Antenatal care service utilization disparities between urban and rural communities in Ethiopia: A negative binomial Poisson regression of 2019 Ethiopian Demography Health Survey

Background Although there have been consistent improvements in maternal mortality, it remains high in developing countries due to unequal access to healthcare services during pregnancy and childbirth. Thus, this study aimed to further analyze the variations in the number of antenatal care utilizations and associated factors among pregnant women in urban and rural Ethiopia. Methods A total of 3962 pregnant women were included in the analysis of 2019 Ethiopian Demographic and Health Survey data. A negative binomial Poisson regression statistical model was used to analyze the data using STATA version 14.0. An incident rate ratio with a 95% confidence interval was used to show the significantly associated variables. Results Of the 3962 (weighted 3916.67) pregnant women, about 155 (15.21%) lived in urban and 848 (29.29%) rural residences and did not use antenatal care services in 2019. Women age group 20–24 (IRR = 1.30, 95%CI:1.05–1.61), 25–29 (IRR = 1.56, 95%CI:1.27–1.92), 30–34 (IRR = 1.65, 95%CI:1.33–2.05), and 35–39 years old (IRR = 1.55, 95%CI:1.18–2.03), attending primary, secondary, and higher education (IRR = 1.18, 95%CI:1.07–1.30), (IRR = 1.26, 95%CI:1.13–1.42) and (IRR = 1.25, 95%CI:1.11–1.41) respectively, reside in middle household wealth (IRR = 1.31, 95%CI:1.13–1.52), richer (IRR = 1.45, 95%CI:1.26–1.66) and richest (IRR = 1.68, 95%CI:1.46–1.93) increases the number of antenatal care utilization among urban residences. While attending primary (IRR = 1.34, 95%CI:1.24–1.45), secondary (IRR = 1.54, 95%CI:1.34–1.76) and higher education (IRR = 1.58, 95%CI:1.28–1.95), following Protestant (IRR = 0.76, 95%CI:0.69–0.83), Muslim (IRR = 0.79, 95%CI:0.73–0.85) and Others (IRR = 0.56, 95%CI:0.43–0.71) religions, reside in poorer, middle, richer, and richest household wealth (IRR = 1.51, 95%CI:1.37–1.67), (IRR = 1.66, 95%CI:1.50–1.83), (IRR = 1.71, 95%CI:1.55–1.91) and (IRR = 1.89, 95%CI:1.72–2.09) respectively, being married and widowed/separated (IRR = 1.85, 95%CI:1.19–2.86), and (IRR = 1.95, 95%CI:1.24–3.07) respectively were significantly associated with the number of antenatal care utilization among rural residences. Conclusion The utilization of antenatal care is low among rural residents than among urban residents. To increase the frequency of antenatal care utilization, health extension workers and supporting actors should give special attention to pregnant women with low socioeconomic and educational levels through a safety-net lens.