Magnitude and determinants of focused antenatal care utilization among reproductive-aged women in Ethiopia: a multilevel analysis

The World Health Organization initially recommends a minimum of four antenatal care (ANC) visits during pregnancy. However, the utilization of Focused antenatal care (FANC) services remains low in many low- and middle-income countries, including Ethiopia. Therefore, this study aimed to investigate the magnitude and determinants of FANC utilization among Ethiopian women aged 15 to 49. A nationwide community-based cross-sectional study was conducted between September and December 2022. Respondents were selected using a two-stage stratified cluster sampling method. Data were collected through face-to-face interviews using structured questionnaires. A total of 5,358 weighted samples were included in the analysis. Multilevel logistic regression analysis was conducted to measure the strength of associations and identify determinants of FANC utilization. Four models were fitted, and the model with the lowest values of the Deviance Information Criterion (DIC) and Akaike’s Information Criterion (AIC) was chosen. In this study, 59.9% of the women attended four or more ANC visits during their pregnancy. In the multilevel logistic regression analysis, respondents aged 30 to 34 years (adjusted OR = 1.5; 95% CI 1.03, 2.32), aged 35 to 39 years (AOR = 1.6; 95% CI 1.08, 2.49), those with secondary education (AOR = 1.5; 95% CI 1.21, 1.80), those with above secondary education (AOR = 1.7; 95% CI 1.25, 2.29), married respondents (AOR = 2.3; 95% CI 1.08, 4.47), divorced/separated individuals (AOR = 2.6; 95% CI 1.17, 5.89), housewives (AOR = 1.7; 95% CI 1.01, 2.73), daily workers (AOR = 1.5; 95% CI 1.10, 2.15), those with a family size below four (AOR = 1.3; 95% CI 1.08, 1.50), those in the middle wealth category (AOR = 1.3; 95% CI 1.09, 1.62), those in the richer wealth category (AOR = 2; 95% CI 1.66, 2.49), and those in the richest wealth category (AOR = 4.3; 95% CI 3.39, 5.55) were significantly associated with ANC utilization. The study identified many individual and community-level factors influencing ANC utilization. The utilization of the Focused ANC visits or contacts remains low. Targeted education for younger and less educated women, and financial support for low-income households, is needed to improve ANC utilization.