1. Introduction

The antenatal care (ANC) services provide an opportunity to prevent and manage existing and potential causes of maternal and newborn mortality and morbidity [1]. Antenatal care is supplied with the aid of talented healthcare providers to pregnant women and juvenile women to ensure the maximum extremely good well-being situations for each mother and baby throughout pregnancy [1]. In the past, the World Health Organization (WHO) has promoted 4 antenatal visits for single pregnancies. The first occurred in the 12 weeks following the age of gestation [2]. Antenatal care remains a major public health concern for the prevention of maternal and neonatal mortality worldwide by increasing the chances of access to vital obstetrics [3].

The high maternal mortality rate in certain parts of the world reflects unequal access to health services. Almost all causes of maternal mortality (99%) take place in the developing world. Over half of these deaths occur in sub-Saharan Africa and nearly one-third in South Asia [4–6].

The global reports in 2017 showed that only three in five women attended at least four antenatal visits. In regions with the highest rates of maternal mortality, such as sub-Saharan Africa, only 52% of women received at least four ANC visits [7]. The proportion of women with four or more ANC visits is considerably lower than the global average of 61.8% [2]. The prevalence of attending at least four or more ANC visits in 12 East African countries was 52.44% with the highest attending at least four or more ANC visits in Zimbabwe (75.72%) and the lowest attending at least four or more ANC visits in Ethiopia (31.82%) in 2012-2019 [2]. In the Ethiopian Demographic and Health Survey of women, 31.8% in 2016 [3, 8] and 43.11% in 2019 [4] received four or more checkups.

Most studies identified that the factors of antenatal care such as women’s education [5, 6, 9], husband’s occupation [6], socioeconomic status [5], place of residence [5, 10], understaffed health facilities [11], and distant ANC facilities [11, 12] were significantly associated with the use of antenatal care services.

The well-timed ANC usage can possibly save women from the direct causes of maternal and neonatal deaths associated with obstetric difficulty and might alleviate the consequences of pregnancy complications [13]. The enforcing and assuring usage of powerful maternity care of women in the growing international community is not a simple task [14–17]. In Ethiopia, the developments in maternal health care provide users with antenatal care, of which most of the women did not attend the minimal number of visits recommended by the World Health Organization [9, 18–20]. Most of the preceding research performed in Ethiopia meditated the low use of antenatal care in towns and cities [16, 19, 20]. Hence, this study is aimed at evaluating the coverage and risk factors of optimal antenatal care usage in the South Gondar Zone in Northwest Ethiopia.

2. Methodology

3. Results

4. Discussion

This study assessed the risk factors of coverage and associated risk factors of optimal antenatal care utilization in the South Gondar Zone. The study illustrated that the proportion of optimal antenatal care utilization was found to be 59.0%. This antenatal care utilization is lower than 60.2% in the Indonesia Demographic and Health Survey 2017 [22]. However, this antenatal care utilization is higher than 30% in the Bangladesh Demographic and Health Survey 2014 [23], 58.53% in Sub-Saharan Africa from 2006 to 2018 [24], 35.3% in Debre Tabor Town, Northwest Ethiopia, 2017 [25], 46% in Rwanda, 2014 [26], 58% in Nigeria using the 2018 Nigeria Demographic Health Survey [27], and 52% in Tharaka Nithi County, Kenya, 2016 [28].

The educational level of women was the factor to receive four and above antenatal care visits. This finding was consistent with the study conducted in Amhara regional states, Ethiopia [29], Ethiopia [30], and Vietnam [31]. It showed that the increased educational level increases women’s received optimal ANC visits. Furthermore, the husband’s education is also a factor of women who use ANC visits. Similar findings were reported in studies conducted in Ethiopia [32]. Most women in the South Gondar Zone are socioeconomically dependent on male partners who make household decisions, and this has an impact on maternal health care utilization [32]. It is because educated mothers are thought to be more aware of the importance and availability of ANC services and more likely to use them. Education provides women with the opportunity to be empowered for more confident and capable decisions to use modern health care services for themselves and their children. Furthermore, it increases women’s knowledge on where and how the best health care can be accessed and enhances women’s capability of making autonomous decisions [33].

Women who had planned and wanted pregnancies were more likely to use four or more ANC services compared to women who had unplanned or unintended pregnancies. This finding is consistent with studies done in East African Countries [34]. This may be because mothers who plan to have a child want to have a safe pregnancy and therefore pay special attention to their prenatal care. Additionally, the wanted pregnancy of women has increased the use of ANC visits. This finding is consistent with studies done in Ethiopia. This could be because mothers who want to have a child want a healthy pregnancy and hence pay special attention to their antenatal care.

