Women's satisfaction with existing labour and delivery services in Ethiopia: a systematic review and meta-analysis.

OBJECTIVE: To estimate the pooled prevalence of women's satisfaction with existing labour and delivery services in Ethiopia.
DESIGN: Systematic review and meta-analysis.
METHODS: MEDLINE/PubMed, Scopus, Hinari, Google Scholar and web of science electronic databases were searched for the study. This meta-analysis included nineteen cross-sectional studies. Cochrane I2 statistics were used to check the heterogeneity of the studies. Subgroup and sensitivity analysis were conducted with the evidence of heterogeneity. Egger test with funnel plot were used to investigate publication bias. RESULT: Nineteen studies were included in the systematic review and meta-analysis. The overall prevalence of women's satisfaction with existing labour and delivery services in Ethiopia was 70.54% (95% CI 60.94 to 80.15). Having informal education of the women (adjusted OR (AOR)=2.19; 95% CI 1.47 to 3.25), time to be seen by the healthcare providers within 20 min (AOR=2.97; 95% CI 2.11 to 4.19), receiving free service (AOR=5.01; 95% CI 2.87 to 8.75), keeping women privacy (AOR=2.84; 95% CI 1.46 to 5.55), planned delivery in the health institution (AOR=2.85; 95% CI 1.99 to 4.07), duration of labour within 12 hours (AOR=2.55; 95% CI 1.70 to 3.81) and have not antenatal care follow-up (AOR=4.03; 95% CI 2.21 to 7.35) were factors associated with women satisfaction with labour and delivery services in Ethiopia.
CONCLUSION: The pooled prevalence of women's satisfaction with existing labour and delivery services was high. Informal education of the women, antenatal care follow-up, planned delivery in the health institution, keeping women privacy, getting free service, time to be seen by the healthcare providers and duration of labour were factors associated with women's satisfaction during labour and delivery services. This finding is important to design strategic policies and to prevent emergency neonatal and women complications during the childbirth and postpartum periods. PROSPERO REGISTRATION NUMBER: CRD42020149217. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

The strength of this study is including wide geographical areas, different eligible articles across the country setting increases the accuracy of the finding.

This systematic review and meta-analysis review provided an overall prevalence of women’s satisfaction with the existing labour and delivery services in Ethiopia.

This systematic review and meta-analysis result reporting was stick on to the Meta-analysis of Observational Studies in Epidemiology guidelines.

Declaring the absence of publication bias by computing trim and fill analysis increase the reliability of the findings.

All included studies in this systematic review and meta-analysis were cross-sectional studies, which may limit the opportunity to generate a causal link between variables.

Introduction

Globally, nearly half million women die during the time of pregnancy and childbirth every year.1 More than two-thirds of obstetric complications has been carried out during labour and delivery. Around 99% of the global maternal deaths happened in low-income and middle-income countries; however, 56% of the global burden accounted in sub-Saharan Africa and 5% of the global maternal death report existed in Ethiopia.2 Globally, 2.5 million neonates died during the neonatal period, moreover two in three neonates died on the day of birth due to inadequate labour and delivery services.3 Women’s satisfaction with existing labour and delivery service is the best predictor for the choice of health facility, comply with service provided, follow-up and early detection of complications and its management during prenatal, childbirth and postnatal period.4–8

Access to proper and adequate labour and delivery services including medical attention and hygienic conditions can reduce the risk of complications and infections that may lead to death or serious illness for the mother and her baby.9 In Ethiopia, 50% of the delivery attended by a skilled provider and 48% of the deliveries were accompanied in the health facility.10 Despite sustainable development goal (SDG) aimed to reduce the global maternal mortality rate to less than 70 per 100 000 live births, the quality of labour and delivery services in settings where lack of skilled professionals and medical equipment’s had been identified as one of the precursors to the incongruously to have maternal mortality rate.11

Ethiopia is still struggling to reduce maternal mortality rate in the country which stands at 412 deaths for every 100 000 live births, which is incredibly far from the SDG achievement with.12 13 The cause can be linked with delay in receiving care due to inadequate skilled personnel in emergency obstetric care, inadequate supplies and equipment and poor quality of services.14 Identifying factors that affect women’s satisfaction with existing labour and delivery services is imperative for healthcare providers to improve the quality of labour and delivery services continuously. Women’s satisfaction with existing labour and delivery services can be affected by numerous factors such as; waiting time and availability of basic drugs, physical environment of the healthcare facility (cleanliness of the environment, delivery room and wards), privacy, cost paid to service and waiting area, lack of consideration for cultural practices and beliefs and health providers’ technical competency.8 15–18

