Introduction: Maternal mortality remains a major challenge to health systems across worldwide. In most sub-Saharan African countries, the most off-track achievements were global maternal deaths; however the significance of facility birth service utilization and threats of death is little known.

Objective: To assess utilization of institutional delivery and associated factors among mothers who gave birth in the last 12 months prior to the study in rural community of Pawe Woreda, Benishangul- Gumuz, North West Ethiopia, 2018.

Methods: A community-based cross-sectional study was conducted on 623 mothers. Data entered to Epi info version7 & analyzed using SPSS [version 20]. Bivariable and Multivariable logistic regression analysis were conducted. P- Value of <0.05 was considered as significantly associated with institutional delivery at 95% confidence intervals.

Results: Overall deliveries 60.5% were assisted at health facilities. Multivariable logistic regression showed that Mothers educational status, ANC visit during their recent pregnancy, delivery plan of recent pregnancy, maternal knowledge on benefit of institutional, decision power about place of delivery and distance to reach the nearby facility on were significantly associated with utilization of institutional delivery.

Conclusions and Recommendations: The utilization of institutional delivery services among rural women in pawe woreda had improvements but still low. Intensifying women education, up taking ANC potential services, address health education for mothers about benefit of institutional birth and counseling danger sign of labor and delivery, involving couples decision power of facility birth and expanding health facilities in the community are recommended interventions.

Key words: Institutional delivery, Pawe, Ethiopia