This research is important for understanding current home delivery practices and factors that affect them in order to intervene to increase the institutional delivery service utilization by individuals, families, and communities, and for policymakers to establish criteria for improving the utilization of institutional and skilled birth attendant service utilization. Despite the fact that the World Health Organization's recommendation for every pregnant woman to give birth at the health facility and by the skilled birth attendant, the rate remains low in developing countries, including Ethiopia. This may be because women need effective support to decrease home delivery practice. It is therefore important to improve women, family, and community awareness about institutional delivery, ANC follows up, and knowledge of danger sign of pregnancy.
Moreover, expanding media access about maternal health, improve woman empowerment, decision-making capacity, creating access to health facilities, improve infrastructures like transportation system including ambulance service would decrease home delivery practice. ,
In this review, thirteen studies comprising a total of 13,535 participants were analyzed to estimate the best available evidence for the prevalence and factors associated with home delivery in Ethiopia. The findings of the review have revealed valuable information which is comparable with all the factors related to the outcome variable across the nation.
This meta-analysis was estimated the national prevalence of home delivery in Ethiopia. Accordingly, the national pooled prevalence of home delivery was 48.53% (95% CI: 35.03, 62.04). The result is in line with Senegal Guinea-Bissau. This finding higher than the studies [25, 26], quite possibly due to socioeconomic differences between the study areas, socio-cultural variation, the study period and setting, sample size, and/or target population. Other possible explanations may be due to maternal health services coverage varying in different countries based on increased awareness and information about institutional delivery and skilled birth attendant service utilization.
Our study findings revealed that not having antenatal care during pregnancy was a statistically significant association with home delivery as compared with those who had antenatal care during pregnancy. This can be explained by the fact that mothers who received antenatal care during pregnancy may get better counseled about birth preparedness and complication readiness plan, maternal health, and complication of delivery which could better understand the risk of the home delivery practice.
Place of women's residence, the rural residency was significantly associated with home delivery practice (AOR = 4.3;95% CI 2.7, 6.8). This finding was consistent with studies in Nigeria and Bhutan.
This might be explained in terms of the characteristics of the rural residents, namely less proportion of educated mothers, poor knowledge on institutional delivery service, less decision-making capacity of woes, less antenatal care follow up service, less availability of health care services nearby, and poor access to information than urban mothers.
The result of this review revealed that not having antenatal care attendance increases the likelihood of home delivery (AOR = 3.3,95%CI:2,6). This finding is consistent with studies conducted in Eretria  and Bhutan. The reason might be visiting ANC increasing women familiarity with medical personal which exposes the women to more health education and counseling which are more likely to decrease home delivery. Moreover, women who had ANC follow up might be better awarded about birth preparedness and complication readiness plan, danger sign of pregnancy, when to visit the health facilities, and might also increase her decision making power to choose her place of delivery.
The odds of women's age 15–24 years were nearly 4 times (AOR = 3.7,95%CI:2,6.6) more likely to deliver at home as compared to those women whose ages were greater than 25 years. The possible explanations might be that younger women are more likely to have an unplanned pregnancy, and more likely to be early married and in turn might be less capacitated to decide on her pace of delivery, more influenced by husband, family, and cultural values. Additionally, young age women might have lower knowledge of danger signs of pregnancy, birth preparedness, and complication readiness plan since they have no childbirth experience.
Moreover, poor knowledge of the danger sign of pregnancy showed a statistically significant association with home delivery practice. Women who had no knowledge of danger signs of pregnancy were five times (AOR = 4.6,95%CI:3,6.8) more likely to give birth at home as compared to women who had knowledge of one or more danger signs of pregnancy. Knowledge is an important factor that affects attitude, intention, and behavior. Women who have sufficient knowledge about delivery danger signs might have perceived service benefits of a health institution, like complication management by skilled health care workers in the time of labor which in turn home delivery practice.
This review indicated the significant association between women's' educational status and home delivery. Women who cannot read & write were 4.4 times (AOR = 4.4,95% CI:3.10, 6.12), Primary level was 4 times (AOR = 4.21, 95%CI:1.52, 11.64) and secondary & above were 1.9 times (AOR = 1.9895%CI:1.13, 3.45)more likely to deliver at home. The reason behind might be as education makes mothers to be more concerned for their health, increased their capacity to understand health-related information, and have more autonomy, increased their ability and freedom to make decisions about their own health is more favorable, which eventually enhance their health-seeking behavior. Education also improves the ability of educated women to afford the cost of medical health care service, so as women educated more, less likely to give birth at home and vice versa.
On the other hand, women who had no access to media were 3 times (AOR = 3.4,95%CI:1.5,7.5) more likely to give birth as compared to women who had access to media. Having inadequate exposure to the media might decrease the woman's concern and awareness of her pregnancy-related issue and the need for professional help and having inadequate exposure to the media decreasing their familiarity with medical personal which expose the women to less health education, literacy, and counseling which are more likely to increase home delivery practice.
The result of this review revealed that distance from the health care facility increased the probability of giving birth at home. Women who lived at a distance of more than 2 hours from a health facility were 7 times (AOR = 7.33 95%CI: 5.75, 9.35) more likely to give birth at home as compared to those women who lived in the nearby health facilities. The reason might be as the distance from health facility increases women might have no transport access to get health care services for ANC, childbirth, or and service and might increase the probability of birth at home.
Husband preference also showed statistically significant association with home delivery. Women whose husbands prefer home delivery were 5 times (AOR = 5.17 95%CI: 1.18, 22.60) more likely to give birth at home as compared to those women whose husbands prefer institutional delivery. This result is in line with the study done in Eretria . The possible reason might be husbands are autonomous in Ethiopian culture, so their preference for home delivery increases their wives to give birth at home.
This systematic review and meta-analysis is the national estimation conducted in Ethiopia. Time-trend analysis might not reflect the exact trend because all the years didn't have reported data.