Institutional delivery reduces the risk of complications and infections of the mother and newborn baby. There was inadequate information in the study area that this study intended to provide. The study assessed institutional delivery and predictors in Gambella, Ethiopia. A community-based cross-sectional study was conducted on 798 subjects from February 1 to June 15, 2017 among reproductive age group women who gave birth at the last one year. The study used multistage technique. The response coded was entered into Epi-info version 7.1 and transferred to statistical package for social science (SPSS) version 21, which was also cleared and analyzed. For qualitative data, two focus group discussions and three in-depth interviews were performed and analyzed in a thematic way. 63.1% of the respondents delivered in health institution. Maternal age, education, antenatal care, and residences were significantly associated with institutional delivery. The number of births correlated with institutional delivery with the mean number of births 2.1. The qualitative result showed cultural factors, attitude of health care providers, alternative delivery services, low incomes, transport access and expectations were independent factors. About 37% of mothers gave birth at home. Policy makers, health planners and programmers need to focus on educating females. Previous experience sharing, knowledge transfer, and improvements on emergency transport utilization are important.
Key words: Institutional delivery, maternal health, ante natal care, Gambella.