Maternal health care service utilization in post-war Liberia: analysis of nationally representative cross-sectional household surveys

BACKGROUND: Post-war Liberia has a fast-growing population and an alarming maternal mortality ratio (MMR). To provide a better understanding about healthcare system recovery in post-war country, we explored the changes in maternal healthcare services utilization between 2007 and 2016. METHODS: We used 2007 and 2013 Liberia Demographic and Health Survey (LDHS) and the 2016 Malaria Indicator Survey (MIS) in this study. The outcomes of interest were: place of delivery and antenatal care visits. Univariate analysis was conducted using percentages and means (standard deviations) and multiple binary multivariable logistic models were used to examine the factors associated with the outcome variables. RESULTS: Between 2007 and 2016, the percentage of adequate ANC visits increased from 71.20 to 79.8%, and that of facility-based delivery increased from 40.90 to 74.60%. The odds of attending at least four ANC visits and formal institutional delivery were low among women residing in rural area, but high among women with higher education, used electronic media, and lived in high wealth index households. Additionally, attending ANC at least four times increased the odds of facility-based delivery by almost threefold. CONCLUSION: The findings suggest that key maternal healthcare utilization indicators have improved substantially, especially facility-based delivery. However, a large proportion of women remain deprived of these life-saving health services in the post-war era. Greater healthcare efforts are needed to improve the quality and coverage of maternal healthcare in order to enhance maternal survival in Liberia.