Women’s health service access and associated factors in Ethiopia: application of geographical information system and multilevel analysis

OBJECTIVES: Women’s access to healthcare services is challenged by various factors. This study aimed to assess women’s health service access and identify associated factors. METHODS: A cross-sectional study design with a two-stage stratified sampling technique, and 12 945 women from the 2016 Ethiopia Demographic and Health Survey dataset were used. The spatial hotspot analysis and purely Bernoulli-based model scan statistics were used to highlight hot and cold spot areas, and to detect significant local clusters of women’s health service access. A multilevel logistic regression analysis was used to assess factors that affect women’s access to health services. A variable with a p<o.o5 was considered as a significant factor. RESULTS: Overall, 29.8%% of women had health services access. 70.2% of women had problems with health services access such as: not wanting to go alone (42%), distance to health facilities (51%), getting the money needed for treatment (55%) and getting permission to go for medical care (32.3%). The spatial distribution of health service access in Ethiopia was clustered, and low health service access was observed in most areas of the country. Women who lived in primary, secondary and tertiary clusters were 96%, 39% and 72% more likely to access health services. Educational status, rich wealth status, media exposure and rural residence were statistically significant factors. CONCLUSIONS: In Ethiopia, women have problems with health services access. The spatial distribution of health services access was non-random, and hotspot areas of women’s health service access were visualised in parts of Benishangul Gumez, Amhara, Afar, DireDawa, Harari, and Somali regions. Creating job opportunities, public health promotion regarding maternal health service utilisation and constructing nearby health facilities are required for better healthcare service access for women.