Effective coverage of skilled birth attendance in Ethiopia: a population-based cross-sectional study

The crude coverage for skilled delivery attendance was 54% (95%CI; 52, 56). The average level of facility readiness to provide skilled delivery service was 72%, ranging from 17% for private and non-governmental facilities to 88% for hospitals. The uterotonic injection coverage was 42% and the mean process quality for skilled delivery service was 46%. Based on the effective coverage cascade, the input-adjusted coverage was 38%, and the intervention-adjusted coverage was 16%, and the quality-adjusted coverage was 7%. Low level of facility readiness and low quality of service explain the low effective coverage of skilled delivery attendance. Apart from the overall low level of readiness, there was variability between different levels of facilities. Though the skilled delivery attendance coverage is improving, the low level of readiness, intervention provision, and poor process quality resulted in low effective coverage. The minimum level of readiness needs to be ensured at all levels of facilities to provide skilled delivery services. The minimum level of service readiness and quality of care need to be ensured at all facilities to provide skilled birth attendance.