Dropout from the maternity continuum of care and its determinants among women in Ethiopia: A systematic review and meta-analysis

Abstract

Background

The maternity continuum of care including antenatal care (ANC), skilled birth attendance, and postnatal care is essential for reducing maternal and neonatal morbidity and mortality, yet many women in Ethiopia discontinue care.

Methods

A systematic review and meta-analysis of observational studies was conducted using five databases (Web of Science, Scopus, PubMed, Cochrane Library, and Google Scholar), covering studies published from 1/1/2015- 4/10/2025. A total of six studies involving 3,181 participants were included. A random-effects model was applied, and heterogeneity was assessed using the I² statistic. Publication bias was evaluated using funnel plot symmetry and Egger’s regression test.

Results

The pooled prevalence of dropout from the continuum was 61.81% (95% CI: 48.53–75.10), with substantial heterogeneity (I ² = 100%). Key associated factors included lack of media exposure, unplanned pregnancy, fewer than four ANC visits, rural residence, and limited awareness of maternal health services. Dropout was highest between ANC and skilled birth attendance.

Conclusion

This review suggests a substantial level of dropout from the maternity continuum of care in Ethiopia. Strengthening health education, improving access to information, promoting adequate ANC visits, and expanding community-based interventions may help improve continuity of maternal care.

Introduction

Globally, an estimated 260,000 maternal deaths were reported. ¹ Although maternal mortality decreased by nearly 40% between 2000 and 2023, more than 712 women continue to die each day due to complications related to pregnancy and childbirth. ¹ Inadequate use of essential maternal health services remains a significant factor contributing to these preventable deaths.^1,2 Furthermore, poor utilization of maternal healthcare services results in inefficiencies within health systems, such as underuse of available resources, delayed detection of complications, and postponed treatment, all of which negatively affect maternal and neonatal health outcomes.^3–5

To mitigate these challenges, the World Health Organization (WHO) recommends strengthening the quality of health services through improved clinical care and community-based interventions. These include delivering integrated maternal, newborn, and child health (MNCH) services, family planning, and safe abortion care across a continuous pathway of care.^6–8 Previously, WHO recommended a focused antenatal care (FANC) model of at least four ANC visits during pregnancy. However, in 2016, WHO updated this guideline to recommend a minimum of eight ANC contacts to improve maternal and neonatal outcomes and increase opportunities for quality care and early detection of complications. According to the updated WHO recommendation, the “Continuum of Care” for MNCH ensures that women receive high-quality services throughout pregnancy, childbirth, and the postpartum period. The eight-contact model recommends visits at approximately 12, 20, 26, 30, 34, 36, 38, and 40 weeks of gestation. ⁹ These contacts should seamlessly link to skilled birth attendance and postnatal care (PNC), delivered across household, community, and health facility levels.^6,10

Each element of this continuum presents a crucial opportunity for improving outcomes. for example, ANC contact enable routine monitoring, early detection of pregnancy-related risks, and timely management of potential complications. ¹⁰ However, many countries in sub-Saharan Africa experience high dropout rates across the maternity continuum of care. For example, substantial gaps persist in Nigeria and Tanzania, where many women fail to complete recommended maternal health services.^9,11In contrast, higher service utilization has been reported in countries such as Cambodia, highlighting global disparities in continuity of care. ¹²

Ethiopia has implemented several initiatives to improve maternal health service utilization. The Health Extension Program (HEP), launched in 2003, deployed more than 38,000 health extension workers to expand community-based primary healthcare. ¹³ Additionally, the country invested in task shifting strategies such as accelerated midwifery training and the Integrated Emergency Surgery and Obstetrics (IESO) program to expand access to basic and emergency obstetric services at primary care facilities. ¹⁴ Significant investments were also made to improve overall access to essential services. ¹⁵

Despite these efforts, Ethiopia’s maternal mortality ratio (MMR) and neonatal mortality rate (NMR) remain among the highest in sub-Saharan Africa. ¹⁶ Low use of maternal health services continues to be a major contributing factor. ¹⁷ . According to the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS), 43% of women attended four or more ANC visits, 48% delivered at health facilities, and only about 13% received postnatal care services. ¹⁸ In addition to poor coverage, the quality of ANC remains inadequate: components such as counseling, education, birth preparedness, and essential screening tests are delivered inconsistently, with some reported as low as 25%. ¹⁹

