Background: In Ethiopia, utilization of post-abortion care service is minimal and it seems that the expanding services are underutilized. The purpose of this study was to assess factors which influence decisions for utilization of abortion related services at community level. Methodology: The study was carried out in six selected districts (woredas) within the three big regions of the country, namely Amhara, Oromiya and SNNPR. The study employed a descriptive cross-sectional design. Both quantitative and qualitative study techniques, including structured interview questionnaires, focus group discussions (FGDs), and in-depth interviews. The study population comprised randomly selected 1,492 women of reproductive age, service providers, and key informants of the sampled districts. Results: Majority of respondents said that they prefer public health facilities. According to the respondents, the reason why women do not visit health facility for PAC services include lack of community support, unavailability of services, services are expensive, facilities are distantly located and lack of means of transportation. From the multivariate analysis it appears that public health facilities are preferred by younger respondents, those with no education, those with no history of unwanted pregnancy and those with better income. The qualitative study indicated that women do not go to health facilities for PAC mainly because of inappropriate treatment by providers at the health facilities. Conclusion: Public health facilities especially health centers are the most preferred but there are barriers that should improve. Introduction of supportive supervision should be considered as a tool for improving quality of care. A mechanism should be in place to obtain community opinion regularly and use it to continuously improve services. To correct some misconceptions and improve community awareness on abortion related issues community providers, including reproductive health agents and health extension workers can teach about availability of services and about abortion related complications. [Ethiop. J. Health Dev. 2010;24 Special Issue 1:123-129]