BackgroundGlobally, an estimated 287 000 maternal deaths occurred in 2010 annually as a result of complications of pregnancy and childbirth. Sub-Saharan Africa and Southern Asia were accounted for 85% of the global burden (245 000 maternal deaths) including Ethiopia. Obstetric related complications cannot be reliably predicted. Hence, insignificant decline of maternal mortality ratio might be due to the non use of birth preparedness and complication readiness strategies. Therefore, this paper aimed to assess knowledge and practices towards birth preparedness and complication readiness and associated factors among women of reproductive age group (15–49) in Robe Woreda, Arsi Zone, Oromia Region, Ethiopia.MethodCommunity-based cross-sectional study supplemented by qualitative design was conducted in January, 2012. A total of 575 women from 5 kebeles were selected after proportionally allocated to population size and interviewed using structured and semi-structured, pre-tested questionnaires. Univariate and bivariate analysis was performed. Multiple logistic regression analysis was also done to control for possible confounding variables.ResultsTaking into account place of delivery identification, means of transportation, skilled attendant identification and saving money, about 16.5% of the respondents were prepared for birth and its complications. Preparation for birth and its complication was higher among educated mothers (AOR = 6.23, 95% CI = 1.5, 25.87). Monthly income of >716 Ethiopian birr (AOR = 1.94, 95% CI = 1.01, 3.87), ANC visit (AOR = 5.68, 95% CI = 1.27, 25.4), knowledge of obstetric complications (AOR = 2.94, 95% CI = 1.61, 5.37) and those who had given birth at health facility before their last delivery (AOR = 3.9, 95% CI = 2.04, 7.46) were also significantly associated with birth preparedness and complication readiness.ConclusionThe study identified very low magnitude of birth preparedness and complication readiness in the study area and poor knowledge and practices of preparation for birth and its complication. Community education about preparation for birth and its complication and empowerment of women through expansion of educational opportunities are important steps in improving birth preparedness. In all health facilities during antenatal care emphasis should given to preparation for birth and its complication and provide information and education to all pregnant women.