Previous research has identified multiple associated factors of dropout from the maternity continuum of care. These include rural residence, unintended pregnancy, attending fewer than four ANC visits, lack of awareness about available services, inadequate ANC counseling, limited decision-making autonomy, low media exposure, insufficient health promotion efforts, and poor knowledge of pregnancy danger signs.^9,11,20–23

Although individual studies have explored dropout from the maternity continuum of care in Ethiopia, their findings are often inconsistent and limited to specific regions, making it difficult to draw generalizable conclusions at the national level. Furthermore, variations in study design, sample size, and measurement of outcomes have contributed to heterogeneity in reported estimates. Therefore, a comprehensive synthesis of the available evidence is essential to generate a pooled national estimate and to identify consistent determinants of dropout. To address this gap, the present systematic review and meta-analysis was conducted to estimate the pooled prevalence of dropout from the continuum of maternal health services and to identify its associated factors. The findings are expected to provide robust and generalizable evidence to inform policymakers and healthcare practitioners in designing targeted interventions to improve continuity of maternal care, reduce maternal and neonatal mortality, and support progress toward national and global health targets.

Materials and methods

This systematic review and meta-analysis was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to ensure methodological rigor and transparency ²⁴ (see Supporting file 1).

Search strategy

A comprehensive and reproducible search strategy was employed to identify studies examining dropout from the maternity continuum of care among women in Ethiopia. The following electronic databases were systematically searched: Web of Science, Scopus, PubMed/MEDLINE, Cochrane Library, and Google Scholar. Each database was searched between 1/1/2015- 4/10/2025, with the final search conducted on April 10, 2025. A combination of Medical Subject Headings (MeSH) terms and free-text keywords was used. The PubMed search strategy, which was adapted for other databases, included: (“Continuity of Patient Care”[MeSH] OR “Maternal Health Services”[MeSH] OR “continuum of care” OR “maternity continuum of care” OR “maternal health service utilization”) AND (“dropout” OR “discontinuation” OR “interruption” OR “loss to follow-up”) AND (“determinants” OR “factors” OR “predictors” OR “associated factors”) AND (“women” OR “pregnant women” OR “childbearing women”) AND (“Ethiopia”). Boolean operators (AND, OR) were applied appropriately, and search terms were modified to suit the syntax requirements of each database, including the use of truncation and wildcards where applicable. The search was limited to observational studies (cross-sectional, case-control, and cohort), published in English, involving women of reproductive age in Ethiopia, and with full text available, up to April 10, 2025. In addition, the reference lists of all included studies and relevant reviews were manually screened to identify any additional eligible articles Supporting file 2.

Inclusion criteria

This study included original research articles that specifically examined the dropout from the maternity continuum of care and their associated factors among women in Ethiopia. Only published studies written in English were eligible for inclusion. Additionally, All relevant studies published from 1/1/2015- 4/10/2025 were considered for inclusion.

Exclusion criteria

Studies without full text or an abstract were excluded. Furthermore, non-research publications, including editorials, letters, reviews, and commentaries, were not considered in the analysis.

Study selection

All studies obtained from different databases were imported into EndNote X7 for management. After removing duplicate entries, two researchers (YAF and AMZ) independently reviewed the titles, abstracts, and full texts to determine eligibility. Any disagreements were resolved through discussion, and when consensus was not reached, a third reviewer was consulted.

Data extraction

Four authors (YAF, ADA, JAB, and WCT) independently extracted and summarized data using a standardized data extraction format adapted from the Hoy assessment tool. The extracted data included the first author’s name, year of publication, region, study design, sample size, sampling method, prevalence of dropout from the maternity continuum of care, and associated factors with their corresponding odds ratios. Any discrepancies during data extraction were resolved through discussion and consensus among the reviewers.

