Spatial distribution and determinants of full package maternal health service utilization in Ethiopia using 2019 Mini Ethiopian Demographic Health Survey.

Antenatal Care, use of skilled delivery attendants, Institutional delivery and postnatal care services are key maternal health services that can significantly reduce maternal mortality. The objective of this study was to identify spatial distribution and factors that affect full package utilization of maternal health services in Ethiopia. Sampling weights were applied, and analyses were conducted using STATA version 17. Spatial statistics, including Moran's I and Getis-Ord Gi*, were performed in ArcGIS to assess spatial autocorrelation and identify FPMHSU clusters. SaTScan software detected purely spatial clusters. Multilevel binary logistic regression identified individual- and community-level factors. Model selection was based on a significant log-likelihood ratio test and Variables with p < 0.05 were deemed significant, with adjusted odds ratios and 95% confidence intervals quantifying associations. The prevalence of in Ethiopia was 56.96% (95% CI: 55.41%, 58.51%) and exhibited significant spatial clustering (Moran's Index = 0.686, P < 0.001). Women aged 20-24 years [AOR = 0.65, 95% CI: 0.44-0.97], high parity [AOR = 0.52, 95% CI: 0.40-0.69] and urban residents [AOR = 0.53, 95% CI: 0.31-0.89] reduce the outcome, while being married [AOR = 1.54, 95% CI: 1.04-2.30], Muslim religion [AOR = 2.25, 95% CI: 1.45-3.48], primary education [AOR = 2.04, 95% CI: 1.65-2.52], secondary education [AOR = 2.30, 95% CI: 1.53-3.45], higher education [AOR = 6.10, 95% CI: 2.43-15.07], awareness of pregnancy complications [AOR = 3.62, 95% CI: 3.00-4.36], poorer households [AOR = 1.77, 95% CI: 1.32-2.37], middle wealth category [AOR = 1.56, 95% CI: 1.13-2.14], richer households [AOR = 2.61, 95% CI: 1.84-2.71], and the richest households [AOR = 6.70, 95% CI: 3.96-11.56] increase the outcome. This study revealed significant disparities in in Ethiopia, with spatial clustering (Moran's I = 0.686) and hotspots in Addis Ababa, Dire Dawa, Harari, and East Gojam. Women with higher education (primary, secondary, and higher), Muslim religion, awareness of pregnancy complications, better economic status (poorer, middle, richer, and richest wealth categories), and urban residence were more likely to utilize maternal health services. Addressing these disparities is crucial for improving maternal health outcomes and ensuring equitable access.