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Background The coverage and uptake of prevention of mother-to-child transmission (PMTCT) of HIV services has remained very low in Ethiopia. One of the pillars of improving quality of health services is measuring and addressing client satisfaction. In Ethiopia, information about the quality of PMTCT services regarding client satisfaction is meager. Methods A facility-based cross-sectional study using quantitative methods was conducted in Adama town. We interviewed 423 pregnant women and 31 health providers from eight health facilities. Satisfaction of clients was measured using a standard questionnaire adapted from the UNAIDS best practices collection on HIV/AIDS. Bivariate and multivariate logistic regression analyses were used to identify factors associated with clients’ satisfaction. Results About three-fourth (74.7%) of clients reported that they were satisfied with the PMTCT services provided by the health facilities. However, a much lower proportion (39%) of the total respondents (pregnant women who underwent an ANC follow-up session), said they received and understood the messages related to mother-to-child transmission (MTCT) of HIV and PMTCT. The main challenges reported by service providers were lack of training, lack of feedback on job performance and inadequate pay. Clients’ satisfaction with PMTCT service was found to be associated with liking the discussion they had with their counselor, non-preference to a different counselor with regards to sex and/or age and not seeing the same ANC counselor before and after HIV test. Conclusion Although 74.7% of clients were satisfied, the majority did not have a good understanding of the counseling on MTCT and PMTCT. We recommend more efforts to be exerted on improving provider-client communication, devising ways of increasing clients’ satisfaction and designing an effective motivation strategy for service providers to enhance the status of PMTCT services.

Background 118 000 newborn babies in Ethiopia die each year and 500 000 pregnancy-related complications occur. Maternal mortality in Ethiopia is also very high (676 deaths per 100 000 livebirths); only 34% of mothers receive antenatal care and 10% of births took place in health facilities in 2011. We identified factors contributing to low use of institutional delivery services in the Southern Nations, Nationalities, and People's Region, Ethiopia. Methods We interviewed mothers who had given birth within the past year and organised six focus group discussions. We selected participants by multistage sampling proportional to the number of expected pregnancies in the 19 administrative zones in the region. We did univariate, bivariate, and multivariate analyses to assess 24 potential predictors of non-institutional delivery. We analysed focus group discussions with NVivo (version 10). Findings We interviewed 502 women from urban areas, 164 from rural pastoral areas, and 2231 from rural agrarian areas. 876 of 2897 (30·2%) births occurred in health institutions—412 of 502 (82·1%) births in urban areas, seven of 164 (4·3%) in rural pastoral areas, and 457 of 2231 (20·5%) in rural agrarian areas. Factors associated with non-institutional delivery include mother's education status (none vs grade 9 or higher: adjusted odds ratio [AOR] 3·91, 95% CI 2·76–5·56), mother's partner's educational status (primary vs none: AOR 0·65, 95% CI 0·49–0·86), occupation (merchant vs farmer: AOR 0·56, 95% CI 0·36–0·87), household financial decision-maker (male partner vs mother: AOR 2·12, 95% CI 1·52–2·95), monthly income ( vs ≥700 birr: AOR 1·77, 95% CI 1·43–2·18), use of antenatal clinic services (no use vs use: AOR 5·63, 95% CI 3·76–8·43), and knowledge of danger signs during delivery (don't know vs do know: AOR 2·16, 95% CI 1·83–2·55). Mothers with no education and who were aged younger than 18 years at their first marriage were more likely to give birth outside of a health institution compared with mothers who were educated to grade 9 or higher (AOR 3·91, 95% CI 2·76–5·56) and mothers who were aged 18 years and older at their first marriage (crude odds ratio 1·69, 95% CI 1·43–1·99). Mothers who planned their last pregnancy were less likely to give birth outside of a health institution compared with mothers who did not plan (AOR 0·48, 95% CI 0·37–0·63). Interpretation Institutional delivery is still uncommon in the Southern Nations, Nationalities, and People's Region despite several interventions. Innovative approaches are needed to attract women to health facilities. Funding Save the Children International.

Background According to the 2011 Ethiopian Demographic and Health Survey, 90.1% of mothers do not deliver in health facilities, with 29.5% citing non-customary service as causative. A low level of skilled attendance at birth is among the leading causes of maternal mortality in low - and middle-income countries. Methods A cross-sectional study was undertaken in four health facilities (one specialized teaching hospital and its three catchment health centers) in Addis Ababa, Ethiopia, to quantitatively determine the level and types of disrespect and abuse faced by women during facility-based childbirth, along with their subjective experiences of disrespect and abuse. A questionnaire was administered to 173 mothers immediately prior to discharge from their respective health facility. Reported disrespect and abuse during childbirth was measured under seven categories using 23 performance indicators. Results Among multigravida mothers (n = 103), 71.8% had a history of a previous institutional birth and 78% (75.3% in health centers and 81.8% in hospital; p = 0.295) of respondents experienced one or more categories of disrespect and abuse. The violation of the right to information, informed consent, and choice/preference of position during childbirth was reported by all women who gave birth in the hospital and 89.4% of respondents in health centers. Mothers were left without attention during labor in 39.3% of cases (14.1% in health centers and 63.6% in hospital; p