A Composite Maternal Healthcare Index and Its Determinants in Ethiopia: A Multilevel Analysis of Mini‐DHS 2019

Background Maternal healthcare utilization is critical for maternal and neonatal health; however, many women in low‐ and middle‐income countries fail to complete the full continuum of care. Binary measures of continuity may oversimplify complex care pathways. This study developed a composite maternal healthcare utilization index and examined its associated factors in Ethiopia. Methods A cross‐sectional analysis was conducted using the 2019 Ethiopia Mini Demographic and Health Survey. A composite index was developed using polychoric principal component analysis on the basis of antenatal care (ANC) attendance, timing of first ANC visit, place of delivery, skilled birth attendance, and postnatal care (PNC). The index was categorized into low, medium, and high utilization tertiles. Multilevel ordinal logistic regression examined individual‐ and community‐level factors associated with utilization. Results Among 2893 women, 34.1% had low, 35.5% medium, and 30.4% high utilization. PNC contributed least to the composite index, indicating an important gap in the continuum of care. Higher education (OR = 3.16, 95% CI: 2.20–4.52), richest household wealth (OR = 2.80, 95% CI: 1.97–3.97), and urban residence (OR = 2.01, 95% CI: 1.46–2.76) were associated with higher utilization. Higher utilization was also observed in Addis Ababa (OR = 2.73, 95% CI: 1.75–4.27), SNNPR (OR = 2.28, 95% CI: 1.50–3.46), and Oromia (OR = 1.69, 95% CI: 1.12–2.54) compared with Tigray. Community‐level clustering accounted for 7.7% of the variance. Conclusions Maternal healthcare utilization varied across socioeconomic and geographic groups, with PNC representing an important gap. Strengthening integrated maternal health services and addressing socioeconomic and geographic disparities may improve continuity of care. The composite index provides a multidimensional measure of maternal healthcare utilization.