Effective coverage of maternal and newborn health services across the antepartum and peripartum continuum in primary health care in Ethiopia.

introductionDespite progress in improving access to and use of maternal and newborn health (MNH) services in Ethiopia, challenges persist in ensuring equitable, high-quality care.

methodsThis study assessed the effective coverage cascade across antepartum and peripartum care (PPC) using formative implementation science research data obtained during July-August 2024. A stratified multistage sampling method recruited 1,922 women with infants (0-11 months), including 1,118 from agrarian and 804 from pastoral regions. The study included facility assessments at 67 primary care facilities and 329 client exit interviews. Service contact was defined as attending at least one antenatal care (ANC) contact and delivering in a health facility. Intervention-adjusted coverage accounted for receipt of key interventions, while readiness- and quality-adjusted coverage incorporated facility input and quality index scores from facility survey readiness assessment and exit interviews. Sampling weights were applied, and household and facility data were linked using ecological methods -that is, by aligning data from the same woreda rather than linking records at the individual level.

resultsMean facility readiness scores for ANC and PPC were 74% and 80%, respectively. The mean care experience score from exit interviews was 83%, while antepartum and peripartum service provision scores were 60% and 61%. Household survey data showed that fewer than three-quarters of women received recommended ANC interventions, while 82% of women received peripartum and newborn interventions. Most facilities had uterotonics, newborn resuscitation bags, and essential maternal health services. However, gaps in trained staff, diagnostics, emergency transport, and dignified care persisted. Missing services-including ultrasound, deworming, maternal depression screening, and postpartum family planning counseling-highlighted critical service delivery challenges. The effective coverage cascade shows significant drop-offs across the continuum of care. For ANC, 81% of women made initial contact, only 63% received care in facilities with essential inputs, 49% received essential interventions, and only 26% ultimately received quality services. A similar pattern was observed for peripartum services: about 74% of women delivered at a health facility, only 59% received PPC in a facility with essential inputs, 49% received essential interventions, and just 26% received quality services. Regional disparities were evident across the cascade.

conclusionWhile MNH service access has expanded, substantial cascade losses and inequities persist, particularly between agrarian and pastoral regions. Addressing these challenges requires equity-focused strategies to enhance readiness, improve service quality, integrate care, and strengthen accountability.