Malaria is the leading cause of morbidity and mortality in many developing countries. In 2018, an estimated 228 million cases of malaria occurred worldwide. An estimated 405,000 deaths due to malaria occurred in 2018 due to malaria with more than 94% of the malaria deaths worldwide occurring in African region [
1]. Each year, approximately 50 million women living in malaria-endemic countries throughout the world become pregnant estimated 10,000 of these women and 200,000 of their infants die as a result of malaria during pregnancy [
2]. Malaria remains the leading public health problem in Ethiopia. About 75% of the landmass of the country is malaria risk areas and 68% of the population are living in such settings [
3].
Bed nets are one of the proven cost-effective components of malaria prevention through vector control approach. The use of a bed net during pregnancy is shown to reduce miscarriages and stillbirths by 33% [
4]. Bed nets have been known to reduce numbers of infective mosquito bites by 70 to 90% in various geographical settings [
5]. In Africa, bed nets compared with no nets reduced placental malaria in all pregnancies, reduced low birth weight and fetal loss in the first to fourth pregnancy [
6]. Studies in Western Kenya had shown that bed nets were associated with reductions in the incidence of malaria parasitaemia and incidence of severe malarial anaemia [
6]. Bed nets have been shown to be the most cost-effective measures in the prevention of malaria [
2].
The prevention and control of malaria during pregnancy is, therefore, crucial as it helps to promote the health of the mother and her unborn child. Utilization of bed net among pregnant women varies from 15.8% in Shashogo District, Southern Ethiopia to 90.5% in Enugu, South Eastern Nigeria [
8,
9]. Studies in different areas of Nigeria showed that utilization of bed nets among pregnant women is 44.2% in Ibadan, 35.3% in Imo, 21.3% in Edo state, and 44% nationwide [
9‐
12]. Utilization of bed nets among pregnant women in Bungoma County Kenya is 82.5%, Kilifi district, Kenya is 70.5%, in Gulu Uganda is 35%, in the Democratic Republic of the Congo is 78.4%, in the Buea Health District, Cameroon is 83.4%, Ghana is 20%, and Sudan is 11.5% [
12‐
18]. In different parts of Ethiopia bed net utilization among pregnant women indicated that 72.5% in Damot Pulasa District, 23.2% in Oromia and Amhara Region, 73.3% in Eastern Ethiopia, 52.3% in Itang, Gambella region [
3,
7,
9,
19]. The HDSS site is one of the malaria endemic area in the southern region of Ethiopia in which pregnant women and children are affected. The finding of the study will be used as an input for the government to further strengthen the already existing strategies of malaria prevention as well as a means for monitoring and evaluation of the performance of the government on bed net distribution. Therefore, this study aimed at assessing the trends of bed net utilization among pregnant women in Arba Minch HDSS from 2010 to 2016.