Background: skilled attendant for every pregnant woman during childbirth is the most critical intervention for improving maternal and child health. Ethiopia with maternal mortality ratio of 673 per 100,000 live births, the majority of births are delivered at home and the proportion of deliveries assisted by skilled attendant is very low. Objective: to assess utilization of skilled birth attendant at delivery, among mothers who gave birth the last one year prior to the survey in Mekelle town. Methodology: A cross-sectional household survey was conducted from Sep. 2006 to Oct.2006.Women who had delivered in Mekelle Town, within the last one-year prior to the survey obtained using proportional to population size of 10 “Tabias” through random walking were interviewed using structured and pre-tested questionnaire. Result: A total of 600 women were included in the study. 69% of the women utilize skilled birth attendant during delivery. Among the client who had institutional delivery their satisfaction to the time the health worker spent with them, cleanliness of instrument or equipment, the courtesy and respect offered by the provider, measures taken to assure their privacy and comfort , and professional competency and skill of the health worker during delivery was (95%). Births to women with primary education are two times more likely (OR=2.19and 95%CI=1.33-3.61), and births to women with secondary and above education are four times more likely (OR=3.90 and 95%CI=1.95-7.81) to utilize SDA as compared to illiterate women. Women who have secondary and above educated husband are three times more likely to utilize SDA than those illiterate (OR=3.10 and 95%CI=1.29-7.42). Women with first pregnancy OR=4.11 and 95%CI= 2.20, 7.68), women who have ANC visits OR=2.95 and (95%CI= 1.63, 5.37), women who know presence of pregnancy and delivery complication OR=3.40 and 95%CI 1.76.-6.57), women who obtained MCH information 2.27 and 95%CI 1.17-4.41), Those who have visit to health facility OR=2.95 and 95%CI=1.06-8.21), those who can get transportation OR=2.67 and 95%CI=1.59-4.49), and those their husband’s prefer to use skilled delivery attendant during delivery OR=4.65 and 95%CI=2.37-9.13), were more likely to utilize skilled delivery attendant than those who are disadvantaged. Conclusions: increasing educational opportunities for both women and their husbands and particularly for girls, promotion of ANC follow-up with provision of MCH information particularly, the need for SDA at every childbirth, health workers particularly health extension workers should promote community awareness programs, home visit, and community-based delivery systems which focus the disadvantaged women and facilitation of supportive environment, such as supplies, equipment, establishing functioning system of referral and appropriate training of midwifes are recommended.