Obstetrics & Gynecology · Medical Literature
Level of completing continuum maternity care and the associated factors in the pastoralist and agrarian districts of the Ari and South Omo zones, Ethiopia, 2024: a comparative study
Abstract
Background Completing continuous maternity care (COCMC) is crucial for preventing morbidity and mortality, but a low proportion of mothers use it. There is a paucity of evidence about the level of COCMC and the associated factors in agro-pastoralist communities. Objective To identify and compare the level of COCMC and associated factors among pastoralist and agrarian communities in Ari and South Omo zones. Design A community-based comparative cross-sectional study was conducted from March to May 2024. Setting A comparative study on COCMC was conducted in Ari and South Omo zones of South Ethiopia. Participants A multistage sampling technique was employed to select 632 women who gave birth 6 months before data collection. Outcome measures The outcome variables were the level of COCMC and its associated factors. The results of outcome variables were presented with proportions and adjusted ORs (AORs) with the corresponding 95% CIs. Data were collected with a standard questionnaire via the Kobo toolbox and analysed with the R software. Due to sparse data about the proportion of COCMC, a penalised likelihood (Firth logistic regression) model was employed. A p value Results A total of 632 women participated in this study giving the response rate of 97.4%. The overall level of COCMC was 46 (7.3%; 95% CI 5.3% to 9.3%), 27 (7.5%) among pastoralists and 19 (7.0%) among agrarian districts, the difference was not statistically significant (p value=0.84). The COCMC was associated with living in urban areas (AOR: 2.76, 95% CI 1.17 to 6.34), women’s ability to pass a decision on household resources (AOR: 2.57, 95% CI 1.17 to 5.55), being a government employee (AOR: 8.71, 95% CI 1.38 to 50.94), middle level household economy (AOR: 3.81, 95% CI 1.16 to 15.83) and receiving no home-to-home healthcare (AOR: 0.33, 95% CI 0.14 to 0.70). Conclusion and recommendations The level of COCMC is low in the study area. Therefore, equitable interventions targeting both communities,
Clinical relevance
Completion of the continuum of maternity care (COCMC) — encompassing antenatal, intrapartum, and postnatal services — is a proven strategy for reducing maternal and neonatal morbidity and mortality, yet uptake remains critically low in marginalized communities. This study addresses a significant evidence gap by focusing on both pastoralist and agrarian populations in the Ari and South Omo zones of Ethiopia, two understudied agro-pastoralist settings where geographic remoteness, socioeconomic vulnerability, and cultural barriers compound healthcare access challenges. Clinicians and policymakers working in low-resource or mobile-population settings should note these findings given Ethiopia's ongoing national target to reduce its maternal mortality ratio and the persistent disparities in reproductive health service coverage.
Key findings
1. Overall COCMC completion was critically low at 7.3% (46/632 women; 95% CI 5.3%–9.3%), with no statistically significant difference between pastoralist (7.5%, n=27) and agrarian (7.0%, n=19) districts (p=0.84). 2. Urban residence was independently associated with higher odds of COCMC completion (AOR: 2.76, 95% CI 1.17–6.34), underscoring the rural-urban healthcare access divide. 3. Women's autonomous decision-making authority over household resources was a significant enabler of COCMC (AOR: 2.57, 95% CI 1.17–5.55), highlighting the role of female agency in care-seeking behavior. 4. Government employment status was the strongest individual-level predictor of COCMC completion (AOR: 8.71, 95% CI 1.38–50.94), reflecting the combined effect of financial stability and health literacy associated with formal sector employment. 5. Middle-level household economic status was associated with significantly higher odds of COCMC completion compared to lower economic strata (AOR: 3.81, 95% CI 1.16–15.83), demonstrating the dose-response relationship between socioeconomic position and maternity care utilization. 6. Absence of home-to-home (outreach) healthcare was associated with significantly lower odds of COCMC completion (AOR: 0.33, 95% CI 0.14–0.70), indicating that community health worker outreach is a critical facilitator of full care pathway adherence. Note: No NNT/NNH values were reported in the abstract; the Firth penalized logistic regression model was used due to sparse outcome data.
Practice implications
Health systems serving pastoralist and agro-pastoralist populations should prioritize structured home-to-home outreach programs — particularly community health worker (e.g., Health Extension Worker) visits — as a key lever to improve full maternity care pathway completion, given the near 3-fold reduction in odds among women lacking such outreach (AOR 0.33). Interventions must simultaneously target structural determinants: programs that promote women's financial independence, household decision-making autonomy, and economic empowerment (e.g., conditional cash transfers, women's savings groups) are likely to yield meaningful gains in COCMC uptake. Since no significant difference was found between pastoralist and agrarian communities, equitable, community-agnostic policies — rather than pastoralist-specific ones alone — should be designed to address the shared root causes of low COCMC completion across both population types.