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Background: Alcohol is the most abused substance worldwide. Globally, alcohol is among the leading risk factors for death and disability adjusted life years (DALYs). Alcohol consumption has become common practice in Ethiopia. There are limited number of studies conducted to examine prevalence and factors associated with alcohol consumption, among women. Therefore, this study aimed to determine the prevalence and determinants of alcohol consumption among women at a national level.

Method: A cross-sectional study was applied to the 2016 Ethiopian Demographic and Health Survey (EDHS) and 15683 reproductive age women were included. Descriptive statistics were performed for all the variables and variables with a p value ≤ 0.05 in the bivariable logistic regression analysis were considered for the multi variable logistic regression analysis. Models adjusted for confounders were used to examine the association between demographic, socioeconomic, and lifestyle factors with alcohol use. Results were presented with adjusted odds ratios (AOR) and 95 % confidence intervals. Sampling weight was applied in all analyses.

Result: This study revealed the lifetime prevalence of alcohol drinking was 35.3% among Ethiopian women. Living in metropolitan cities (AOR = 2.42; 95 % CI 1.52, 3.86), having multiple sexual partners (AOR=2.19; 95%CI: 1.57, 3.06) and partner alcohol use (AOR=3.22, 95% CI: 2.39, 4.35) were found positively and significantly associated with alcohol consumption. On the other hand, being Muslim (AOR = 0.01, 95% CI: 0.00, 0.01), Protestant (AOR = 0.02, 95% CI: 0.01, 0.03), other religion follower (AOR = 0.09, 95% CI: 0.04, 0.19), primary education (AOR=0.54; 95% CI: 0.37, 0.77), secondary education (AOR=0.46, 95% CI 0.25, 0.84), and khat chewing (AOR=0.47, 95% CI: 0.24, 0.93) were found to have a protective effect on alcohol consumption.

Conclusion: This study revealed alcohol use was high among women and factors such as region of residence, religious affiliation, educational attainment, khat, partner alcohol use and multiple sexual partners were significantly associated with alcohol use. A holistic and multisectoral approach should be designed for the prevention and intervention of alcohol use among women. This includes enforcement of existing policy, health education for women, reducing availability of alcoholic drinks, regulation of locally produced alcoholic products, involvement of partner in health promotion interventions, and incorporating alcohol education into all settings including religious institutions.