Exploring the paradox: women’s childbirth with non-healthcare assistance after receiving skilled antenatal care in Ethiopia

Background The reasons why women seek assistance from non-healthcare providers during childbirth, despite having received antenatal care (ANC), remains unclear. This study aimed to identify the determinants and geographic variations of non-healthcare provider-assisted childbirth among women who received antenatal care (ANC) in Ethiopia. Methods We included 2,918 women who attended at least one ANC visit as reported in the 2019 Ethiopian Mini Demographic and Health Survey. Multilevel binary logistic regression and geographic analysis were used to identify the determinants of non-healthcare providers’ assisted childbirth. Results One in three (33%) (95% confidence interval (CI): 31, 35) women who had at least one ANC visit were assisted by non-healthcare providers during childbirth. The odds of non-healthcare provider assisted childbirth were greater among women who had only one ANC visit (adjusted odds ratio (AOR)=5.2; 95% CI; 3.19, 8.63) or received poor quality ANC visits (AOR=1.74; 95% CI; 1.38, 2.20) or women who resided in pastoral communities (AOR=3.38; 95% CI; 1.05, 11.32) or rural areas (AOR=2.93; 95% CI; 1.44, 5.93). Lower odds of non-healthcare providers’ childbirth were experienced among women with secondary or above education (AOR=0.44; 95% CI; 0.29, 0.68), and from wealthier households (AOR=0.41; 95% CI; 0.30, 0.45). There was a nonrandom spatial distribution of non-healthcare providers-assisted childbirth after having ANC visit in Ethiopia. Conclusions This study highlighted substantially higher non-healthcare provider assistants in childbirth in Somali, Afar, and the southwest part of Amhara regions. Interventions are needed to provide comprehensive ANC services and empower women through education and financial support to increase healthcare provider-assisted childbirth.