Introducing and testing the maternal vulnerability segmentation tool (MVST) for essential health services use: demonstrating its use in Oromia, Ethiopia

Ethiopia has made substantial progress in improving maternal health outcomes; however, significant disparities remain among populations whose individual, interpersonal, community and cultural factors place them at greater risk, as compared with those with better access to resources and healthcare facilities. Addressing these disparities requires initiating advanced and targeted segmentation tools to effectively identify and reach vulnerable groups.This study developed and validated a maternal vulnerability segmentation tool designed to assist community health workers to identify pregnant women who are least likely to access essential maternal care services. Key predictors of maternal health service utilisation were identified and incorporated into an initial 20-item questionnaire. Through a process of refinement and validation, these were condensed into six items for rural and four for urban-rural settings. Findings indicated that women with higher vulnerability scores were significantly less likely to attend antenatal care and more likely to deliver at home (p<0.01, for each). Based on these results, a maternal vulnerability segmentation tool was tested and implemented by community health workers to identify and support underserved pregnant women in Ethiopia.