Introduction: Giving birth in a health facility is associated with lower maternal mortality than giving birth at home. A recent Tanzania Demographic Health survey showed that, although more than 90% of pregnant women attended at least one antenatal clinic visit, only 50% of pregnant women delivered at a health facility. The aim of this study was to document the magnitude and predictors of institutional delivery in order to assist in setting priorities and developing appropriate intervention measures to reduce maternal mortality. Methods: We conducted a cross-sectional study of women in Biharamulo district who delivered during the year preceding the survey. Multistage sampling was used to obtain598 participants. A structured questionnaire was used to collect data. Bivariate and multivariate analysis was performed. Results: 56% of women delivered in a health facility. Factors most strongly associated with institutional delivery were past care experience (aOR=265.1, 95%CI 28.6- 2466.7), advice from health care provider to deliver at a health care facility (aOR=29.2, 95%CI 2.9-291.5), decision making on health care seekingon a pregnancy (aOR=7.1, 95%CI 2.7-19.0), maternal education (aOR=6.7, 95%CI 2.3-20.0), first antenatal care visit at Conclusion: The prevalence of institutional delivery in Biharamulo District remains low. To raise the prevalence, the district should implement measures to make institutional delivery the preferred option for pregnant women. These measures should include encouraging women to make early antenatal care visits and make plans with their spouses for institutional delivery, reducing costs, improving the experience for women undergoing delivering in a healthcare facility, and consider locating new facilities closer to the women who need them.Keywords: Institution delivery, home delivery, antenatal care service
