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Addressing these gaps requires advanced, targeted segmentation tools that identify vulnerable groups and improve reach. This study developed and validated a maternal vulnerability segmentation tool to help community health workers identify pregnant women least likely to access essential maternal care services.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/introducing-and-testing-the-maternal-vulnerability-segmentation-tool-mvst-for-essential-health-services-use-demonstrating-its-use-in-oromia-ethiopia/458816/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/introducing-and-testing-the-maternal-vulnerability-segmentation-tool-mvst-for-essential-health-services-use-demonstrating-its-use-in-oromia-ethiopia/458816.png","ImageObject",300,407,{"name":92,"@type":93},"Anna Hans","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What problem does the maternal vulnerability segmentation tool (MVST) address?","Question",{"text":112,"@type":113},"The MVST is designed to identify pregnant women least likely to access essential maternal care services, helping reduce disparities in antenatal care and facility delivery.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was the MVST developed and refined in the study?",{"text":117,"@type":113},"The study identified key predictors of maternal health service utilisation, incorporated them into an initial 20-item questionnaire, then refined and validated items into shorter versions for rural and urban-rural settings.",{"name":119,"@type":110,"acceptedAnswer":120},"What outcomes were associated with higher vulnerability scores?",{"text":121,"@type":113},"Women with higher vulnerability scores were significantly less likely to attend antenatal care and more likely to deliver at home.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},458816,1790790000,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":41,"preview_page_count":4},5909892332657,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Original research  \n Introducing and testing the maternal vulnerability segmentation tool (MVST) for essential health services use: demonstrating its use in  \nOromia, Ethiopia  \nYihunie Lakew  ,1 Habtamu Tamene  ,1 Bee-Ah Kang  ,2  \nNandita Kapadia-Kundu  ,2 Simon Heliso Kuka  ,1 Rajiv Rimal  2  \nTo cite: Lakew Y, Tamene H, Kang B-A, et al. Introducing and testing the maternal vulnerability segmentation tool (MVST) for essential health services use:  \ndemonstrating its use in Oromia, Ethiopia. BMJ Glob Health 2026;11:e018811 . doi:10 . 1136/ bmjgh-2024-018811  \nHandling editor Helen J Surana ► Additional supplemental material is published online only.  \nTo view, please visit the journal online ([https://doi.org/10.1136/](https://doi.org/10.1136/)[ ](https://doi.org/10.1136/)[bmjgh-2024-018811](bmjgh-2024-018811)) .  \nReceived 28 December 2024 Accepted 12 November 2025  \n© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY. Published by BMJ Group. 1Center for Communication Programs, Johns Hopkins University, Addis Ababa, Ethiopia 2Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, MD, USA  \nCorrespondence to  \nYihunie Lakew; [yihunierh@yahoo.com](yihunierh@yahoo.com)  \nABSTRACT  \nEthiopia has made substantial progress in improving maternal health outcomes; however, significant disparities remain among populations whose individual, interpersonal, community and cultural factors place them at greater risk, as compared with those with better access to resources and healthcare facilities. Addressing these disparities requires initiating advanced and targeted segmentation tools to effectively identify and reach vulnerable groups. This study developed and validated a maternal vulnerability segmentation tool designed to assist community health workers to identify pregnant women who are least likely to access essential maternal care services. Key predictors of maternal health service utilisation were identified and incorporated into an initial 20-item questionnaire. Through a process of refinement and validation, these were condensed into six items for rural and four for urban– rural settings. Findings indicated that women with higher vulnerability scores were significantly less likely to attend antenatal care and more likely to deliver at home (p\u003C0 .01, for each) . Based on these results, a maternal vulnerability segmentation tool was tested and implemented by community health workers to identify and support underserved pregnant women in Ethiopia.  \nINTRODUCTION  \nEthiopia has shown significant progress in many maternal and child health indicators over the past few decades. For example, in 2000, the maternal mortality ratio (MMR) was 871 deaths per 100 000 live births and declined to 412 in 2016.1 This achievement is largely attributed to the government’s health initiatives2 that improved the coverage of maternal and child health services, such as antenatal care (ANC) and health facility delivery.3 Indeed, timely access to maternal child health services has been shown to reduce maternal deaths by between 16% and 33%4 and neonatal mortality by 29% .5  \nWHAT IS ALREADY KNOWN ON THIS TOPIC  \n\n| ⇒ Nearly half of Ethiopian pregnant women are not using essential maternal services such as antenatal care and health facility delivery, placing their newborn and own health at risk.\u003Cbr>⇒ Pregnant women are less likely to use those services because of individual, social, economic and environmental factors.\u003Cbr>WHAT THIS STUDY ADDS |\n| --- |\n| ⇒ This study provides new maternal vulnerability segmentation tools to identify women living with vulnerabilities for targeted interventions.\u003Cbr>⇒ It explains the extent to which intersecting vulnerability scores affect essential maternal service utilisation.\u003Cbr>HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY |\n\n⇒ This study enables community health workers to classify pregnant women according to their degree of vulnerability, thus paving the way for devel","cbCairFRkTIVc8SY","https://ap.wps.com/l/cbCairFRkTIVc8SY","pdf",1754511,12,"English","# Abstract\n# Introduction\n## What is already known on this topic\n## What this study adds\n## How this study might affect research, practice or policy","[{\"question\":\"What problem does the maternal vulnerability segmentation tool (MVST) address?\",\"answer\":\"The MVST is designed to identify pregnant women least likely to access essential maternal care services, helping reduce disparities in antenatal care and facility delivery.\"},{\"question\":\"How was the MVST developed and refined in the study?\",\"answer\":\"The study identified key predictors of maternal health service utilisation, incorporated them into an initial 20-item questionnaire, then refined and validated items into shorter versions for rural and urban-rural settings.\"},{\"question\":\"What outcomes were associated with higher vulnerability scores?\",\"answer\":\"Women with higher vulnerability scores were significantly less likely to attend antenatal care and more likely to deliver at home.\"}]","Introducing and testing the maternal vulnerability segmentation tool (MVST) for essential health services use - demonstrating its use in Oromia, Ethiopia | PDF",1790754515]