WHO promotes skilled birth attendance at every birth to reduce maternal mortality and recommends that women’s satisfaction is the most important index to improve the quality and effectiveness of healthcare provision. Moreover, only provision of maternal healthcare services does not improve maternal health and her babies.19

Although studies have been conducted to assess women’s satisfaction with existing labour and delivery services in Ethiopia; however, the representativeness and the findings of a single study are not conclusive and consistent. Likewise, at national level, the proportion of women satisfaction with existing labour and delivery services remains unknown yet. Therefore, this systematic review and meta-analysis aimed to estimate the level of women’s satisfaction with existing labour and delivery services in Ethiopia and to identify predictors of women’s satisfaction with existing labour and delivery services. Furthermore, the finding of this study will be important to monitor and improve the quality of labour and delivery services. Improving maternity care services in the healthcare system of the country has a vital role to reduce maternal mortality and morbidity related to complications of pregnancy, labour and delivery.

Methods

Study design and setting

This systematic review and meta-analysis were conducted to assess the pooled prevalence of women’s satisfaction towards labour and delivery services and its associated factors in Ethiopia, 2019.

Reporting

This systematic review and meta-analysis were presented according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) (online supplementary table S1).

Search strategies

Studies were searched from databases MEDLINE/PubMed, Hinari, Google Scholar and web of science electronic databases and grey literature from repository. Besides, research articles from MEDNAR, World Wide Science Maternity and Infant Care and Wiley Online Library were retrieved (table 1). Moreover, missing data were handled by contacting corresponding authors. Comprehensive search strategy had been developed using different Boolean operators via Population Intervention Comparison and outcome (PICO) standard questions. The following search terms were used using OR and AND Boolean operators: satisfaction AND “delivery Services” OR “delivery care services” OR “skilled delivery services” OR “institutional delivery services” OR “Labor” OR “labor and delivery services” OR “labor and delivery care” OR “labor and delivery care services” OR “intrapartum care” OR “childbirth care” OR “childbirth care services” AND “mother’s” OR “women” OR “clients” AND “associated factors” AND Ethiopia and related terms. All articles searched from databases was exported to End Note library and initially screening by title and abstract. The full text of those articles satisfying inclusion criteria by title and abstract were reviewed the full articles. Systematic review with narrative synthesis was used to summarise the findings of articles in Ethiopia. Quantitative meta-analysis was considered for the articles that are homogeneous.

Table 1

Example of searches for the MEDLINE/PubMed and Google Scholar databases to assess women’s satisfaction with existing labour and delivery services in Ethiopia

Databases	Searching terms	Number of studies
PubMed	(“satisfaction” AND “delivery care services”[All Fields] OR “childbirth care”[All Fields] OR “labor services”[MeSH Terms]) OR (“skilled delivery services”[All Fields] OR “intrapartum care”[MeSH Terms] AND women[All Fields] OR (“client”[MeSH Terms] OR “mother”[All Fields] AND' “determinants” AND (“Ethiopia” [MeSH Terms]	41
Google Scholar	“Satisfaction” and “determinants” or “associated factors” and “women” or “client” and “labor” or “delivery services” and “Ethiopia”	113
From other databases		351
Total retrieved articles		524
Number of included studies		19

Eligibility criteria

Inclusion criteria

Population

Only studies involving women who gave birth in public and private institutions.

Study design

All observational studies (ie, cross-sectional, case–control and retrospective and prospective cohort studies and national survey and surveillance reports) were considered for this review.

Study area

Only studies conducted in Ethiopia without time limiting and reported the prevalence or at least one associated factors of women satisfaction towards labour and delivery services.

Publication status and language

Only English language literature and research articles were included.

Search date

All research articles accessed from 1 September 2019 to 30 September 2019 were included.

Exclusion criteria

Citations without abstracts and/or full-text, commentaries, anonymous reports, letters, editorials and articles not reporting our outcome of interest were excluded after reviewing the full texts.

