Maternal mortality remains a major challenge to health systems worldwide1. It is estimated that more than 536, 000 women die every year in the world due to complications related to pregnancy or childbirth; half of them live in Sub-Saharan Africa (SSA). Pregnancy related complication is among the leading causes of death and disability for women age 15-49 in the developing countries . Ethiopia has one of the highest maternal mortality ratios in Africa and the world, estimated at 673 per 100,000 live births and high neonatal mortality rate of 38/1000 live births , which is, remain among the highest in the world6. Maternal mortality in Ethiopia is likely linked both to extremely low utilization of ANC, skilled birth attendants and facility delivery and to even lower use of emergency obstetric care. The 2005 Demographic and Health Survey found that only 25% of all Ethiopian mothers living in rural areas received any antenatal care from a health professional in their last pregnancy, 3% delivered in a health facility, and 0.3% delivered by Caesarean section . During evaluability assessment, in Agaro according to expert interview and document review, most mothers suffer from complication.