ORIGINAL RESEARCH article
Front. Public Health
Sec. Life-Course Epidemiology and Social Inequalities in Health
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1517724
This article is part of the Research TopicAdvancing Equity in Maternal Health: Addressing the Care Needs of Underserved WomenView all 8 articles
Spatial Disparities of Antenatal Care Utilization among Pregnant Women in Sub-Saharan Africa: Bayesian Geo-Additive Modelling Approach
Provisionally accepted
- 1Bahir Dar University, Bahir Dar, Ethiopia
- 2College of Natural and Computational Science, Injibara University, Injibara, Amhara Region, Ethiopia
- 3University of Pretoria, Pretoria, South Africa
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Background: Antenatal care is critical for ensuring healthy pregnancies and positive birth outcomes. Despite its importance, significant disparities in antenatal care access and utilization exist across Sub-Saharan Africa (SSA), influenced by various socio-economic, geographical, and systemic factors. This study aimed to analyse the spatial disparities of the proportion of recommended antenatal care utilization and its associated risk factors among pregnant women in 34 sub-Saharan Africa countries.Method: This study used the most recent Demographic and Health Survey data across 34 SSA countries. To assess the spatial disparities and its associated risk factors of antenatal care utilization, a geo-additive model via the Integrated Nested Laplace Approximation (INLA) was adopted.The overall prevalence of recommended antenatal care utilization in SSA was 22.15%, with a large difference between countries which ranges from 0.27% in Rwanda to 76.28% in Zimbabwe. Both Moran's I and Geary's C tests with difference neighbourhood structures evidenced the existence of spatial autocorrelation of antenatal care utilization among women in SSA countries. Bayesian geo-additive model with Besag-York-Mollie (BYM) mixed effect was found to be the best model to assess the spatial dependencies and the non-linear effects of the factors on antenatal care utilization among women with reproductive age. The study showed the existence of spatial disparities in ANC utilization and media exposure, mothers work status; partners working status, age of mother, age at first cohabitation and place of delivery have significant effect on the antenatal care utilizations.The overall coverage of recommended antenatal care in SSA countries is far from the global coverage of the minimum recommended antenatal care utilization. The lower coverage and inequality of antenatal care utilizations influenced by underutilization of health care services, economic status, women education coverage, poor/absence of transportation facility and media exposure related to healthy reproduction. Empowering women through different media outlets, strengthen their economic power, easy access to health facilities and decision-making power increases maternal healthcare service utilization.
Keywords: Antenatal Care contacts, Geo-additive, Spatial disparities, InlA, sub-Saharan Africa
Received: 29 Nov 2024; Accepted: 28 May 2025.
Copyright: © 2025 Belay, Fenta, Birhan, Rad and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Denekew Bitew Belay, Bahir Dar University, Bahir Dar, Ethiopia
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