Outcome variables

This systematic review and meta-analysis had two main outcomes. Level of women satisfaction with existing labour and delivery services was the primary outcome whereas factors affecting satisfaction of women towards labour and delivery was the second outcome of the study.

Data extraction

After collecting findings from all databases, the articles were exported to Microsoft Excel spreadsheet. Two authors (AD and GG) independently extracted the data and reviewed all the screened and included articles. Second, all studies were exported to Microsoft Excel spreadsheet. Data extraction was carried out using a standardised data extraction form which was adapted from the JBI data extraction format. Substantial agreement between reviewers that is, Cohen’s kappa coefficient >0.60 was accepted and resolved through discussion and consensus. For the first outcome (prevalence) the data extraction format included (primary author, year of publication, regions, study area, sample size and prevalence with 95% CI). For the factors affecting level of women satisfaction with labour and delivery services were extracted with 2 by 2 table format and then the log OR for each factor was calculated.

Quality assessment

Two authors (AD and GG) independently assessed the quality of each studies using Newcastle-Ottawa-Scale (NOS) for cross-sectional studies.20

The methodological quality, comparability, outcome and statistical analysis of the study were the major assessment tools that we used to declare the quality of the study. The inter-rater reliability coefficient (Cohen’s kappa) between two authors (AD and GG) was 0.95 which suggest that there was almost perfect level of agreement between two authors.21 Moreover, studies scored a scale of ≥7 out of 10 was considered as having good quality. During quality appraisal of the articles, any discrepancies between the two authors were resolved by taking the second group authors (AW, AG, MB and BA). All of the studies were included based on the NOS quality assessment criteria (online supplementary table S2).

Data processing and analysis

Random effect model was applied to estimate the pooled prevalence of women satisfaction towards labour and delivery services. After extraction of the articles, the analysis was carried out using STATA V.14 statistical software. Cochrane Q-test and I2 statistics were computed to assess heterogeneity within the studies.22 After computing the statistics, results showed there is significant heterogeneity among studies (I2=99.3%, p<0.001). To estimate the overall prevalence of having good knowledge of the postnatal women, via back-transform of the weighted mean of the transformed proportions arcsine variance weights and Dersimonian-Laird weights for fixed-effects model and random effect model, respectively.23 Publication bias was assessed using Egger’s test. Subgroup analysis was done based on the study setting (study setting (region), year of study and sample size to minimise the random variations between the point estimates of the primary study. Furthermore, trim and fill analysis using Duval and Tweedie were implemented.24 Forest plot format was used to present the pooled point prevalence with 95% Cl. For associations, a log OR was used to decide the association between associated factors and satisfaction of women towards delivery services in the included studies.

Patient and public involvement

Neither patient nor public were involved in the review protocol, proposal development, the design and analysis of the study.

Results

Characteristics of the included studies

524 articles were retrieved using a search strategy regarding women satisfaction towards labour and delivery and associated factors in Ethiopia at MEDLINE/PubMed, Scopus, Google Scholar, Hinari, MEDNAR, World Wide Science, Maternity and Infant Care and Wiley Online Library, a web of science and other grey and online repository accessed literatures. After duplicates removed, 324 studies were remained. Out of the remaining 324 articles, 248 articles were excluded after review of their titles and abstracts. Therefore, 76 full-text articles were accessed and assessed for inclusion criteria, which resulted in the further exclusion of 57 articles primarily due to reasons. As a result, 19 studies were fulfilled the inclusion criteria to undergo the final systematic review and meta-analysis. This systematic review and meta-analysis consist of nineteen cross sectional studies (figure 1).

Figure 1

Flow chart of study selection for systematic review and meta-analysis of women satisfaction with labour and delivery services and its associated factors in Ethiopia.

In the present meta-analysis, a total of 19 cross sectional studies were included across different regions of Ethiopia. Among, six of the studies were from Amhara, four from SNNPR, two from Harari, three studies from Addis Ababa, four from Oromia. In this meta-analysis, 8614 study participants were involved to estimate the pooled prevalence of women satisfaction towards the existing labour and delivery services in Ethiopia. Concerning sample size, the sample size of the individual studies ranged from 256 to 736. The highest and lowest prevalence (95%) and (19%) of women satisfaction towards existing labour and delivery services were reported in studies conducted in Wolaitta Soddo Town, Southern Nations, Nationalities, and Peoples Region and Addis Ababa, respectively25–43 (table 2).

