Perceived Community Acceptance of Maternal - Newborns Care Continuum and its Correlates in Ethiopia

Background : Maternal and newborns care continuum service use decision making process is influenced by seeking validation and the sole approval from significant others. Evidences has shown that one of the bottlenecks hindering the completion of the maternal and newborns care continuum is community acceptance and/or encouragement for the care continuum. Besides, among the critical determinants for the success of the new maternal, new born and child health care continuum (MCH) paradigm shift is the acceptance and support of the community for women and newborns to obtain the three recommend cares and their retention in the care. This is less explored, leading a dearth of evidence. Hence, this study aimed at documenting the level of pregnant women maternal and newborns care continuum perceived community acceptance and identify associated factors among pregnant women. The findings could provide actionable evidence for the Health Ministry and relevant developmental partners to improve maternal and newborns health outcomes. Methods: This study used the baseline cross sectional data form the Ethiopian Performance Monitoring for Action (EPMA) cohort one survey. The study screened, enrolled and collected data from pregnant and six week postpartum women. The analytic sample were 2,219 pregnant women. Frequencies were computed to describe the pregnant women. Multinomial logistics regression statistical modeling was fitted to identify correlates of maternal and newborns care continuum perceived community acceptance. Results were presented in the form of percentages and odds ratio with 95% Confidence Intervals. Statistical significance was declared at p-value of 0.05. Results: The overall proportion of perceived maternal and newborns care continuum community acceptance was 93.30% (95%CI: 91.61%, 94.41%). However, this proportion of perceiving for most and few people in their community to accept and/or encourage women to obtain the three domains of maternal and newborns care continuum services was found to be only 33.66% (31.42%, 35.96%) and 31.93 (29.60%, 34.36%) respectively. Women age, secondary educational status, contraceptive ever use history, health facility as desired place of delivery and residing in Oromiya regional state were found to increase the likelihood of maternal and newborns care continuum perceived community acceptance. On the contrary, this likelihood was lowered by factors: higher birth order, rural residence, higher wealth index and family member and desired birth attendant. Conclusions: This suboptimal level of maternal and newborns care continuum perceived community acceptance by most people in the community signals that the global community have a long way to go to achieve nurturing a positive influence of the community for women to complete the care continuum. Context specific and age sensitive efforts and activities which targeted in diversifying contraceptive provision, postpartum contraceptive use counseling, which target less educated women, economically disadvantage women and those with polygamous marriage are imperative to improve perceived community acceptance on maternal and newborns care continuum. Installing the inter pregnancy preconception care packages is imperative in this regard. Working on mechanisms for incorporating community input is the core implication. These include strengthening the implementation of community score card and; scaling up the community maternal and newborns health family meetings.