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Women’s preferences for obstetric care in rural Ethiopia: a population-based discrete choice experiment in a region with low rates of facility delivery
  1. Margaret E Kruk1,*,
  2. Magdalena M Paczkowski1,
  3. Ayalew Tegegn2,
  4. Fasil Tessema2,
  5. Craig Hadley3,
  6. Makonnen Asefa2,
  7. Sandro Galea1
  1. 1 University of Michigan School of Public Health, United States;
  2. 2 Jimma University, United States;
  3. 3 Emory University, Ethiopia
  1. Correspondence to: Margaret Elizabeth Kruk, Health Management and Policy, University of Michigan, 109 Observatory Road, SPH II M3166, Ann Arbor, 48109-2029, United States; mkruk{at}


Background: Delivery attended by skilled professionals is essential to reducing maternal mortality. Although the facility delivery rate in Ethiopia’s rural areas is extremely low, little is known about which health system characteristics most influence women’s preferences for delivery services. We investigated women’s preferences for attributes of health facilities for delivery in rural Ethiopia.

Methods: We fielded a population-based discrete choice experiment (DCE) in Gilgel Gibe, in southwest Ethiopia among women with a delivery in the past five years. Women were asked to select a hypothetical health facility for future delivery from two facilities on a picture card. A hierarchical Bayesian procedure was used to estimate utilities associated with facility attributes: distance, type of provider, provider attitude, drugs and medical equipment, transport, and cost.

Results: 1006 women completed 8045 DCE choice tasks. Among them, 93.8% had delivered their last child at home. The attributes with the greatest influence on the overall utility of a health facility for delivery were availability of drugs and equipment (mean β=3.9, p<0.01), seeing a doctor versus a health extension worker (mean β=2.1, p<0.01) and a receptive provider attitude (mean β=1.4, p<0.01).

Conclusion: Women in rural southwest Ethiopia who have limited personal experience with facility delivery nonetheless value health facility attributes that indicate high technical quality: availability of drugs and equipment and physician providers. Well-designed policy experiments that measure the contribution of quality improvements to facility delivery rates in Ethiopia and other countries with low health service utilization and high maternal mortality may inform national efforts to reduce maternal mortality.

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