Table 2

Study characteristics included in the systematic review and meta-analysis

Authors	Region	Study area	Study design	Sample size	Prevalence	Quality
Asres25	Amhara	Bure	Cross sectional	420	88.09	Low risk
Getenet et al26	Harari	Harar	Cross sectional	398	84.67	Low risk
Temamo et al27	SNNPR	Wolaita	Cross sectional	736	95.00	Low risk
Edaso and Teshome28	Oromia	West Arsi	Cross sectional	477	74.60	Low risk
Gashaye et al29	Amhara	Gondar	Cross sectional	579	31.30	Low risk
Yarinbab et al30	SNNPR	Mizan	Cross sectional	280	30.40	Low risk
Demas et al31	Addis Ababa	Addis Ababa	Cross sectional	394	19.00	Low risk
Bitew et al32	Amhara	Debre Markos	Cross sectional	398	81.70	Low risk
Kidane33	Harari	Harar	Cross sectional	400	80.00	Low risk
Melese et al34	Addis Ababa	Addis Ababa	Cross sectional	423	92.90	Low risk
Gonie et al35	Oromia	Jimma	Cross sectional	366	78.70	Low risk
Tayelgn et al36	Amhara	Dessie and Bahirdar	Cross sectional	417	61.90	Low risk
Dewana et al37	SNNPR	Arbaminch	Cross sectional	256	90.20	Low risk
Tesfaye et al38	SNNPR*	Gamogofa zone	Cross sectional	430	79.10	Low risk
Mekonen et al39	Amhara	Bahirdar	Cross sectional	594	74.90	Low risk
Amdemichael et al40	Oromia	Assela	Cross sectional	398	80.70	Low risk
Haile Tadesse and Bayou41	Oromia	Omo Nada	Cross sectional	391	65.20	Low risk
Assefa42	Addis Ababa	Addis Ababa	Cross sectional	461	82.00	Low risk
Demis et al43	Amhara	Woldia	Cross sectional	398	51.00	Low risk

*Southern Nation Nationalities and Peoples Region.

Level of women satisfaction with labor and delivery services in Ethiopia

The overall pooled prevalence of women satisfaction with existing labour and delivery services is presented with a forest plot (figure 2). Therefore, the pooled estimated prevalence of women satisfaction with labour and delivery services in Ethiopia was 70.54% (95% CI 60.94 to 80.15; I2=99.3%, p<0.001).

Figure 2

Forest plot of the prevalence with corresponding 95% CIs of the 19 studies on women satisfaction with labour and delivery services in Ethiopia.

Publication bias

Funnel plot was assessed for asymmetry distribution of women satisfaction with labour and delivery services by visual inspection (figure 3A). Egger’s regression test showed with a p value of 0.002 with the evidence of publication bias. As a result, trim and fill analysis was conducted to overcome the publication bias. After three studies were filled, twenty-two studies were enrolled and computed through trim and fill analysis (figure 3B) with pooled prevalence of 66.36% (95% CI 55.52 to 77.20) using random effect model.

Figure 3

Funnel plot before adjustment (A) and after adjustment (B) trim and fill analysis.

Sensitivity analysis

In this meta-analysis, to investigate the potential source of heterogeneity observed in pooled prevalence of women satisfaction with existing labour and delivery service a leave-one-out sensitivity analysis was executed and suggesting that our findings was not dependent on a single study. The pooled prevalence of women satisfaction with existing labour and delivery service was varied between 69.18% (95% CI 59.25 to 79.09) and 73.43% (95% CI 65.29 to 81.55) after deletion of a single study (table 3).

Table 3

Sensitivity analysis of prevalence for each study being omitted with 95% CI: prevalence of women satisfaction with existing labour and delivery services in Ethiopia

