• Assefa Seme Addis Ababa University
  • Abera Seifu South West Showa Health Department


Introduction: Institutional delivery is very low in Ethiopia, particularly in Oromia where less than one-third of antenatal care attendees utilize the services. This study assessed the magnitude of institutional delivery and associated factors in South West Showa Zone of Oromia.

Methods: A cross-sectional community based study was conducted in 2010. A stratified cluster sampling technique used to select study districts, villages and households. Four hundred thirty childbearing women with at least one birth in the past 5 years preceding the survey were interviewed. Qualitative study method was employed to supplement the quantitative data. Data analyses were done using SPSS v15. Frequency tables and percentages were used to describe study population. Association of independent variables with outcome variable was measured using odds ratio with 95% confidence interval. Multivariate logistic regression analysis was run to control for confounding variables.

Results: Eighty percent (344) respondents were from rural. Mean age of the women was 28.8 (±6.6). Most (70.5%) respondents and 39% of their husbands were uneducated. A quarter of them delivered at health institutions over five years preceding the survey. In a regression model with maternal age, residence, maternal and paternal education, all were significantly associated with use of institutional delivery services. Obstetric factors have also showed a statistically significant association. The qualitative findings revealed that trust in traditional birth attendants and health workers’ negative attitude were among the reasons for not delivering at health institutions.

Conclusion: Institutional delivery service utilization in the zone is affected by maternal and paternal education, ANC attendance and duration of labor. Traditional beliefs and health workers’ negative attitude were among the identified barriers. Multiple interventions involving community, service providers and health system are recommended.


Key words: Institutional delivery, antenatal care, Oromia


Author Biographies

Assefa Seme, Addis Ababa University

Associate Professor 
Department of Reproductive Health and Health Service Management
School of Public Health, College of Health Sciences
Addis Ababa University

Abera Seifu, South West Showa Health Department

Head, South Showa Health Department


The World Report 2005: Make every mother and child count. WHO 2005

Maternal mortality in 2005: Estimates developed by WHO, UNICEF, UNFPA and the World Bank. WHO 2007

Identifying priorities for child health research to achieve Millennium Development Goal. Consultation Proceedings, Geneva, 26–27 March 2009.

Alemayehu S, Teferra F, Mazengia A, Solomon M. Institutional delivery service utilization and associated factors among mothers who gave birth in the last 12 months in Sekela District, North West of Ethiopia: A community - based cross sectional study. BMC Pregnancy and Childbirth 2012;12:74

Amano et al. Institutional delivery service utilization in Munisa Woreda, South East Ethiopia: a community based cross-sectional study. BMC Pregnancy and Childbirth 2012;12:105

Rahman MH, Mosley WH, Ahmed S, Akhter HH. Does service accessibility reduce socioeconomic differentials in maternity care seeking? Evidence from rural Bangladesh. J Bio Soc Sci. 2008 Jan; 40(1):19-33

Kamal M, Factors affecting utilization of maternity care services among married adolescents in Bangladesh. Asian Population Studies 2009, 5(2):153-170.

Onah HE, Ikeako LC, Iloabachie GC. Factors associated with the use of maternity services in Enugu, southeastern Nigeria. Soc Sci Med. 2006 Oct; 63(7):1870-8

Central Statistical Agency and ORC Macro. 2006. Ethiopian Demographic and Health Survey 2005. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ORC Macro

Central Statistical Agency and ICF international 2012.

Ethiopian Demographic and Health Survey 2011. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ICF international

Mekonen Y, Mekonen A. Utilization of Maternal Health Care Services in Ethiopia. ORC Macro Calverton, Maryland, USA November 2002.

Federal Democratic Republic of Ethiopia Population Census Commission. Summary and Statistical report of the 2007 population and housing census. December 2008, Addis Ababa

Annual Health Service Statistics report, Oromiya Regional Health Bureau. Finfinne 2001 EFY.

Nigussie M, H/Mariam D, Mitike G. Assessment of safe delivery service utilization among women of childbearing age in North Gondar zone, North West Ethiopia. Ethiop. J. Health Dev. 2004; 18(3): 145-52.

Kitui1 et al. Factors influencing place of delivery for women in Kenya: an analysis of the Kenya demographic and health survey, 2008/2009. BMC Pregnancy and Childbirth 2013, 13:40

Bimeta K, Dibaba Y, Woldeyohannes D. Determinants of maternal health care utilization in Holeta town, central Ethiopia. BMC Health Services Research 2013, 13:256

Shiferaw S, Spigt M, Godefrooij M, Melkamu Y, Tekie M. Why do women prefer home births in Ethiopia? BMC Pregnancy and Childbirth 2013, 13:5

Fantahun M, Olwit G, Shamebo D. Determinants of ANC attendance and preference of site of delivery in Addis Ababa. Ethiop J Health Dev 1992;6 (2):17-21.

Sychareun Y, Hansana V, Somphet V, Xayavong S, Phengsavanh A, Popenoe R. Reasons rural Laotians choose home deliveries over delivery at health facilities: a qualitative study. BMC Pregnancy and Childbirth 2012, 12:86

Impact of Health center availability on utilization of maternity care and pregnancy outcome in rural areas of Haryana. J. Indian MedAssoc1997;95(8):448-50.






Original Article