Spatial clustering and determinants of zero-utilization of antenatal care among pregnant women in Ethiopia

Zero-utilization of antenatal care (ZUANC) is a significant public health problem that increases the risks of maternal morbidity and mortality. However, the association of individual and community-level factors and the spatial clustering effects of ZUANC are often overlooked in Ethiopia. This study aimed to assess the spatial clustering and determinants of zero utilization of ANC services in Ethiopia. This study used a nationally representative sample of 3,926 women from the 2019 Ethiopian Mini Demographic and Health Survey. Multilevel binary logistic regression models were fitted. The Adjusted Odds Ratio (AOR) along with 95% Confidence Intervals (CI) was calculated, with p-values less than 0.05 considered statistically significant. The prevalence of ZUANC in Ethiopia was 25.56% (95% CI: 24.87, 27.63). It was significantly clustered across the country, with notable hotspot areas detected in Ethiopia. Besides, women with no education (AOR = 6.42; 95% CI: 3.77, 10.91) and those with primary education (AOR = 3.53, (95% CI: 2.09, 5.95) had higher odds of ZUANC. Women from poor (AOR = 2.41; 95% CI: 1.77, 3.29) and middle-income households (AOR = 1.64; 95% CI: 1.16, 2.33), those not using any contraceptive method (AOR = 1.78; 95% CI: 1.41, 2.24), women from rural areas (AOR = 2.03; 95% CI: 1.28, 3.21), and residing in the Somali regions (AOR = 5.08; 95% CI: 3.18, 7.92) also had higher odds of ZUANC. On the other hand, marriage reduced the likelihood of ZUANC (AOR = 0.26; 95% CI: 0.09, 0.73). In this study, one-fourth of pregnant women in Ethiopia had ZUANC. Therefore, targeted public health interventions to address these factors, particularly in the identified hotspot areas of ZUANC, are strongly recommended to increase ANC utilization.