Disrespect and abuse of women during institutional childbirth services is one of the deterrents to utilization of maternity care services in Ethiopia and other low- and middle-income countries. This paper describes the prevalence of respectful maternity care (RMC) and mistreatment of women in hospitals and health centers, and identifies factors associated with occurrence of RMC and mistreatment of women during institutional labor and childbirth services. This study had a cross sectional study design. Trained external observers assessed care provided to 240 women in 28 health centers and hospitals during labor and childbirth using structured observation checklists. The outcome variable, providers’ RMC performance, was measured by nine behavioral descriptors. The outcome, any mistreatment, was measured by four items related to mistreatment of women: physical abuse, verbal abuse, absence of privacy during examination and abandonment. We present percentages of the nine RMC indicators, mean score of providers’ RMC performance and the adjusted multilevel model regression coefficients to determine the association with a quality improvement program and other facility and provider characteristics. Women on average received 5.9 (66%) of the nine recommended RMC practices. Health centers demonstrated higher RMC performance than hospitals. At least one form of mistreatment of women was committed in 36% of the observations (38% in health centers and 32% in hospitals). Higher likelihood of performing high level of RMC was found among male vs. female providers ( $$ \widehat{\beta}=0.65 $$ , p = 0.012), midwives vs. other cadres ( $$ \widehat{\beta} = 0.88 $$ , p = 0.002), facilities implementing a quality improvement approach, Standards-based Management and Recognition (SBM-R©) ( $$ \widehat{\beta}=1.31 $$ , p = 0.003), and among laboring women accompanied by a companion $$ \widehat{\beta} = 0.99 $$ , p = 0.003). No factor was associated with observed mistreatment of women. Quality improvement using SBM-R© and having a companion during labor and delivery were associated with RMC. Policy makers need to consider the role of quality improvement approaches and accommodating companions in promoting RMC. More research is needed to identify the reason for superior RMC performance of male providers over female providers and midwives compared to other professional cadre, as are longitudinal studies of quality improvement on RMC and mistreatment of women during labor and childbirth services in public health facilities.

Despite remarkable gains in maternal and child health (MCH) outcomes globally, the lack of access to and use of essential health services remains a challenge in low-income countries, like Ethiopia. To address health service access and use, the Ethiopian government has endorsed a fifteen-year “Optimizing Ethiopian Health Extension Program” strategy. This study explored gender barriers to access to and use of MCH services in the primary health care (PHC) setting in Ethiopia. An exploratory qualitative study was conducted in nine districts in Ethiopia. Data were collected using 87 key informants and 134 discussants in 18 Focus Group Discussions. Maximum variation sampling use used to identify participants.. Collected data were coded and gender-related barriers were categorized using the USAID’s gender analysis domains. The study enrolled 221 study participants who represented key stakeholders, and 45.7% of them were female. Although Ethiopia adopted and ratified global human rights conventions to protect the legal rights and status of women and children, there are gaps in institutional practices of laws, policies, and regulations. Socio-cultural norms favor men and boys over women and adolescent girls which adversely affect their access to and control over assets and resources. Power and decision-making imbalances between men and women are exacerbated by low men’s understanding of MCH needs. Women are not empowered to utilize exempted services. Women’s traditional workload in the household during and after pregnancy is prioritized over healthcare. Women face challenges in accessing and use of health services due to socio-cultural norms, beliefs, and implementation gaps within the health system of Ethiopia. It is suggested to work with agrarian and pastoral communities to overcome socio-cultural, knowledge-based gender barriers, and addressing gender gapsthat limit women’s access to available health services while institutionalizing and tailoring national gender-integrated policies to improve access to and utilization in the PHC system of Ethiopia.

The current healthcare system’s efforts to reduce the spread of COVID-19 in Ethiopia and limit its effects on human lives are being hampered by hesitancy toward the COVID-19 vaccine. The aim of this study was to assess the knowledge levels, attitudes, and prevention practices of COVID-19, in the context of the level of vaccine hesitancy with other associated factors in Ethiopia. A community-based cross-sectional design with mixed-method data sources was employed. It comprised 1361 study participants for the quantitative survey, with randomly selected study participants from the studied community. This was triangulated by a purposively selected sample of 47 key informant interviews and 12 focus group discussions. The study showed that 53.9%, 55.3%, and 44.5% of participants had comprehensive knowledge, attitudes, and practices regarding COVID-19 prevention and control, respectively. Similarly, 53.9% and 47.1% of study participants had adequate knowledge and favorable attitudes toward the COVID-19 vaccine. Only 29.0% of the total survey participants had been vaccinated with at least one dose of vaccine. Of the total study participants, 64.4% were hesitant about receiving the COVID-19 vaccination. The most frequently reported reasons were a lack of trust in the vaccine (21%), doubts regarding the long-term side effects (18.1%), and refusal on religious grounds (13.6%). After adjusting for other confounding factors, geographical living arrangements, the practices of COVID-19 prevention methods, attitudes about the vaccine, vaccination status, perceived community benefit, perceived barriers toward vaccination, and self-efficacy about receiving the vaccine were significantly associated with vaccine hesitancy. Therefore, to improve vaccine coverage and reduce this high level of hesitancy, there should be specifically designed, culturally tailored health education materials and a high level of engagement from politicians, religious leaders, and other community members.