Study omitted	Prevalence	95% CI
Asres25	69.56	59.39 to 79.73
Getenet et al26	69.75	59.62 to 79.88
Temamo et al27	69.18	59.25 to 79.09
Edaso and Teshome28	70.31	60.22 to 80.41
Gashaye et al29	72.74	63.89 to 81.59
Yarinbab et al30	72.76	63.37 to 82.14
Demas et al31	73.43	65.29 to 81.55
Bitew et al32	70.02	59.92 to 80.12
Kidane33	70.01	59.91 to 80.12
Melese et al34	69.29	59.12 to 79.45
Gonie et al35	70.09	60.01 to 80.16
Tayelgn et al36	71.02	61.08 to 80.96
Dewana et al37	69.44	59.38 to 79.50
Tesfaye et al38	70.06	59.95 to 80.18
Mekonnen et al39	70.29	60.14 to 80.45
Amdemichael et al40	69.98	59.87 to 80.08
Haile Tadesse and Bayou41	70.84	60.86 to 80.05
Assefa42	69.90	59.75 to 80.05
Demis et al43	71.62	61.84 to 81.41

Subgroup analysis

Sub group analysis was conducted with the evidence of heterogeneity. Therefore sub group analysis was done by study year, sample size and study area. Based on the subgroup analysis, the level of women satisfaction with existing labour and delivery services was highest in Harari region 82.41% whereas 84.51% in the study conducted within the year of 2006–2010 (table 4).

Table 4

Sub group analysis on the level of women satisfaction with existing labour and delivery services in Ethiopia (n=19)

Variables	Subgroup	Studies (n)	Prevalence (95% CI)	I2 (%)	P value
Sample size	≥400	10	76.02 (65.05 to 86.99)	99.2	<0.001
	<400	9	64.45 (47.72 to 81.17)	99.3	<0.001
Study area	Addis Ababa	3	64.67 (22.47 to 96.88)	99.8	<0.001
	Oromia	4	74.89 (68.61 to 81.17)	89.0	<0.001
	Amhara	6	64.53 (46.82 to 82.25)	99.2	<0.001
	Harari	2	82.41 (77.84 to 86.99)	66.7	0.083
	SNNPR	4	73.78 (51.91 to 95.64)	99.4	<0.001
Study year	2006–2010	2	84.51 (73.20 to 95.82)	94.0	<0.001
	2011–2015	7	74.63 (69.40 to 79.86)	91.6	<0.001
	2016–2019	10	64.95 (48.19 to 81.70)	99.6	<0.001

SNNPR, Southern Nation Nationalities and peoples Representative.

Associated factors for women satisfaction with labor and delivery services

In this systematic review and meta-analysis; duration of labour, free service, keeping privacy, time to be seen by healthcare provider <20 min, planned delivery in the health institution, antenatal care and maternal education were the factors associated with women satisfaction with existing labour and delivery services.

Women who had not formal education were 2.19 times more likely to be satisfied with the existing labour and delivery services than women who had formal education (adjusted OR (AOR)=2.19; 95% CI 1.47 to 3.25) (figure 4).

Figure 4

Pooled OR of the association between educational status and satisfaction of women with labour and delivery services in Ethiopia.

The odds of women satisfaction with existing labour and delivery services were 4.03 times more likely among women who had not antenatal care (ANC) follow-up as than women who had ANC follow-up (AOR=4.03; 95% CI 2.21 to 7.35) (figure 5).

Figure 5

Pooled OR of the association between antenatal care and satisfaction of women with labour and delivery services in Ethiopia.

In this study women who had planned delivery in the health institution were 2.85 times more likely to be satisfied with existing labour and delivery services than their counterparts (AOR=2.85; 95% CI 1.99 to 4.07) (figure 6).

Figure 6

Pooled OR of the association between planned pregnancy and satisfaction of women with labour and delivery services in Ethiopia.

Women who have seen by the healthcare provider within 20 min were 2.97 times more likely satisfied by the labour and delivery services than their counterparts (AOR=2.97; 95% CI: 2.11 to 4.19) (figure 7).

Figure 7

Pooled OR of the association between time to be seen by healthcare provider and satisfaction of women with labour and delivery services in Ethiopia.

Women whose privacy kept were 2.84 times more likely to be satisfied with the existing labour and delivery services as compared with their counterparts (AOR=2.84; 95% CI 1.46 to 5.55) (figure 8).

Figure 8

Pooled OR of the association between privacy of the mother and satisfaction of women with labour and delivery services in Ethiopia.

The odds of women satisfaction with existing labour and delivery services were 2.55 times more likely among women not staying more than 12 hours to give birth than women who stayed more than 12 hours to give birth (AOR=2.55; 95% CI 1.70 to 3.81) (figure 9).

Figure 9

Pooled OR of the association between duration of labour and satisfaction of women with labour and delivery services in Ethiopia.