Risk of bias (quality) assessment

The Hoy assessment checklist for analytical cross-sectional studies was used to evaluate the quality of the included studies. ²⁵ The tool consists of nine criteria assessing population representativeness, sampling methods, non-response bias, data collection procedures, case definition, and reliability and validity of study instruments. Each item was scored as 0 (“Yes” or “Low risk”) or 1 (“No” or “High risk”), and the total score ranged from 0 to 9. Studies were categorized as low risk (0–3), moderate risk,^4–6 or high risk.^7,8,10

Outcome measurement

In this review, the outcome variable was defined as discontinuation from the maternity continuum of care. The original studies described this as occurring when a woman did not complete any component of the care continuum such as antenatal care (ANC), delivery assisted by a skilled birth attendant, or postnatal care services. ²²

To determine the factors linked to dropout from the maternity continuum of care, the researchers utilized odds ratios (OR) as the key statistical measure. These ORs were derived from binary outcome data presented in each primary study, comparing the likelihood of dropping out between women exposed to certain factors and those who were not. Priority was given to ORs that showed statistically significant relationships specifically, those with confidence intervals that did not include 1 and to findings that were consistent across several studies. Preference was also given to adjust ORs, as they account for potential confounding variables. Ultimately, the selected ORs were combined through a meta-analysis to provide an overall estimate of how each factor influenced the likelihood of dropout from the maternity continuum of care among women in Ethiopia.

Data synthesis and analysis

The data were extracted using a Microsoft Excel spreadsheet and subsequently imported into STATA version 11 for further analysis. The original studies were described, and key findings were presented in tables, charts, and forest plots (a specific chart used in research). The pooled prevalence estimate was calculated using a random effects model due to the observed heterogeneity across the studies. The levels of heterogeneity were classified as follows: none (I² = 0.0%), low (I² < 25%), moderate (25% ≤ I² ≤ 75%), and high (I² ≥ 75%). ²⁶ Heterogeneity was evaluated using Cochrane’s Q test and the I² statistic. The association between various factors influencing women’s dropout from the maternity continuum of care was estimated through odds ratios with 95% confidence intervals (CI). To minimize random variations in the estimates of the primary studies, a subgroup analysis was performed. Additionally, meta-regression and sensitivity analyses were conducted to identify potential sources of variability. Publication bias, particularly the small study effect, was assessed using a funnel plot and Egger’s test. ²⁷ To determine the factors linked to dropout from the maternity continuum of care, the pooled odds ratio (POR) along with a 95% confidence interval (CI) was computed.

Results

Study selection

A total of 12,535 articles were initially identified dropout from the maternity continuum of care and/or associated factors among women in Ethiopia. After removing 7,625 duplicate studies, 4,790 articles were excluded based on a review of their titles and abstracts. Among the remaining 120 full-text papers assessed for eligibility, 114 were further excluded, primarily due to unreported outcomes of interest or differences in the study population. Ultimately, six studies were included in the final meta-analysis (Figure 1).

Figure 1.

Flow chart of study selection for systematic review and meta-analysis of drop out from maternity continuum of care and associated factors among women in Ethiopia, 2025.

Characteristics of the included studies

Of the studies included, five were Community-based cross-sectional studies, while one was institutional-based cross-sectional study assessing the dropout from the maternity continuum of care. All studies were published between 2019 and 2024. Regarding sampling methods, three studies utilized simple random sampling, two employed cluster sampling, and the remaining one was systematic random sampling.

A total of 3,181 participants were included out of an estimated 3, 291 women, with sample sizes ranging from 361(29) to 867(30). The prevalence of dropout from the maternity continuum of care among women varied between 32.2% ²⁸ to 78.38%. Geographically, two of the studies were conducted in Oromia,^29,30 two in Amhara Region,^22,28 one in Tigray, ²³ and one in the Addis Ababa ³¹ (Table 1).

Table 1.

Descriptive summary of primary studies included in the meta-analysis of dropout from maternity continuum care and associated factors among women’s in Ethiopia, 2025.

Id	Author	Pub year	Region	Study design	Study population	Sample size	Prevalence (%)	Response rate (%)
1	Nakachew Amare 19	2019	Amhara	CBCS	Women	641	32.2	94.4
2	Dawit Desta 22	2021	Addis Ababa	CBCS	Women	630	58.39	92.8
3	Mesfin Tadese 3	2022	Amhara	CBCS	Women	867	69.1	97.1
4	Gelana M. et al. 23	2023	Oromia	IBCS	Women	370	78.38	100
5	Abebay Tilahun 24	2021	Oromia	CBCS	Women	422	66.4	100
6	Maezu Teka 17	2024	Tigray	CBCS	Women	361	66.4	98.9

IBCS; Institutional Based Cross-sectional Study.

CBCS; Community Based Cross-sectional Study.

Meta-analysis

Risk of bias assessment for the included studies

The quality of each study was evaluated using the nine criteria from the Hoy critical appraisal checklist. All included studies were deemed to have a low risk of bias, with scores ranging from 0 to 3(supporting file 3).

