Beyond Number of Visits: A Multifaceted Study of the Quality of Antenatal Care Services at Wolaita Zone Public Hospitals, Southern Ethiopia

Maternal mortality in Ethiopia is an unacceptably high at 401 per 100,000 live births in 2017. This is 67 times higher than the maternal mortality ratio in European countries (6/100,000 LB). Antenatal care (ANC) is one of the strategies that can mitigate the complications of pregnancy and lead to better outcomes for mothers, babies, families and society. This study describes a multifaceted investigation of  ANC services in terms of their structure, processes and outcomes, and explored maternal mortality  in public hospitals of Wolaita Zone, Southern Ethiopia. The study used Sequential explanatory mixed methods with cross sectional design for quantitative and grounded theory methods for qualitative study with simple random and theoretical sampling techniques respectively.Multivariate analysis for quantitative study, and constant comparison analysis using Nvivo 12 plus software for qualitative study were used. Results suggest that Socio demographic factors (Age, income and marital status of client.And sex, age and experience of health care providers),Health facility factors such as (primary and tertiary hospitals),walking distance with in 2 hours, closeness of health facility,and pregnancy, more than one ANC visits are statistically significant in the summary scores derived for the components of ANC. And exploring clients and health professionals evolved five Parent Nodes such as heavy bleeding, uterine rupture, delay in decision to seek care, delay in reaching health facility and delay in receiving adequate care. The study has generated evidence-based and locally relevant strategies that could have clinical application for improving maternal and child health care in the study setting. It is thought that results will provide programmers and policy makers with data on the quality of antenatal care from structure, process and outcome,and maternal mortality themes evolved and theoretically conceptualized and supposed  to assist in the development of strategies to improve maternal health care services, particularly antenatal care.The multifaceted quality of ANC and maternal mortality theory developed through this study could feed into reproductive health programmes and guide the development of policies and programmes for improving quality in the ANC at national level in general and Southern National Nationalities People’s State in particular.