Women who received the existing labour and delivery service without fee were 5.01 times more likely to be satisfied as compared with women who got their service with cost expense (AOR=5.01; 95% CI 2.87 to 8.75) (figure 10).

Figure 10

Pooled OR of the association between getting free service and satisfaction of women with labour and delivery services in Ethiopia.

Discussion

Globally critical maternity and infant care implementing efforts are important strategy to reduce maternal mortality has been stepped up, maternal satisfaction with the existing labour and delivery services need to be easily addressed in low-income and middle-income countries. Quality improvement efforts in low-income and middle-income countries could focus on strengthening the process of labour and delivery cares. In this systematic review and meta-analysis, the pooled level of women satisfaction with existing labour and delivery services in Ethiopia was 70.54% (95% CI 60.94 to 80.15). The finding of this systematic review and meta-analysis is consistent with the study done in India15 and Egypt.44 This similarity finding might be due to labour and delivery services provided in low-income and middle-income countries are nearly similar due to the limited number of health institutions, health professionals and the availability of drugs whereas the finding of this study is lower than the study conducted in Senegal45 and Nepal.46 The possible reason for this discrepancy might be due to, this study reports a review result from many institutions whereas studies reported in Senegal and Nepal are from a single institutions. Besides, the difference might be due to variation in sociodemographic, socioeconomic characteristics and measurement tools used to quantify the level of satisfaction and sample size.

Regarding the subgroup analysis result, using study area, sample size and study year revealed that the highest level of women satisfaction with existing labour and delivery service was reported in Harari region, having a sample size of less than four hundred and among studies published between 2006 and 2010. This difference might be explained as due to number of studies conducted in Harari region and published in between 2006 and 2010 were limited than studies conducted and published in other regions of the country and published above 2010 years.

Women who have been seen by the healthcare provider within 20 min were a key determinant factor for women to be satisfied with the existing labour and delivery services. This finding is consistent with the stud done in Nepal.46 This might be due to that, being treated with dignity, respect, kindness, approachability and courtesy was a key interpersonal behaviour which enhances women satisfaction.

Being able to maintain privacy is the important associated factor for women satisfaction with existing labour and delivery services. This study finding is supported by the study report from low-income and middle-income countries8 and Uganda.47 This might be the fact that inadequate privacy during labour and delivery care and counselling was associated with women’s poor perception of services.

Absence of antenatal care follow-up is one of the predictors for women satisfaction with existing labour and delivery care in this systematic review and meta-analysis. The probable reason might be that the exposure to facilities through antenatal care increases the understanding of women about the service provided by the healthcare professionals. This, in turn, demands enhanced healthcare services and better-quality labour care in the hospitals or health centres. The odds of having planned delivery in the health institution was nearly three times more likely to be satisfied with the labour and delivery services which provided in the institution. Women who had awareness and knowledge regarding facility delivery and its important may enhance the utilisation and satisfaction towards the labour and delivery services. Indeed, clients had various expectations about hospital delivery that influenced their perception of care.

Having informal education of the women were two times more likely to be satisfied with the existing and provided labour and delivery services in the health institutions. This finding is parallel with the study conducted in Uganda47 and Serbia.48 This might be explained as women who had higher educational status, may expect high quality care of labour and delivery is provided which might be inconsistent due to limited number of healthcare professionals, availability of medications and the number of equipped health facilities which results low satisfaction among labouring women.

The odds of receiving free service are the associated factor for women satisfaction with labour and delivery services. This might be due to providing available and accessible medications and medical resources with free service setting may significantly increase their satisfaction.

Women whose labour is commenced within 12 hours are 2.7 times more likely to be satisfied by the labour and delivery services. This might be due to the fact that women whose labour persists beyond 12 hours were more prone to privacy breakage due to repeated pelvic examination, and persistent labour pain which results in dissatisfaction.

Conclusion

The pooled prevalence of women satisfaction with labour and delivery services was higher. Informal educational status of the women, not having antenatal care follow-up, planned delivery in the health institution, keeping women privacy, getting free service, time to be seen by the healthcare providers within 20 min and duration of labour within 12 hours were the associated factors of women’s satisfaction with labour and delivery services. This finding is important to design strategic policies and interventions to prevent preventable maternal and neonatal complications during childbirth and postpartum period.