Access to Institutional Delivery Services and Associated Factors among Mothers in Jimma Zone, Southwest Ethiopia

Background Poor utilization of institutional delivery services has been identified as a major contributory factor to poor maternal and newborn outcomes. Previous studies have tried to measure access in terms of utilization while it has different dimensions that need to be measured separately. Therefore, this study assessed the four dimensions of access (geographic accessibility, perceived availability, affordability, and acceptability) and associated factors.Methods A community based cross-sectional study design was used to undertake this study from March 16 to April 15, 2018, in Jimma Zone. The sample size for this study was 605 mothers who had given birth in the last six months preceding the study. Multi-variable binary logistic regression was used to identify factors associated with the four dimensions of access by using AOR with 95% CI. Ethical clearance was obtained from Jimma University Institutional Review Board.Results Five hundred and ninety-three mothers participated in this study resulting in a response rate of 98%. Four hundred five (68%), 273(46%), 279(47%) and 273(46%) had geographic, perceived availability, affordability and acceptability access to institutional delivery services respectively. Antenatal [AOR=3.74(1.56, 8.98)], occupation of mother [AOR=5.10(1.63, 15.88)], and residence [AOR=1.93(1.13, 3.29)] were independently associated with geographic accessibility. Household graduation [AOR=1.46(1.03, 2.06)], residence [AOR=1.74(1.17, 2.59)] and ANC [AOR=3.80(1.38, 10.50)] were independently associated with perceived availability. Moreover, wealth quintile [AOR=11.60(6.02, 22.35)], ANC [AOR=3.48(1.36, 9.61)] and occupation of husband [AOR=3.63(1.51, 8.74)] were independently associated with affordability. Lastly, mother’s education [AOR=2.69(1.42, 5.09)], residence [AOR=2.60(1.66, 4.08)] and household graduation [AOR=3.12(2.16, 4.50)] were independently associated with acceptability of institutional delivery services.Conclusions Moderate proportions of mothers have geographic accessibility to institutional delivery services but access to the other three dimensions was low. ANC visits of 4 and above, occupation of mothers' husbands, urban residence, graduation of mother’s household as a model family, higher wealth quintiles of mother’s household, and maternal educational level of secondary school and above significantly affect access to institutional delivery services. Thus, it was recommended that concerned bodies should give special attention to ANC service, female education, training of model families, and enhancement of household wealth through job creation opportunities to improve access to institutional delivery services.