Determinants of Family Planning Service Utilization and Health Facility Delivery in Six Regions of Ethiopia: A Population-Based Cross-Sectional Study

Background: Ensuring access to family planning (FP) and health facility-based delivery services to women of reproductive age is essential to prevent maternal deaths. Studies conducted thus far in Ethiopia are limited in their geographical coverage and sample size, and they did not adequately address potential factors that influence use of these services. The aim of this study was to assess the determinants of facility-based FP and delivery service utilization in the six regions of Ethiopia. Methods: The study design was cross-sectional. In total, 7,938 women of reproductive age were selected randomly to answer a structured questionnaire. Data were analyzed using SPSS version 22.0. Results: Status of a woman's decision-making power about her own health (AOR = 1.95, 95% CI: 1.38 - 2.76), husband's support of FP service utilization (AOR = 4.19, 95% CI: 3.33 - 5.25), delivery of the last child at a health facility (AOR = 1.88, 95%CI: 1.56 - 2.27), and availability of a family health card at household (AOR: 1.28, 95%CI: 1.09 - 1.51) were significantly associated with FP service use. Visit to a health facility for any family member's health problem prior to delivery (AOR = 2.30, 95% CI = 1.70 - 3.12), status of a woman's decision making power about her own health (AOR: 3.71, 95%CI: 2.38 - 5.78), availability of a family health card at household (during the pregnancy period) (AOR = 1.38, 95%CI = 1.05 - 1.82), antenatal care visit during the last pregnancy (AOR = 3.61, 95%CI: 2.12 - 6.16), and perception of receiving respectful care (AOR = 9.08, 95%CI: 6.93 - 11.89) were associated with delivery in a health facility. The study considered factors that were inadequately assessed in previous studies. In this study, these factors were associated with FP and health-facility delivery service utilization, corroborating with the findings of other studies done outside the country. It adds new information to the existing literature. Conclusion: The main implication of this study's findings is that holistic interventions at household and health facility can influence the use of facility-based family planning and delivery services.