IntroductionAnemia is a global public health problem that has affected a significant number of pregnant mothers worldwide. The World Health Organization has estimated the prevalence of anemia in pregnant women at 18% and 56% in developed and developing countries, respectively. This study aimed to identify factors associated with severe anemia among laboring women in Mekelle city public hospitals, Tigray, Ethiopia.MethodsThis unmatched case–control study involved 264 (88 = cases and 176 = controls) pregnant women who were recruited when they came for delivery service in Mekelle city public hospitals. The data was collected from July to August, 2016. In this study, a systematic sampling technique was used inselecting controls, but the cases were enrolled until the required sample size was reached. Bivariate and multivariate analyses were conducted to find predictors of severe anemia. Statistically significant predictors of severe anemia were identified at P-value <0.05 and 95% confidence interval.ResultsA total of 264 pregnant women who came for delivery services were enrolled in this study. The major predicting variables for the occurrence of severe anemia among laboring women were residency (AOR = 3.28, 95% CI: 1.26–8.48), number of pregnancies (AOR = 2.46, 95% CI: 1.14–5.29), iron folate supplementation (AOR = 3.29, 95% CI: 1.27–8.49), dietary diversification score (AOR = 3.23, 95% CI: 1.19–8.71) and duration of menstrual cycle (AOR = 2.37, 95% CI: 1.10–5.10). The variable ‘blood loss during pregnancy’ (AOR = 6.63 95% CI: 2.96–14.86) was identified as a strong predictor of the outcome variable, severe anemia.ConclusionThis study identified determinants of severe anemia among laboring women in Mekelle city public hospitals, Northern Ethiopia. To reduce anemia, strengthening health education provision related to the importance of birth spacing and consuming diversified and iron-enriched food should be considered. Moreover, screening of pregnant women for state of anemia during their visits to health facilities, as well as de-worming for intestinal parasites infection are needed.