Dropout from maternity continuum of care

In this study, the overall estimate of women’s dropout from the maternity continuum of care was 61.81% (95% CI: 48.53–75.10). A high degree of heterogeneity was observed among the included studies (I² = 100%; p-value < 0.001). Therefore, a random-effects model was applied. Given the extreme heterogeneity, the pooled estimate should be interpreted with caution and considered exploratory rather than definitive, as it reflects substantial variability across study settings and populations(Figure 2).

Figure 2.

Forest plot of the pooled prevalence of dropout from maternity continuum care among women in Ethiopia, 2025.

Subgroup analysis

A subgroup analysis based on the sampling techniques used in the primary studies revealed that studies employing simple random sampling reported a higher dropout rate from the maternity continuum of care, with a prevalence of 68.36% (95% CI: 56.61, 80.10). In contrast, studies that used cluster sampling showed a lower dropout rate, with a prevalence of 50.28% (95% CI: 14.13, 86.43) (Figure 3).

Figure 3.

Subgroup analysis by sampling techniques of Dropout from maternity continuum of care among women in Ethiopia, 2025.

Subgroup analysis by region also demonstrated regional differences in dropout rates. The highest prevalence of dropout from the maternity continuum of care was observed in the Oromia region, at 72.89% (95% CI: 61.19, 84.59), while the lowest prevalence was reported in the Amhara region, at 50.28% (95% CI: 14.13, 86.43) (Figure 4).

Figure 4.

Subgroup analysis by region of Dropout from maternity continuum of care among women in Ethiopia, 2025.

Similarly, subgroup analysis based on study design indicated that institutional-based cross-sectional studies reported a higher prevalence of dropout from the maternity continuum of care, estimated at 78.38% (95% CI: 69.27, 87.49). In contrast, community-based cross-sectional studies showed a comparatively lower prevalence of 58.18% (95% CI: 38.67, 77.69) (Figure 5).

Figure 5.

Subgroup analysis by study design of Dropout from maternity continuum of care among women in Ethiopia, 2025.

Publication bias

To evaluate potential publication bias, both Egger’s regression test and a visual inspection of funnel plot asymmetry were performed. The results revealed evidence of publication bias, as Egger’s test showed statistically significant results (p-value < 0.001), indicating bias. Furthermore, a visual examination of the funnel plots revealed an uneven distribution of studies, which also pointed to the presence of publication bias in the included research (Figure 6).

Figure 6.

Graphic representation of publication bias using funnel plots of all included studies in Ethiopia, 2025.

Trim and fill analysis

A trim-and-fill analysis was conducted to assess potential publication bias in the meta-analysis. The method suggested two potentially missing studies; however, given the small number of included studies (n = 6), these findings should be interpreted with caution as they are exploratory and may not provide a stable estimate of publication bias.

Meta-regression and sensitivity analysis

Given the high heterogeneity among the included studies, meta-regression and sensitivity analyses were performed. The meta-regression examined publication year, sample size, and participant characteristics, but none of these variables significantly explained the observed heterogeneity. A leave-one-out sensitivity analysis was conducted by sequentially omitting each study to assess its influence on the pooled estimate. The results showed that no single study had a substantial effect on the overall pooled prevalence, indicating the robustness of the findings (Table 2).

Table 2.

Shows meta-regression of dropout from maternity continuum care and associated factors among women’s in Ethiopia, 2025.

Logprevale∼e	Coef	Std. Err.	t	P>|t|	[95% Conf. Interval]
Participants	.0062374	.0455363	0.14	0.904	-.1896894	.2021643
Pubyear	.1108179	.4142646	0.27	0.814	-1.671619	1.893255
Samplesize	-.0058029	.043189	-0.13	0.905	-.1916301	.1800243
cons	-220.0586	837.9548	-0.26	0.817	-3825.487	3385.37