Female genital cutting (FGC) remains highly prevalent in Ethiopia, in spite of a slowly decreasing trend over the last decade. In an effort to inform and strengthen FGC interventions in Ethiopia, this study aimed to assess FGC prevalence in cross-administrative border* districts and to explore barriers to ending FGC. A mixed methods, cross-sectional study was employed in three districts in the Afar and Amhara regions in Ethiopia. A sample of 408 women with female children under the age of 15 were included in the study. Additionally, 21 key informant interviews and three focus group discussions were held with local government officials and community stakeholders. The study found that the prevalence of FGC among mothers interviewed was 98%. Seventy-four percent of the female children of participants had undergone FGC. Of the youngest (last born) female children, 64.7% had experienced FGC. The participation of respondents in cross-administrative FGC practices ranged from 4% to 17%. Quantitative analysis found that knowledge and attitude towards FGC, level of literacy, place of residence, and religious denomination were associated with FGC practice. The study also found that the lack of participatory involvement of local women in programs that aim to end FGC and the lack of suitable legal penalties for those who practice FGC exacerbate the problem. A significant proportion of participants support the continuation of FGC practices in their communities. This finding indicates that FGC practice is likely to persist unless new approaches to intervention are implemented. It is recommended that a comprehensive response that couples community empowerment with strong enforcement of legislation is administered in order to effectively end FGC in Ethiopia by 2025, in alignment with the national plan against Harmful Traditional Practices. * Cross-administrative border means a border between two regional states in Ethiopia. In this document, it refers to the movement of people between Amhara and Afar regional states.

Background: Sexual violence is a serious public health and human rights problem with both short-term and long-term consequences. This review aims to systematically assess the link between sexual violence and poor mental health among sub-Saharan African women. Methods: Systematic review and meta-analyses of observational studies were performed. MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane, Global Health and the University of Melbourne library electronic databases were used to find relevant published literature over 12 years from 2012 to 2024 in sub-Saharan Africa with stringent eligibility criteria. Random effects meta-analyses were used to pool estimates of ORs and 95% CIs. The I² statistic was used to assess heterogeneity. Results: This systematic review and meta-analysis of 76 observational studies included a total of 80 313 participants and found a consistent small-to-medium association between lifetime sexual violence and experiences of poor mental health. The pooled ORs suggest that women who were exposed to sexual violence were more than twice as likely to experience post-traumatic stress disorder (OR 2.75; 95% CI 1.96 to 3.86; I²=73.4%), depression (OR 2.38; 95% CI 2.04 to 2.77; I²=56.6%), anxiety (OR 2.81; 95% CI 1.67 to 4.72; I²=77.2%), common mental disorders (OR 2.12; 95% CI 1.70 to 2.64; I²=0.0%), suicidal behaviour (OR 2.44; 95% CI 1.92 to 3.10; I²=68.0%) and emotional distress (OR 3.14; 95% CI 1.73 to 5.69; I²=79.6%) compared with women who have not experienced sexual violence. Conclusions: Exposure to lifetime sexual violence was consistently associated with small to medium effects on poor mental health among women in sub-Saharan Africa. Thus, policy-makers should develop response strategies as well as mental health screening tools for all violence response service delivery points. In addition, health practitioners must prioritise screening for mental health conditions in patients who present with a history of sexual violence.

This study aimed to explore the sociocultural determinants of family planning (FP) utilization among women in pastoralist areas of Ethiopia. A community-based cross-sectional survey was conducted involving 682 reproductive-aged women selected from three regions in pastoralist districts. Hierarchical logistic regression was used to identify factors associated with women who did not use FP. This study revealed that 47% of women did not use FP. Women who did not use FP were more likely to have shorter spacing between births, lack their partner’s support, not be involved in decisions regarding large household purchases, and have low household expenditures. Overall, the prevalence of not using FP is significantly high in pastoralist communities in Ethiopia. The authors recommend that investment in women’s health and FP be targeted at educational campaigns to raise awareness about FP and its importance. Engaging men and community leaders, promoting their support for FP and contraceptive use, and providing financial assistance to address financial barriers, such as transportation costs and healthcare fees, are important aspects that can increase the utilization of FP methods.