Background: High maternal mortality rate is one of the major public health concerns inrndeveloping countries including Ethiopia. Most of the deaths are caused by factors attributed tornpregnancy and childbirth. In Ethiopia about 10% of women delivered in health facility with widernvariation among regions being lowest in SNNP (5.6%) and highest in Addis Ababa (62%).rnObjective: This study assessed safe delivery service utilization and associated factors amongrnmothers who gave birth during five years preceding the survey in Wayu town, Roomie RegionalrnState, 2014.rnMethods and Materials: A cross sectional analytical study was carried out among women withrnchildren less than five years prior to survey conducted in from January,2014 to May, 2014 inrnWayu town. Systematic random sampling technique was used to select 371 participants. A prerntested and structured questionnaire was used to collect data. Bivariate and multivariate logisticrnregression data analysis was performed using SPSS version 21.0 software. Statistical tests wererndone at a level of significance of p < 0.05.rnResult: A total of 371 women were recruited into the study, whereby 107(28.8%) of the mothersrnwere in the age range of 20 â€“ 24 years, 342 (92.2%) were married, 237 (63.9%) were educatedrnand 134(36.1%) were unable to read and write. The study indicated that 175(47.2%) of thernmothers delivered in health facilities and 196(52.8%) mothers who gave birth at home. Ofrn196(52.8%) mothers who gave birth at home, 52 (14%) deliveries conducted by Traditional birthrnattendants and 142 (38.3%) without any assistance of skilled personnel while only two deliveriesrnoccurs on the way to health facility. The common reasons for home delivery were sudden onsetrnof labor 125 (63.8%), presence of TBAs 30 (14.3%), Negative attitude of health workers 2(1%),rnand others 41(20.2%) were Believe in God, Fear of high cost services, Lack of skilled personnel,rnPoor services, Negligence of women. Factors such as; maternal education (AOR=3.746, 95%CI=rn1.118, 12.552), parity (AOR=2.620, 95%CI= 1.294, 2.885), socio economic status (AOR=2.457,rn95%CI=1.054, 3.837), and frequency of antenatal care visit (AOR=0.460, CI=0.271-0.783) werernstatistically significant predictors with delivery in health facility.rnConclusion: Inadequate (47%) institutional delivery service utilization was observed in thernstudy area though 80.3% of the mothers attended ANC services during their last pregnancy. Arnlarge proportion (53%) of mothers gave birth at home without a skilled attendant. AssociatedrnFactors such as maternal education, parity, socio economic status, and frequency of antenatalrncare visit were statistically significant predictors with delivery in health facility.rnRecommendation: Community education about pregnancy, child birth and postpartum, trainingrnall Health Extension Workers so that they could have some midwifery skills, and Information,rneducation, communication, and empowering mothers are recommended. A qualitative studyrnapproach need to be conducted in both urban and Rural of the wereda and should involve healthrncare providers to have deeper understand of factors affecting delivery in health facilityrnVersion No 1, version Date 11/06/2014