Background
The benefits of Health and Demographic Surveillance sites for local populations have been the topic of discussion as countries such as Ethiopia take efforts to achieve their Millennium Development Goal targets, on which they lag behind. Ethiopia's maternal mortality ratio is very high, and in the 2011 Ethiopia Demographic and Health Survey (2011 EDHS) it was estimated to be 676/100,000 live births. Recent Global Burden of Disease (GBD) and estimates based on the United Nations model reported better, but still unacceptably high, figures of 497/100,000 and 420/100,000 live births for 2013. In the 2011 EDHS, antenatal care (ANC) utilization was estimated at 34%, and delivery in health facilities was only 10%.

Objectives
To compare maternal health service utilization among populations in a Health and Demographic Surveillance System (HDSS) to non-HDSS populations in Butajira district, south central Ethiopia.