Despite the importance of safe obstetric practice in reducing mother-to-child HIV transmission and adverse perinatal outcomes, little is known about access to intrapartum obstetric care for HIV positive women. A cohort of HIV positive women were followed to assess the rate of intrapartum transfers and associated adverse outcomes in Addis Ababa. Overall, 282 HIV positive pregnant women were followed, 75% gave birth at Emergency Obstetric and Neonatal Care facilities, 42% of them transferred between health facilities during the intrapartum period and 36% were transferred two or more times. Sixty four percent of the first time transfers were due to obstetric complications, while all subsequent transfers
were due to practical constraints. Women in their second pregnancy were less likely (OR 0.3 95% CI 0.2- 0.6) to be transferred than women in their first pregnancy. Transferred women experienced more stillbirths than women who were not transferred. The rate of stillbirths was not significantly associated with the syphilis test result, the CD4 count and initiating antiretroviral therapy. There appeared to be serious challenges within the health care system compromising the intrapartum care for our
participants and increasing the risk of stillbirth and MTCT. Undue transfers during the intrapartum period should be addressed at all levels of the health care system.