Background: Mortality in African children is unacceptably high. Providing free health care tornyoung children has been hypothesized to improve access to health care and lead to betterrnhealth outcomes. However, there have been only few methodologically robust studies testingrnthis hypothesis. This study examined the impact of free healthcare provided to a birth cohortrnof children born from March, 2005 to June, 2006 in Butajira DSA (Demographic SurveillancernArea) through the C-MaMiE project (Child outcomes in relation to Maternal Mental health inrnEthiopia), in comparison to three cohorts of user fee children (children born within 2.5 yearsrnbefore and after the intervention and parallel with the intervention).rnObjective: The aim of this study was to assess the impact of making health care services freernat the point of use upon under-fives mortality.rnMethods: This controlled quasi-experimental study compared intervention cohort, childrenrnborn in Butajira from March, 2005 to June, 2006 and received free health care provided by thernC-MaMiE project, from pre-birth (pregnancy) to 12 months, and from 24 to 60 months, andrnthree comparison cohorts of children born in the same geographical area (2.5 years before,rnduring and after the intervention). The crude and adjusted under-five mortality in thernintervention cohort versus the comparison cohorts was evaluated using Cox regression model.rnResult: Incidence of under-five mortality was 15.7 (12.3-20.0), 98.7 (88.3-110.3), 41.2 (35.2-rn48.2) and 39.3 (33.5-46.1) per 1000 person-years of observation children provided free, userrnfee before intervention, user fee during intervention and user fee after intervention health carernservices, respectively. The risk of under-five mortality among user fee children (before, duringrnand after the intervention) were 5.87 (4.47-7.72), 2.45 (1.84-3.28), and 2.72 (2.03-3.66) timesrnhigher than those provided freely, respectively. Maternal death (AHR=2.10; 95% CI; 1.36-rn3.23), rural residence (AHR=0.56; 95% CI; 0.44-0.72) and death of elder child (AHR=1.28;rn95% CI; 1.01-1.61) were also found to be independent predictors of under-five mortality.rnConclusion and recommendation: There was a slow decrement of early childhood mortalityrnin the study area and was relatively high among user fee children, even compared to the afterrnarm comparison cohort whereby lower mortality is expected, and health policy makers shouldrngive more emphasis on abolition of user fee health care services as it is one of the methodsrnwhich significantly reduce under five mortality