Determinants of maternal transportation mode and travel time for timely emergency obstetric care in selected public hospitals, Addis Ababa, Ethiopia, 2025.

BACKGROUND

Inadequate transportation infrastructure and ineffective emergency transport services remain critical barriers to timely obstetric care in low- and middle-income countries, particularly in sub-Saharan Africa. In Ethiopia, despite efforts to expand ambulance coverage, many pregnant women still face delays in accessing emergency obstetric services, contributing to preventable maternal morbidity and mortality.

OBJECTIVE

This study aimed to assess determinants of maternal transportation mode and travel time for emergency obstetric care (EmOC) among pregnant women attending selected public hospitals in Addis Ababa, Ethiopia.

STUDY

DESIGN

An institutional-based cross-sectional study was conducted from June to July 2025 across three public referral hospitals in Addis Ababa. Data were collected through a pretested structured questionnaire. Of the 319 mothers selected, 311 provided complete responses, yielding a response rate of 97.2%. Analysis was conducted exclusively on these respondents. Descriptive statistics summarized participant characteristics, and logistic regression was employed to identify associations between transportation mode and influencing factors. Statistical significance was set at P<.05.

RESULTS

A majority of the participants relied on private car or ride-hailing service (39.2%) during obstetric emergencies, with only 35.7% utilizing ambulances. Despite an average travel time of approximately 51 minutes, 27% experienced a second delay in reaching care. Ambulance use was significantly associated with urban residence, transportation preparedness, prior awareness of emergency transport phone numbers, and knowledge of available services, while 27.7% of participants experienced delivery complications-most commonly prolonged labor (8%), eclampsia (6.8%), and retained placenta (5.1%).

CONCLUSION

This study underscores that transportation barriers-especially reliance on private transport and underutilization of ambulances-remain a major contributor to delays in accessing EmOC in Addis Ababa. Key predictors of ambulance use, such as residence and awareness of emergency services, point to systemic gaps in public education and referral coordination. Strengthening transport systems and community awareness is essential to reducing second delays and improving maternal outcomes in urban Ethiopia.