Inequalities in the completion of maternal continuum of care in Ethiopia using the 2019 mini-Ethiopian demographic and health survey

The maternal continuum of care (CoC) is comprehensive healthcare provided for women during pregnancy, childbirth, and postpartum. Equitable maternal CoC can reduce the risk of maternal and neonatal mortality. We examined inequalities in the completion of maternal continuum of care, and factors associated with CoC among reproductive age women in Ethiopian using the 2019 mini-Ethiopian Demographic and Health Survey (mini-EDHS). The concentration curve and concentration curve index were used to examine socioeconomic inequalities in maternal CoC. Odds ratios were used to assess associations, with significance at p < 0.05. Overall, 23.97% (95% CI 21.63-26.48) of women completed maternal continuum of care. There was pro-rich inequality in the completion of maternal CoC in Ethiopia (Concentration index: 0.244 (95% CI 0.177-0.311, p ≤ 0.001)), rural resident (Concentration index: 0.146 (95% CI 0.087-0.205, p ≤ 0.001)), and urban resident (Concentration index: 0.154 (95% CI 0.045-0.263, p ≤ 0.01)). Being urban resident (adjust odds ratio (AOR) = 1.59, 95% CI 1.09-2.33), attaining secondary (AOR = 1.67, 95% CI 1.19-2.33), or higher education (AOR = 1.93, 95% CI 1.30-2.87), and early initiation of antenatal care (AOR = 1.97, 95% CI 1.61-2.41) were positively associated with the completion of maternal CoC. However, belonging to pastoral region (Afar or Somali) (AOR = 0.46, 95% CI 0.28-0.77), belonging to poorest (AOR = 0.58, 95% CI 0.37-0.92) or middle (AOR = 0.62, 95% CI 0.40-0.96) wealth quintile, not being informed about obstetric danger signs (AOR = 0.54, 95% CI 0.43-0.66), and blood pressure not being measured (AOR = 0.53, 95% CI 0.32-0.85) were negatively associated with maternal CoC. The results of this study revealed that completion of the maternal continuum of care was low in Ethiopia and there was a significant inequality in the completion of maternal CoC across wealth status, place of residence, and educational status. Targeted strategies are needed to improve maternal healthcare utilization among disadvantaged women, particularly those in rural areas, with low education, and from poor households. Interventions should focus on improving access, promoting early and high-quality ANC, and providing culturally tailored services.