demographic and Health Survey 2019: Key Indicators. Mid Atlantic Region: EPHI and ICF; 2019."},{"key":"12639_CR14","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1186\/1471-2393-14-161","volume":"14","author":"SM Tarekegn","year":"2014","unstructured":"Tarekegn SM, Lieberman LS, Giedraitis V. Determinants of maternal health service utilization in Ethiopia: analysis of the 2011 Ethiopian Demographic and Health Survey. BMC Preg Child. 2014;14:161.","journal-title":"BMC Preg Child."},{"key":"12639_CR15","doi-asserted-by":"publisher","first-page":"174550572210917","DOI":"10.1177\/17455057221091732","volume":"18","author":"D Addisu","year":"2022","unstructured":"Addisu D, Mekie M, Melkie A, Abie H, Dagnew E, Bezie M, Degu A, Biru S, Chanie ES. Continuum of maternal healthcare services utilization and its associated factors in Ethiopia: A systematic review and meta-analysis. Womens Health (Lond). 2022;18:17455057221091732.","journal-title":"Womens Health (Lond)."},{"key":"12639_CR16","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1186\/s12978-021-01265-x","volume":"18","author":"TL Dadi","year":"2021","unstructured":"Dadi TL, Medhin G, Kasaye HK, Kassi GM, Jebena MG, Gobezie WA, Alemayehu YK, Teklu AM. Continuum of maternity care among rural women in Ethiopia: does place and frequency of antenatal care visit matter? Reprod Health. 2021;18:220.","journal-title":"Reprod Health"},{"key":"12639_CR17","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1186\/s12978-022-01508-5","volume":"19","author":"Muluwas Amentie Zelka AWYaGTD","year":"2022","unstructured":"Muluwas Amentie Zelka AWYaGTD. The effects of the completion of a continuum of care in maternal health services on adverse birth outcomes in Northwestern Ethiopia: a prospective follow-up study. Reprod Health. 2022;19:200.","journal-title":"Reprod Health"},{"issue":"1","key":"12639_CR18","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1186\/s12978-018-0556-x","volume":"15","author":"EWA Gebre","year":"2018","unstructured":"Gebre EWA, Bukola F. Inequities in maternal health services utilization in Ethiopia 2000\u20132016: magnitude, trends, and determinants. Reprod Health. 2018;15(1):119.","journal-title":"Reprod Health"},{"key":"12639_CR19","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1186\/s12939-019-1111-2","volume":"18","author":"AD Wuneh","year":"2019","unstructured":"Wuneh AD, Medhanyie AA, Bezabih AM, Persson L\u00c5, Schellenberg J, Okwaraji YB. Wealth-based equity in maternal, neonatal, and child health services utilization: a cross-sectional study from Ethiopia. Int J Equity Health. 2019;18:201.","journal-title":"Int J Equity Health."},{"key":"12639_CR20","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1186\/s12939-019-1079-y","volume":"18","author":"A Defar","year":"2019","unstructured":"Defar A, Okwaraji YB, Tigabu Z, et al. Geographic differences in maternal and child health care utilization in four Ethiopian regions; a cross-sectional study. Int J Equity Health. 2019;18:173. https:\/\/doi.org\/10.1186\/s12939-019-1079-y.","journal-title":"Int J Equity Health"},{"key":"12639_CR21","doi-asserted-by":"publisher","first-page":"1455","DOI":"10.1186\/s12913-022-08850-1","volume":"22","author":"BT Seboka","year":"2022","unstructured":"Seboka BT, Mamo TT, Mekonnen T. Identifying geographical inequalities of maternal care utilization in Ethiopia: a Spatio-temporal analysis from 2005 to 2019. BMC Health Serv Res. 2022;22:1455. https:\/\/doi.org\/10.1186\/s12913-022-08850-1.","journal-title":"BMC Health Serv Res"},{"key":"12639_CR22","doi-asserted-by":"publisher","unstructured":"Zimmerman L, Desta S, Yihdego M, Rogers A, Amogne A, Karp C, Wood SN, Creanga A, Ahmed S, Seme A, Shiferaw S. Protocol for PMA-Ethiopia: A new data source for cross-sectional and longitudinal data of reproductive, maternal, and newborn health. Gates Open Res. 2020;4:126. https:\/\/doi.org\/10.12688\/gatesopenres.13161.1. PMID: 33150302; PMCID: