The study was done to assess spatial variations in the use of healthcare facilities for birth and to identify associated factors. The research design selected for this research was a cross‐sectional analysis of population‐ and healthcare facility‐based data. A sample included a total of 6954 women who gave birth in the 5 years preceding EDHS 2016 and 717 healthcare facilities providing delivery care.

A one‐unit increase in the mean score of the readiness of health facilities to provide basic EmOC was associated with a two‐fold increase in the odds of facility birthing. A woman’s attendance for at least four antenatal care visits was significantly associated with facility birth. Distance to a healthcare facility was inversely related to a woman’s use of facility birthing. Women in the richest wealth quintile were also more likely to have facility births.

There were geographic variations in facility births in Ethiopia, revealing critical gaps in service availability and readiness. It is important to ensure that health facilities are in a state of readiness to provide EmOC.

The study concluded that there is a failure to ensure health facility readiness which is associated with failure to give birth at a healthcare facility.