Associated factors

The study explored several factors influencing the discontinuation of the maternity continuum of care. However, certain variables were excluded due to inconsistencies in how the independent factors were categorized across studies. The findings revealed a strong correlation between lack of media exposure and discontinuation of maternal healthcare services. Three separate studies consistently showed that women without access to media were significantly more likely to drop out of the care continuum, with those lacking media exposure being 8.14 times more likely to discontinue care compared to their counterparts with media access (Pooled Odds Ratio [POR] = 8.14, 95% CI: 5.65–11.72). Additionally, three studies identified unplanned pregnancy as a significant factor contributing to dropout. Women whose pregnancies were unplanned had 5.52 times higher odds of discontinuing maternity care than those with planned pregnancies (POR = 5.52, 95% CI: 3.74–8.14). Furthermore, two studies indicated that receiving fewer than four antenatal care (ANC) visits was associated with a higher likelihood of dropping out. Women who attended fewer than four ANC sessions were 4.47 times more likely to discontinue care compared to those who received four or more visits (POR = 4.47, 95% CI: 3.36–5.95). The studies also highlighted the impact of residence. Women living in rural areas were significantly more likely to exit the maternity care continuum than urban residents, with a pooled odds ratio of 11.48 (95% CI: 7.81–16.87). Lastly, lack of awareness about maternal health services was found to be a critical determinant. Two studies showed that women who were unaware of maternal health services were 3.25 times more likely to discontinue the continuum than those who had received information (POR = 3.25, 95% CI: 2.16–4.88). Due to the moderate level of heterogeneity among the included studies (I² = 76.8%, P < 0.001), the researchers applied a random-effects model for the analysis (Figure 7).

Figure 7.

Showing the forest plot of the association between factors and Sexual violence during armed conflict among women in Ethiopia, 2025.

Discussion

This meta-analysis aimed to assess the nationwide prevalence of dropout from maternity continuum of care in Ethiopia, along with the key factors influencing these rates. To the best of our knowledge, this is the first study to provide a pooled estimate of dropout from maternity continuum of care and their associated factors among Ethiopian women. The findings indicate a wide variation in dropout from maternity continuum of care range from 32.2% ²⁸ to 78.38%. ³² This variation could be attributed to several factors, including differences in study settings (urban vs. rural), the availability and accessibility of maternal health services, disparities in socio-economic and educational backgrounds of the populations studied, and variations in the operational definitions of dropout used across studies. In addition, differences in study periods may have influenced the findings, as maternal health service utilization and healthcare access may change over time due to policy reforms and program implementation. The pooled prevalence of dropout from maternity continuum of care in Ethiopia was estimated at 61.81% (95% CI: 48.53–75.10). These findings align with recent studies conducted in Nepal 50% ³³ and Nigeria 50.8%. ⁹

The current study found a lower prevalence of drop out from maternity continuum of care when compared with the finding in Tanzania 83.86%. ³⁴ This difference could be attributed to variations in healthcare delivery systems, maternal health policies, and community-level interventions between the two countries. Ethiopia may have implemented more targeted strategies, such as community health extension programs, maternal health education, or improved referral systems, which could enhance continuity of care. ³⁵ Additionally, differences in the study populations, including women’s educational status, socioeconomic conditions, cultural beliefs, and levels of autonomy in decision-making regarding health services, may contribute to the observed variation. Methodological differences, including study design, sampling, and definitions of dropout, might also explain the discrepancy.

The current study found a higher prevalence of drop out from maternity continuum of care when compared with the finding in Pakistan 27% ³⁶ and Uganda (42%). ³⁷ This might be due to the differences in health system performance and maternal health program implementation across countries may contribute to the variation. Pakistan and Uganda may have better service integration, stronger community health worker involvement, or more effective maternal health education strategies that improve service utilization across the continuum. The variation might also be due to methodological differences between the studies, including sample size, definitions of “dropout,' and the periods during which the studies were conducted. These factors could collectively explain the higher prevalence observed in the current study.

This study offers valuable insights into the determinants of dropout from the maternity continuum of care. Specifically, limited media exposure, unintended pregnancies, attending fewer than four antenatal care (ANC) visits, living in rural areas, and inadequate awareness of maternal health services were found to be independently associated with an increased risk of dropping out.

The study found that lack of media exposure significantly increases the likelihood of dropping out from the maternity continuum of care. Women without media exposure were 8.14 times more likely to discontinue care compared to those who had media access. This result is consistent with findings from studies conducted in Pakistan, ³⁶ Bangladesh, ³⁸ and Nepal. ³³ A possible explanation is that, although some women may attend at least one antenatal care (ANC) visit, exposure to mass media plays a critical role in disseminating information about maternal health and the importance of continued care throughout pregnancy, childbirth, and the postnatal period. Mass media helps to enhance women’s awareness and positively shape their attitudes toward completing the full spectrum of maternity care. In contrast, women who lack access to such media may miss out on essential health messages, contributing to a higher chance of dropout from the continuum of care.

