According to this study, the proportion of institutional delivery among women who attended the PWC was 54.3%, higher compared with 39.9% among women who didn’t attend the PWC. Similarly, higher institutional delivery among women who involved in the community-based interventions was reported in the studies done in Burkina Faso (56% VS 36%), Eritrea (46.8% VS 51.2) and Guatemala (54.7% VS 31.2%) [15,16,17]. The reason might be, women who involved in the intervention expected that they were better informed about obstetric danger signs and birth preparedness, that enables women were better placed to make reasonable decisions [18]. Community-based behavioral changing interventions believed that increase institutional delivery, however, in the study done Kenya (28% VS 37%), Bangladesh (10.5% VS 12.5%), and India (22.5% VS 21.8%) institutional delivery among intervention groups similar or lower compared with not encompass in the interventions [19,20,21]. The reason might be a poor monitoring system of the interventions, and different socio-demographic characteristics of the participants.
The level of institutional delivery in both groups lower compared to studies done in Arba Minch (73.2%), Debre-Berhan (80.2%), and Ghana (63.3%) [22,23,24]. However, it was higher compared with the studies done in Dangla District (18.3%), and Banja District (15.7%) [25, 26]. The reason might be due to differences in socio-economic, and demographic characteristics of participants. Women who are educated, single, urban residents, and higher socioeconomic status are able to make wise decisions about their own health than their counterparts [18, 27,28,29,30,31].
This finding revealed that the awareness of obstetric danger signs in pregnancy, labor, and postpartum was higher among women who attended the PWC compared to those women who didn’t attend the PWC. This finding was in line with the studies done in Eritrea, and Bangladesh [16, 20]. On the other hand, acquiring of obstetric danger signs knowledge was not always consistency with related interventions. The studies conducted in Nepal and Bangladesh showed that obstetric danger signs knowledge of women who involved in the intervention were similar or lower compared to women those not participating in the interventions [32, 33]. The level of well-preparedness for birth and its complication practice was also significantly higher among women who attended the PWC, accounting 38.9% compared with 27.5% among women who didn’t attend the PWC. Similarly, in the studies done in Burkina Faso, Eretria, Nepal, and Tanzania the higher level of well-preparedness for birth and its complication was made among women who participated in the interventions [8, 16, 34, 35]. The reason might be women who involved in the intervention were better informed about birth preparedness and its complications.
The odds of institutional delivery among PWC attendant women who had knowledge of childbirth and postpartum danger signs were higher compared to their counterparts. On the other hand, among PWC non-attendant women who had knowledge of pregnancy danger signs were more likely to institutional delivery compared to their counterparts. Similarly, obstetric danger signs knowledge was positively associated with institutional delivery in the previous study done in Ethiopia, Pakistan, and Tanzania [18, 36, 37]. The possible explanation might be having knowledge of obstetric danger signs may influence women’s perceptions about their susceptibility to and seriousness of the complications. This might motivate women to give birth at health facilities [31].
In both groups, women who well-prepared for birth and its complication were more likely to institutional delivery. The reason might be women who were well prepared for birth and its complication might be knowledgeable about obstetric complications that may occur before, during and after birth; positively influence to give birth at a health facility.
Traveling time from the nearest health facility was significantly associated with institutional delivery in both women who attended and didn’t attend the PWC. In both groups, women who lived within 1 h of walking from the nearest health facility were more likely to institutional delivery compared to their counterparts. This finding was in line with other previous studies [18, 27, 28, 31]. The reason might be a lack of means of transportation to health facilities. Secondly, fear of financial cost for transport might be negatively influenced to decide institutional delivery.
The odds of institutional delivery among PWC attendant women who had a discussion with partners/families about the place of birth were higher compared with women who didn’t discuss. This may enable women to have autonomy in the choice of birthplace jointly. Women with the highest level of autonomy most likely to seek institutional delivery [36, 38,39,40]. In addition, this might create a better opportunity for families to involve in arranging transport, save money, and help mothers to choice a place of delivery.