Place of residence was a factor of women to use four or more ANC services. This result was consistent with those of studies in Ethiopia [25]. Women who live in an urban area may have easier access to material resources (such as money, automobiles, or motorcycles) that can make ANC services more accessible. This could be attributed to the fact that urban women are more inclined than rural women to use various media, information, and written papers, as well as have more understanding about their health. Another factor might be that you are too worried about other hobbies, your family, and your self-image or you do not have access to enough health care.

Women who were exposed to the media were more likely to use four and more ANC services than women who were not exposed to the media. This finding is similar to studies conducted in Ethiopia [30], Vietnam [31], and Tanzania [35]. Access to the media may have resulted in the more frequent use of ANC visits because the media may have offered relevant health promotion messages, such as the advantages of ANC and information on the danger signs of probable pregnancy problems [35]. Women who had to travel more than two hours to reach the nearest health facility were less likely to use the recommended four ANC visits. This finding is consistent with studies conducted in Ethiopia [32]. These findings revealed that enhancing access to and distribution of health care, especially in rural areas, should be a primary priority [32]. The proportion of women who had the recommended four ANC visits was lowest among women who had four or more births. This is in line with other studies conducted in Nigeria [27].

The occupation of husbands (work in the governmental or nongovernmental sector) had a significant impact on women to use four or more ANC services in the study area. It is known that most women are socioeconomically dependent on male partners who are decision-makers in households, and this influences maternal health care services utilization in Ethiopia [36]. This study contradicts the previous study in Ari Woreda, South Omo Zone, Ethiopia [37], which states that occupation had no significant effect with optimal ANC visit.

The time needed to get to the nearest HF was an important factor for women to use four or more ANC services in this study. This study was in line with the previous study [11, 12], which shows that increased distance to a health facility decreased ANC services. This might be the distance to a health facility or time taken to get to the nearest HF that decreases the chance of getting health services due to less access to the transportation system and low economy for payment for transportation. In addition, the optimal use of antenatal care in this study had a significant impact on road access to HFs. In fact, the cost of transport and the type of transport depend on the availability of the road as it increases optimal use of antenatal care.

This study identified the behavior of health care providers as an important factor in optimal maternal use of antenatal care. This is because health care workers who had good behavior initiate mothers who use ANC visits and may give further explanation about the importance of optimal antenatal care utilization for mothers. The study showed that the number of live children from mothers was significantly related to optimal use of antenatal care. This might be because as the number of children increases, the mothers’ want for pregnancy decreases—which leads to a decrease in the use of ANC visits. Similarly, family size in the household reduces the optimal use of the mother’s antenatal care in this study. Because the large size of the family leads to a low economic level, an undesired pregnancy leads to low optimal use of maternal prenatal care.

5. Conclusion and Recommendations

The purpose of this study was to find out what factors influence optimal maternal antenatal care utilization in the South Gondar Zone, such as socioeconomic, demographic, health, and environmental factors. The result of this study showed that the magnitude of ANC services was 59%. When compared to the national average, this figure was extremely low. The study found that maternal education, maternal occupation, husband’s education, husband’s occupation, media exposure, time taken to get the nearest health facility, planned pregnancy, wanted pregnancy, health profession preferred by women, source of information about maternal care, media exposure, residence, and road accessibility to the nearest health facility was significantly associated with optimal maternal antenatal care utilization.

Ensuring the continuity of maternal optimal antenatal care utilization in the area, the government’s efforts to establish a functional referral system through the distribution of ambulances to districts and the free maternal care policy should be maintained and strengthened as well as expanding educational programs aimed at educating mothers and their husbands on the benefits of a planned pregnancy, wanted pregnancy, and maternal health care and transportation problem and costs require long-term solutions for rural areas.

Ethical Approval

Ethical approval was obtained from a research and ethical approval committee of the College of Natural and Computational Sciences of Debre Tabor University, Ethiopia, with a code number of DTU/CNCS/855/21.

Conflicts of Interest

The authors declare that they have no competing interests.

Authors’ Contributions

ATB and SMF conceived the study and contributed to study design and led the coordination fieldwork for the study implementation and data analysis. HB, YA, and MM were part of the team that conceived the study and also contributed to the study design. MM contributed to conceiving the study and reviewed the study variables and their consistency. All authors contributed to the development of the study protocol and reviewed the study. All authors read and approved the final manuscript.