# Estimates and determinants of health facility delivery in the Birhan cohort in Ethiopia

## TL;DR

This study examines why many women in Ethiopia still give birth at home despite efforts to increase health facility deliveries.

## Contribution

The study identifies specific socio-demographic factors and delays that influence health facility delivery in the Amhara region of Ethiopia.

## Key findings

- 73.6% of deliveries occurred in health facilities, while 24.3% were at home.
- Factors like education, travel time, and wealth increased the likelihood of facility delivery.
- Delays in decision-making were the most common reason for not using health facilities.

## Abstract

Health facility delivery is one of the critical indicators to monitor progress towards the provision of skilled delivery care and reduction in perinatal mortality. In Ethiopia, utilization of health facilities for skilled delivery care has been increasing but varies greatly by region and among specific socio-demography groups. We aimed to measure the prevalence and determinants of health facility delivery in the Amhara region in Ethiopia. From December 2018 to November 2020, we conducted a longitudinal study from a cohort of 2801 pregnant women and described the location of delivery and the association with determinants. We interviewed a subset of women who delivered in the community and analyzed responses using the three delays model to understand reasons for not using health facility services. A multivariable poisson regression model with robust error variance was used to estimate the presence and magnitude of association between location of delivery and the determinants. Of the 2,482 pregnant women followed through to birth, 73.6% (n = 1,826) gave birth in health facilities, 24.3% (n = 604) gave birth at home and 2.1% (n = 52) delivered on the way to a health facility. Determinants associated with increased likelihood of delivery at a health facility included formal maternal education, shorter travel times to health facilities, primiparity, higher wealth index and having attended at least one ANC visit. Most common reasons mothers gave for not delivering in a health facility were delays in individual/family decision to seek care. The proportion of deliveries occurring in health facilities is increasing but falls below targets. Interventions that focus on the identified social-demographic determinants and delays are warranted.