PMC7593701.","DOI":"10.12688\/gatesopenres.13161.1"},{"issue":"6","key":"12639_CR23","doi-asserted-by":"publisher","first-page":"e0218101","DOI":"10.1371\/journal.pone.0218101.g001","volume":"14","author":"A Abraha","year":"2019","unstructured":"Abraha A, Mylus A, Byass P, Kahsay A, Kinsman J. Three-tier Ethiopian health care system (Source: Ethiopian health sector development plan 2010\u20132015). PLOS One. 2019;14(6):e0218101. https:\/\/doi.org\/10.1371\/journal.pone.0218101.g001.","journal-title":"PLOS One"},{"key":"12639_CR24","unstructured":"CSA (Central Statistical Agency). Population Projection of Ethiopia for the Year 2014 Federal Democratic Republic of Ethiopia Central Statistical Agency, Addis Ababa.\u00a02013;4 38."},{"key":"12639_CR25","unstructured":"Addis Ababa University School of Public Health and The Bill & Melinda Gates Institute for Population and Reproductive Health at The Johns Hopkins Bloomberg School of Public Health. Performance Monitoring for Action Ethiopia (PMAET) Household and Female Cross-sectional Survey 2019, PMAET-HQFQ-2019. Ethiopia and Baltimore. USA: Maryland; 2019."},{"issue":"1","key":"12639_CR26","doi-asserted-by":"publisher","first-page":"010601","DOI":"10.7189\/jogh.08.010601","volume":"8","author":"B Willey","year":"2018","unstructured":"Willey B, Waiswa P, Kajjo D, Munos M, Akuze J, Allen E, Marchant T. Linking data sources for measurement of effective coverage in maternal and newborn health: what do we learn from individual- vs ecological-linking methods? J Glob Health. 2018;8(1):010601. https:\/\/doi.org\/10.7189\/jogh.08.010601. PMID:29497508;PMCID:PMC5823029.","journal-title":"J Glob Health"},{"key":"12639_CR27","unstructured":"Mitchell A.\u00a0The ESRI Guide to GIS Analysis,\u00a0Volume 2. ESRI Press; 2005."},{"key":"12639_CR28","unstructured":"Lawson AB. Statistical methods in spatial epidemiology. John Wiley & Sons; 2013."},{"issue":"1","key":"12639_CR29","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1186\/1471-2458-9-464","volume":"9","author":"P-J Tsai","year":"2009","unstructured":"Tsai P-J, Lin M-L, Chu C-M, Perng C-H. Spatial autocorrelation analysis of health care hotspots in Taiwan in 2006. BMC Public Health. 2009;9(1):464. https:\/\/doi.org\/10.1186\/1471-2458-9-464. PMID: 20003460.","journal-title":"BMC Public Health."},{"issue":"2","key":"12639_CR30","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1016\/j.jssas.2016.02.001","volume":"17","author":"GS Bhunia","year":"2018","unstructured":"Bhunia GS, Shit PK, Maiti R. Comparison of GIS-based interpolation methods for spatial distribution of soil organic carbon (SOC). J Saudi Soc Agric Sci. 2018;17(2):114\u201326.","journal-title":"J Saudi Soc Agric Sci"},{"issue":"12","key":"12639_CR31","doi-asserted-by":"publisher","first-page":"4292","DOI":"10.3390\/ijerph17124292","volume":"17","author":"R Dahab","year":"2020","unstructured":"Dahab R, Sakellariou D. Barriers to Accessing Maternal Care in Low Income Countries in Africa: A Systematic Review. Int J Environ Res Public Health. 2020;17(12):4292. https:\/\/doi.org\/10.3390\/ijerph17124292. PMID:32560132;PMCID:PMC7344902.","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"12639_CR32","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1186\/s12939-023-02015-0","volume":"22","author":"A Asefa","year":"2023","unstructured":"Asefa A, Gebremedhin S, Marthias T, Nababan H, Christou A, Semaan A, Banke-Thomas A, Tabana H, Al-Beity FMA, Dossou JP, Gutema K, Delvaux T, Birabwa C, Dennis M, Grovogui FM, McPake B, Be\u0148ov\u00e1 L. Wealth-based inequality in the continuum of maternal health service utilisation in 16 sub-Saharan African countries. Int J Equity Health. 