Maternal delays and associated factors in utilizing institutional delivery in East Wallaga Zone, Oromia, Ethiopia

Abstract Background Pregnancy and childbirth-related complications are unpredictable; however, they are preventable by timely care-seeking to obstetric care services. Maternal delay in utilizing institutional delivery is associated with high maternal mortality in developing countries, including Ethiopia. There were limited studies on the magnitude and associated factors with maternal delays in the study area. Objective To assess the magnitude of maternal delays and associated factors in utilizing institutional delivery among women who gave birth at public hospitals in East Wallaga Zone, Oromia, Ethiopia, 2023. Methods A facility-based cross-sectional study design complemented by the qualitative inquiry was used to conduct the study. The data collection period was from February 4 to April 10, 2023, and 422 systematically selected mothers were included in the study. The data was collected by trained data collectors using an interviewer-administered, pre-tested structured questionnaire, and the collected data was checked for completeness, entered into Epi-Data version 4.6, cleaned, and exported to SPSS version 24.0. The association between dependent and independent variables was estimated by an adjusted odds ratio (AOR) along with a 95% confidence interval (CI). A P-value < 0.05 was considered to declare statistical significance. Result The study revealed that 47.2% [95% CI: 42.7, 51.7)] of the mothers experienced a first delay, 71.3% [95% CI: 64.5, 78.1)] of them experienced a second delay, and 10.2% [95% CI: 9.23, 11.17)] experienced a third delay. Obstetric complications during the current pregnancy [AOR = 1.73, 95% CI: (1.08, 2.76)] and referral cases [AOR = 1.60, 95% CI: (1.04, 2.47)] were associated with the first delay. Poor knowledge of danger signs of labor [AOR = 2.93, 95% CI: 1.47, 5.86] was associated with the second delay. Obstetric complications during the current pregnancy [AOR = 2.26, 95% CI: (1.01, 5.05)] and lack of money for transportation [AOR = 3.98, 95% CI: (1.66, 9.57)] were associated with the third maternal delay in utilizing institutional delivery. Conclusion The current study showed that the magnitude of first- and second-maternal delays in the utilization of institutional delivery services was high. Obstetric complications during current pregnancy, referral cases, poor knowledge of danger signs of labor, and lack of money for transportation were associated with maternal delays in utilizing institutional delivery. To further reduce delays, this study emphasizes the significance of addressing three delays in seeking institutional delivery services. The government’s support is indispensable to help the mothers in prompt utilization of institutional delivery, especially in supporting the referral linkages as more mothers encounter delays after they had been referred from the first institution. Making service free of charge only cannot reduce maternal delays by itself, but the provision of free ambulance services must be strengthened to accompany the mothers to the health institutions. When the need arises for the mothers to be provided with free service, they should first be accompanied to the health facilities; otherwise, the maternal delays can even endanger the lives of the mothers or their newborns.