The study also found that women with unplanned pregnancies were 5.52 times more likely to drop out from the maternity continuum of care compared to those with planned pregnancies. This result aligns with findings from a study conducted in Turkey. ³⁹ One possible reason for this association is that unplanned or unintended pregnancies may reduce the likelihood of seeking timely and adequate maternal healthcare. Women in such situations might delay initiating antenatal care or may not prioritize maternal health services, leading to insufficient preparation for childbirth and limited awareness about the benefits of receiving continuous maternity care.

In this study, women who attended fewer than four antenatal care (ANC) visits were 4.47 times more likely to drop out from the maternity continuum of care compared to those who had four or more ANC visits. This could be attributed to the fact that initiating ANC early and attending the recommended number of visits increases opportunities for receiving health education, including awareness of pregnancy-related danger signs and potential obstetric complications. Such information can positively influence maternal health-seeking behavior and encourage continued engagement with maternity care services.^40–42

The current study found that the likelihood of dropout from the maternity continuum of care was 11.48 times higher among rural residents. This finding is consistent with prior studies showing that urban residency is often linked to higher completion rates of maternity care.^9,43,44 Several factors could explain this discrepancy. First, rural areas frequently encounter difficulties in accessing healthcare services, such as greater distances to health facilities, inadequate road infrastructure, and limited transportation, making it more challenging for women to attend regular antenatal and postnatal visits.^20,45,46 Additionally, rural regions may have fewer healthcare providers and facilities capable of offering comprehensive maternal care, leading to higher dropout rates. Cultural norms and traditional practices may also affect maternal health-seeking behaviors, with rural communities possibly more influenced by such beliefs, which could further contribute to discontinuation of care. Finally, there may be lower awareness in rural areas about the importance of continuous maternity care, which can result in fewer women seeking and completing the full continuum of services.

Finally, mothers who had never heard of maternal healthcare services were 3.25 times more likely to drop out from the maternity continuum of care compared to those who had heard about these services. This could be explained by the fact that women who are informed about maternal healthcare services are likely to have a better understanding of the benefits these services provide, particularly in reducing maternal and neonatal mortality. As a result, they are more likely to engage in health-seeking behaviors and remain committed to completing the continuum of care, unlike those who have no prior knowledge of maternal healthcare services.^47,48

Strength and limitation

Although this study is the first systematic review and meta-analysis examining dropout from the maternity continuum of care among women in Ethiopia, several limitations should be considered. The analysis included only six cross-sectional studies, limiting causal inference. Substantial heterogeneity was observed among studies (I² = 100%), indicating considerable variability in effect estimates. Publication bias assessment was also limited by the small number of included studies. Restriction to English-language publications may have introduced language bias, and exclusion of non-full-text studies may also have affected the evidence base. In addition, inconsistent definitions of variables across studies limited pooling of some associated factors, and the included studies were conducted in only four regions of Ethiopia, which may limit generalizability.

Furthermore, we acknowledge that some of the large pooled effect sizes may reflect residual confounding, inconsistent covariate adjustment across studies, and possible sparse data bias; therefore, these estimates should be interpreted with caution.

Conclusion

This systematic review and meta-analysis indicates substantial dropout from the maternity continuum of care in available Ethiopian studies; however, the findings should be interpreted with caution due to the limited number of included studies and the heterogeneity among them. The review also suggests that dropout is associated with factors such as lack of media exposure, unplanned pregnancies, attending fewer than four ANC visits, rural residence, and limited awareness of maternal health services. Strengthening community-based interventions and enhancing health education are recommended to support continuity of maternal care and improve maternal and newborn health outcomes in Ethiopia.

Appendix.

Abbreviations

POR

Pooled odd ratio

AOR

Adjusted odd ratio

CI

Confidence intervals

PRISMA

Preferred Reporting Items for Systematic review and Meta-analysis

ANC

Antenatal Care

PNC

Postnatal Care

SDG

Sustainable Development Goal.

ORCID iDs

Yeshiwas Ayale Ferede https://orcid.org/0000-0003-0180-5495

Agerie Mengistie Zeleke https://orcid.org/0000-0002-9390-9189

Jember Ayelgne Beyene https://orcid.org/0009-0001-2735-3522

Data Availability Statement

All relevant data generated and analyzed is included in this article.*