Effect of pregnancy intention on the timing and sustained use of antenatal care services in Rwanda.

We investigated the relationship between intended pregnancy and utilization of antenatal care services in Rwanda. Using Demographic and Health Survey 2014/2015, secondary data was obtained on maternal health services utilization. We performed stepwise logistic regression analysis to examine the effect of independent variables on women's early and late utilization, as well as their sustained use of antenatal services. Dependent and main independent variables included: first trimester visits, completed antenatal visits and intended pregnancy respectively. Of 5,944 women sampled; 56.6% had made early antenatal visits and 44% had completed 4 visits. Unintended pregnancies were less likely to make early antenatal visits and complete 4 antenatal visits. Religion and being in union had positive association with standard antenatal visits; while age (>24 years), grand multiparty, and poor economic status had negative association. Our results call for deeper sensitization on utilization of antenatal services and more use of contraception to reduce unintended pregnancies.

Spatio-temporal disparities in maternal health service utilization in Rwanda: What next for SDGs?

The Sustainable Development Goals (SDGs) in part aim to further improve maternal health outcomes by reducing spatial disparities in utilization of critical services such as antenatal and assisted delivery, with emphasis on decentralization and integration of strategies. Yet, our understanding of within country spatial disparities in maternal health services (MHS) utilization over time has been scant. By fitting multiple regression models to a pooled dataset of the 2010/11 and 2014/15 Rwanda Demographic and Health Surveys (n = 12,273), and employing post-estimation margins analysis, we examined spatial differentiation of MHS trends prior to the SDGs in Rwanda. Our study found that women in 2014/15 were more likely to utilize antenatal services and assisted delivery (OR = 1.757, p ≤ 0.001) compared with 2010/11, but with nuanced spatial variations. Compared with Nyarugenge, women in nineteen out of the twenty-nine remaining districts were more likely to report utilization of antenatal services and skilled birth delivery, while the probability of accessing four or more antenatal services in seven districts declined between 2010/11 and 2014/15. Physical, financial and socio-cultural factors were associated with maternal health service utilization over the period. Based on our findings, we present policy suggestions for improving utilization of MHS in Rwanda and in similar contexts in the SDGs period.