Introducing and Testing Maternal Vulnerability Segmentation Tool (MVST) for Essential Service Utilization: Initial Evidence from Implementation Research in Oromia, Ethiopia

In Ethiopia, utilization of maternal health services, including antenatal care and health facility delivery remain low. This is particularly acute among women living with individual, social, and environmental vulnerabilities. This study aimed to develop and test a maternal vulnerability segmentation tool to enable community workers to identify pregnant women least likely to access maternal care services. Guided by Project Pathways Vulnerability Framework, predictors of maternal health service utilization were identified, and a 20-item questionnaire was developed from identified predictors. We employed exploratory and confirmatory factor analysis to create a latent variable called maternal vulnerability. Vulnerability items with acceptable internal reliability were tested to confirm association with antenatal care and institutional delivery through mediation regression analysis. A factor with eigenvalue greater than one was identified, which were further reduced and refined to 10, four for urban-rural residents, and six for a rural sample. This resulted in a root mean square error of approximation (RMSEA) values of between 0.01 to 0.08, comparative fit index (CFI) > 0.90, and Tucker Lewis index (TLI) value > 0.90. Women with higher vulnerability score were less likely to access antenatal care visits and more likely to deliver at home (p<0.01). Our data-driven work leveraging this tool provide guidance to effective programs in identifying underprivileged pregnant women to enable community workers to narrow maternal health service gaps in Ethiopia. What is already known on this topicO_LINearly half of pregnant women are not using essential maternal services such as antenatal care and health facility delivery, placing their delivery and own health at risk. C_LIO_LIPregnant women are least likely to use those services because of individual, social, economic, and environmental factors C_LI What this study addsO_LIThis study provides new maternal vulnerability segmentation tools to identify women living with vulnerabilities for targeted interventions. It explains the extent to which intersecting vulnerability scores affect essential maternal service utilization. C_LI How this study might affect research, practice or policyO_LIThis study enables community health workers to classify pregnant women according to their degree of vulnerability, thus paving the way for developing well-targeted interventions C_LIO_LIIt also calls for further research aimed at generating more validated vulnerability segmentation tools that effectively and efficiently address maternal vulnerabilities across different contexts in low-income and middle-income countries. C_LI