Introduction: Antenatal care (ANC) is an umbrella term used to describe medical care and procedures that are carried out for pregnant women. Data on the number of antenatal care visits can help policymakers to show the gap in service provision. So, the paper determines associated factors of the number of antenatal care visits among women who gave birth in the last five years in rural Ethiopia.Methods: Total weighted sample of 6611 women who gave birth in the 5 years preceding the survey were included from the nationally representative 2016 Ethiopian Demographic and Health Survey. We used multi-level negative binomial regression analysis to consider the hierarchal nature of the data. In the multivariable analysis, variables with a p-value < 0.05 were considered to be significantly associated with the number of antenatal care visits. Results: Overall, 27.3% (95% CI: 14.63, 15.76) of women had at least four antenatal care visits during their pregnancy in rural Ethiopia. Age group 25-29 years (adjusted incidence rate ratio (AIRR)=1.13,95% CI:1.02,1.26), household rich wealth status (AIRR=1.17, 95% CI:1.04,1.31), women’s educational status (primary, AIRR=1.19,95% CI:1.08,1.32; Secondary, AIRR= 1.30,95% CI:1.08,1.55; above secondary, AIRR=1.35, 95%CI:1.07,1.71), partner educational status (primary, AIRR=1.16, 95%CI:1.05,1.28; secondary, AIRR=1.22,95% CI:1.08,1.38), and autonomy to decision to their care (AIRR=1.25,95%CI:1.10,1.42) were positively associated individual-level factors with number of antenatal care visits whereas having a birth order of five or more (AIRR=0.80,95% CI: 0.69,0.94) was a negatively associated factor with number of antenatal care visits. Among community-level variables; being in higher community level literacy (AIRR=1.35, 95% CI: 1.14, 1.59) and higher poverty level (AIRR=0.77, 95% CI: 0.64, 0.92) were significantly associated factors with the number of antenatal care visits. Conclusions and recommendations: The level of antenatal care visits in rural areas was low. Age of women, wealth status, women's educational status, partner educational status, autonomy to decision making in health care, and birth order were the most important associated factors with the number of antenatal care visits. Furthermore, poverty and literacy are also important determinants at the community level. Addressing economic and educational interventions for rural women should be given the top priority.
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