Trends and predictors of the use of unskilled birth attendants among Ethiopian mothers from 2000 to 2016

Introduction: Previous studies have shown that home delivery assisted by unskilled individuals contributes to maternal and neonatal deaths in developing countries. It also increases the risks of long-term maternal morbidities such as uterine prolapse, pelvic inflammatory disease, fistula, incontinence and infertility. This study aimed to determine the trends and predictors of the use of unskilled birth attendants among Ethiopian mothers from 2000 to 2016. Methods: This study draws on the Ethiopia Demographic and Health Survey data for the years 2000 (n=10,873), 2005 (n=9,861), 2011 (n=11,654) and 2016 (n=10,641) to estimate the trends in the use of unskilled birth attendants. Multinomial logistic regression models with adjustment for clustering and sampling weights were used to investigate the association between the independent and response variables. Results: The analysis revealed that while births attended by Traditional Birth Attendants (TBAs) increased from 28% in 2000 to 42% in 2016, home deliveries decreased slightly from 94% to 73%. Rural residence is associated with increased odds of using unskilled birth attendant while high and middle household wealth, educational status of the women and their partners (> primary), four or more antenatal care (ANC) visits, having any form of employment and mass media engagement were factors significantly associated with decreased odds of unskilled birth attendant utilization during child birth in Ethiopia. Conclusions: The results of this analysis show that the proportion of Ethiopian women giving birth without a skilled attendant is high. Interventions aiming to improve skilled attendance during childbirth should focus on the individual, community and need factors of Anderson’s behavioural model.