Predictors of institutional delivery service utilization in Ethiopia: an umbrella review

One of the global health's top priorities is improving maternal health. There is a high maternal mortality ratio, despite its major progress in the past two decades. Many countries in Sub-Saharan Africa, including Ethiopia, have not yet reached the sustainable development goal target. The majority of women die of labor and delivery-related complications, which are preventable if they had access to maternal health service utilization, particularly institutional delivery services. The low institutional delivery services utilization in Ethiopia was related to several factors. There are literature disagreements on these predictors and systematic review and meta-analysis (SRMA) studies reported different contributing factors. Therefore, this umbrella review aimed to identify pooled predictors of institutional delivery service utilization in Ethiopia.

PubMed, Web of Science, Embase, CINAHL, Scopus, Google Scholar and Cochrane were searched for SRMA studies on the predictors of institutional delivery service utilization in Ethiopia. All SRMA studies selected for potential inclusion in the umbrella review were subjected to a rigorous, independent appraisal by two critical reviewers using the Assessment of Multiple Systematic Reviews tool. Authors selected SRMA studies and abstracted data independently, and discrepancies were resolved through discussion or a third author intervened. A random-effects meta-analysis model was used to pool estimates of the included SRMA studies. Studies' heterogeneity and risk of bias were assessed using I² and Egger tests, respectively.

The umbrella review revealed that institutional delivery services utilization in Ethiopia was 24% (95% confidence interval, CI: 14 to 34). Further, women education (odds ratio, OR = 3.54, 95% CI: 3.04, 4.12), attitude of the women toward maternal and child health (MCH) service (OR = 2.20, 95% CI: 1.30, 3.74), place of residence (OR = 3.29, 95% CI: 2.02, 5.34), live less than 5 km away from the nearest health facilities (OR = 3.48, 95% CI: 2.58, 4.71) and having at least one antenatal care follow-up (OR = 3.62, 95% CI: 3.03, 4.33) were significantly associated with institutional delivery service utilization.

The proportion of pregnant women using institutional delivery services is low in Ethiopia. The findings highlight women's education, tailored intervention in the attitude of women toward maternal and child health services, supporting rural communities, improving access and availability of health facilities and promoting antenatal care (ANC) follow-up play a crucial role in enhancing facility childbirth, thereby reducing maternal and neonatal mortality and achieving sustainable development goal 3.1 and 3.2.