Ethiopia is the second-most populous nation in Africa next to Nigeria, with an estimated population of 110 million. The country has one of the highest maternal mortality rates globally, with 412 deaths recorded in 2019 per 100,000 live births. Improving maternal and newborn health care is a priority of the Sustainable Development Goals (SDGs). Evidence suggests that the utilisation of mainstream maternal health services (antenatal, delivery and postnatal) has a significant effect on the reduction of death and morbidity through early detection and management of potential complications. Studies that have examined the utilisation of Ethiopian maternal health services have had small sample sizes and covered very small geographical areas. Therefore, the representativeness of these studies and the national generalisability of the findings are questionable. Based on the absence of research, this study used the four rounds of the Ethiopian Demographic and Health Survey (EDHS), a nationally representative and relatively large sample size study, to produce more rigorous national estimates for analysis of the utilisation of Ethiopian maternal health services. These estimates include 20-year trends of antenatal care (ANC), skilled delivery and postnatal care (PNC) service utilisation and its influencing factors. The study found that although ANC, skilled delivery and PNC service utilisation showed an increasing trend from 2000 to 2016, skilled delivery and PNC remained low. In addition, the study revealed an increasing trend in the use of traditional birth attendants (TBAs) during childbirth. The study also identified several factors across the four levels of Andersen’s health behaviour model that affect Ethiopian women’s utilisation of maternal health services. The study also identified that need factors, such as birth spacing intentions and contraceptive use, and enabling factors, such as distance to a health facility, are statistically significant factors affecting engagement with maternal health care. The findings of this study emphasise that increasing access to quality maternal health services, improving the continuum of ANC, skilled delivery and PNC service engagements and transitioning from birth with a TBA to birth with a skilled birth attendant are necessary to ensure reproductive age women in Ethiopia have maternal health care that satisfies their needs and aspirations and improves care access experiences. This research is critical to inform policy decision-making to improve maternal health in Ethiopia by achieving the SDGs of reducing maternal mortality to below 70 per 100,000 live births by 2030
