OBJECTIVES: To investigate factors influencing maternal and foetal-neonatal characteristics of home and institutional childbirths in Ethiopia.

METHODS: A total weighted sample of 7590 women were used. A mixed-method multilevel regression models were employed, accounting for design and clustering effects. The Kriging spatial interpolation, and the Gettis-OrdGi statistical analysis were used to visualize the prevalence of home and institutional birth practices in unmeasured areas of the regions, respectively.

RESULTS: The weighted prevalence of home births in Ethiopia was 68.3%. Women who delivered at home were more likely to have lower education levels (AOR=5.57, 95%CI: 4.02-7.75, p<0.001), limited access to media (AOR=1.30, 95%CI: 1.07-1.58, p<0.01), experienced economic hardship (AOR=1.33, 95%CI: 1.11-1.61, p<0.01), and partnered with a husband who lacks formal education (AOR=2.48, 95%CI: 1.90-3.22, p<0.001). Home births were more common among multiparous women residing in rural areas, far from health facilities, and experienced no antenatal care visits (p<0.05). Skilled birth attendants were present in most institutional births, while unskilled attendants were involved in the majority of home births (AOR=4.58, 95%CI: 3.89-5.19, p<0.001). Twins and larger newborns were more likely to be delivered in healthcare institutions (p<0.001), where C-section rate was about 7.60%. Geospatial analysis revealed a widespread home birth practices in south-eastern costs of Oromia, Afar, and Somali regional states.

CONCLUSIONS: This study shows that childbirth characteristics varied by place of birth in Ethiopia. Local clusters of areas with a low prevalence of institutionalized births were detected in south-eastern sections of Oromia, Somali and Afar regions. The likelihood of home births was considerably increased among women with low socioeconomic backgrounds and educational levels. Hence, improving perinatal care services would improve the outcome of childbirth at home and would be cheaper and easier to carry out instead of persuading women to give birth institutionally.