Globally, every year about 303,000 women die due to complications of pregnancy or childbirth [1]. Sub-Saharan Africa alone accounted for roughly two-thirds (196 000) of maternal deaths worldwide [2]. Ethiopia is 4th among the top ten countries in terms maternal death burden with annual number of maternal deaths of 13,000 [1]. Since most maternal deaths and obstetric complications cluster around the time of delivery [3] and cannot be predicted prior, one of the cornerstones to reducing maternal mortality is institutional delivery where births are assisted by skilled health professionals. Skilled attendance during labor, delivery and the early post-partum period could reduce an estimated 13-33% of maternal deaths [4]. However, in Ethiopia, institutional delivery service utilization very low and varies from region to region and place to place [5-7]. The 2016 Ethiopian Demographic and Health Survey (EDHS) showed that the national prevalence of home delivery was 73%, with significant variations across regions ranging from 3% in Addis Ababa to 85% in Afar [5]. Findings from studies conducted in pastoralist districts in Dubti, Afar Region, Ethiopia also indicated 92.6% of births took place at home [8]. Hence, this systematic review and meta-analysis aimed at estimating the pooled prevalence of institutional delivery service utilization and associated factors among women in pastoral communities of Ethiopia, thereby producing real evidence for decision makers and program managers.