2023;22(1):203. https:\/\/doi.org\/10.1186\/s12939-023-02015-0. PMCID:PMC10544383.","journal-title":"Int J Equity Health"},{"issue":"6","key":"12639_CR33","doi-asserted-by":"publisher","first-page":"e11190","DOI":"10.1371\/journal.pone.0011190","volume":"5","author":"S Ahmed","year":"2010","unstructured":"Ahmed S, Creanga AA, Gillespie DG, Tsui AO. Economic Status, Education and Empowerment: Implications for Maternal Health Service Utilization in Developing Countries. PLoS ONE. 2010;5(6):e11190. https:\/\/doi.org\/10.1371\/journal.pone.0011190.","journal-title":"PLoS ONE"},{"issue":"1","key":"12639_CR34","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.08.010416","volume":"8","author":"TMHA Huda","year":"2018","unstructured":"Huda TMHA, Dibley MJ. Examining horizontal inequity and social determinants of inequality in facility delivery services in three South Asian countries. J Glob Health. 2018;8(1): 010416.","journal-title":"J Glob Health"},{"key":"12639_CR35","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1007\/s10995-021-03250-z","volume":"26","author":"EM Sidze","year":"2021","unstructured":"Sidze EM, Wekesah FM, Kisia L, Abajobir A. Inequalities in access and utilization of maternal, newborn and child health services in sub-Saharan Africa: a special focus on urban settings. Mat Child Health J. 2021;26:250\u201379.","journal-title":"Mat Child Health J."},{"key":"12639_CR36","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1186\/s12884-018-2027-3","volume":"18","author":"M Ag Ahmed","year":"2018","unstructured":"Ag Ahmed M, Hamelin-Brabant L, Gagnon M. Sociocultural determinants of nomadic women\u2019s utilization of assisted childbirth in Gossi, Mali: a qualitative study. BMC Preg Child. 2018;18:388. https:\/\/doi.org\/10.1186\/s12884-018-2027-3.","journal-title":"BMC Preg Child"},{"issue":"2","key":"12639_CR37","doi-asserted-by":"publisher","first-page":"e0280992","DOI":"10.1371\/journal.pone.0280992","volume":"18","author":"IYAE Addo","year":"2023","unstructured":"Addo IYAE, Nyarko SH, Boateng ENK, Dickson KS. Factors associated with unskilled birth attendance among women in sub Saharan Africa: A multivariate-geospatial analysis of demographic and health surveys. PLoS ONE. 2023;18(2):e0280992.","journal-title":"PLoS ONE"},{"key":"12639_CR38","first-page":"47","volume":"12","author":"Joseph Kwame Wulifan ADDaJS","year":"2022","unstructured":"Joseph Kwame Wulifan ADDaJS. Nomadic pastoralists\u2019 experience accessing reproductive and maternal healthcare services in low and middle-income countries: A contextual scoping review Pastoralism. 2022;12:47.","journal-title":"Nomadic pastoralists\u2019 experience accessing reproductive and maternal healthcare services in low and middle-income countries: A contextual scoping review Pastoralism"}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-025-12639-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12913-025-12639-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-025-12639-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,26]],"date-time":"2025-04-26T06:20:12Z","timestamp":1745648412000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/s12913-025-12639-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,26]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["12639"],"URL":"https:\/\/doi.org\/10.1186\/s12913-025-12639-3","relation":{},"ISSN":["1472-6963"],"issn-type":[{"value":"1472-6963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,26]]},"assertion":[{"value":"7 June 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 April 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This paper presents findings from a secondary analysis of data collected as part of the PMA Ethiopia project. The study was conducted according to the declaration of Helsinki. The original study underwent rigorous review and approval by the Ethical Review Board at Addis Ababa University, College of Health Sciences (AAU\/CHS) (Ref: AAUMF 01\u2013008), as well as the Johns Hopkins University Bloomberg School of Public Health (JHSPH) (FWA00000287). Authorization to utilize the dataset was granted by Addis Ababa University. Informed consent was obtained from all women before interviews.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"610"}}