Conflict-driven antenatal care interruption in conflict zones of Ethiopia: a systematic review and meta-analysis

The delivery of maternal health services is compromised by conflict’s substantial disruption of health systems. Antenatal care (ANC) continuity in Ethiopia has been jeopardized by ongoing armed hostilities in conflict areas of Ethiopia. The purpose of this systematic review and meta-analysis was to determine the pooled prevalence of ANC interruption and investigate its drivers in war affected regions of Ethiopian. We systematically researched articles published between 2015 and 2025 in PubMed, Embase, CINAHL and Scopus. Grey literatures (International Humanitarian Organizations, United Nations and International Monitoring Agencies like Offices of Coordination of Humanitarian Affairs-OCHA) were used to support completeness of the sources. Studies that reported ANC utilization or disruption in Ethiopia’s conflict-affected areas were included. Information about ANC results, study parameters, and contextual factors were extracted. I² statistics were used to evaluate heterogeneity, and pooled prevalence was estimated using random-effects model meta-analysis. Eight peer-reviewed studies were included for the review. The pooled prevalence of ANC interruption was 54.3% (95% CI: 39.2–69.4). Facility destruction, insecurity, and population displacement were among the determinants. These results were supported by grey literature, which stated that maternal services were extremely limited and most health institutions were non-operational. Grey literature corroborated these findings, reporting that the majority of health facilities were non-functional and maternal services severely limited. ANC interruption in conflict-affected Ethiopia is high, affecting more than half of pregnant women. Immediate interventions are required, including health facility rehabilitation, mobile outreach services, workforce strengthening, and supply chain restoration to mitigate maternal and neonatal morbidity and mortality.