Abstract
BACKGROUND: Maternal mortality is a significant public health problem, particularly in sub-Saharan Africa, including Ethiopia. However, evidence on the determinants of access to maternal healthcare services is inadequate in Ethiopia. Therefore, this study aimed to identify the determinants of access to maternal healthcare services among women in southern Ethiopia. METHODS: We conducted a community-based unmatched case‒control study between April 15 and May 15, 2023. A sample size of 360 (120 cases and 240 controls) was selected using a systematic random sampling technique. The collected data were entered into EpiData software and exported to SPSS software version 25. The profiles of the participants were explored using descriptive analysis. Binary logistic regressions and multivariate analysis were used. RESULTS: Access to maternal healthcare services was greater among women who perceived a need for maternity healthcare (AOR = 7.96 (95% CI = 3.49–18.21)), who were able to seek maternity healthcare (AOR = 6.08 (95% CI = 3.12–15.68)), who were able to reach maternity healthcare (AOR = 4.46 (95% CI = 1.89–10.52)), who were able to pay for maternity healthcare (AOR = 3.41 (95% CI = 1.54–7.56)), and who perceived maternal healthcare services as approachable (AOR = 2.89 (95% CI = 1.32–6.37)) and had greater access to maternal healthcare services than their counterparts. CONCLUSION: Health sector administrators at the Woreda and Zonal levels better to work on maternal healthcare services advocacy, improving women’s economic capacity, and empowering them in decision making. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12905-025-04105-3.