Uptake of Skilled Maternal Healthcare in Ethiopia: A Positive Deviance Approach

Seman K. Ousman, Jeanette H. Magnus, Johanne Sundby and Mekdes K. Gebremariam
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Seman K. Ousman: St Paul’s Hospital Millennium Medical College (SPHMMC), Addis Ababa 22728/1000, Ethiopia
Jeanette H. Magnus: Faculty of Medicine, University of Oslo, 1078 Oslo, Norway
Johanne Sundby: Institute of Health and Society, HELSAM, University of Oslo, N-0316 Oslo, Norway
Mekdes K. Gebremariam: Department of Nutrition, University of Oslo, 0317 Oslo, Norway

IJERPH, 2020, vol. 17, issue 5, 1-22

Abstract: Risk factor approaches are often used when implementing programs aimed at enforcing advantageous health care behaviors. A less frequently-used strategy is to identify and capitalize on those who, despite risk factors, exhibit positive behaviors. The aim of our study was to identify positive deviant (PD) mothers for the uptake of skilled maternal services and to explore their characteristics. Data for the study came from two waves of the Ethiopian Demographic and Health Surveys conducted in 2011 and in 2016. PD mothers were defined as those reporting no formal education but with adequate use of antenatal care (ANC) and/or institutional delivery services. Two-level multilevel regression analysis was used to analyze the data. Factors associated with PD for the use of ANC services were: partner’s education status, involvement in household decision making, exposure to media, and distance to the health facility. Factors associated with PD for health facility delivery were: partner’s education, woman’s employment status, ANC visit during index pregnancy, exposure to media, and perceived challenge to reach health facility. Rural-urban and time-related differences were also identified. The positive deviance approach provides a means for local policy makers and program managers to identify factors facilitating improved health behaviour and ultimately better health outcomes while acknowledging adverse risk profiles.

Keywords: positive deviance; skilled maternal healthcare; multilevel approach; DHS; Ethiopia (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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