Researchers studied prenatal care services in Tigray, Northern Ethiopia, a region affected by recent conflict. They surveyed over 2,300 mothers and checked 32 health clinics to see how many pregnant women were getting proper check-ups during pregnancy. While most women (87%) went to at least one prenatal visit, very few completed all recommended visits or went early enough in their pregnancy. The clinics also lacked important supplies and staff training. Overall, only about 4% of pregnant women received truly effective prenatal care that met quality standards. The study shows that conflict-affected areas need better equipment, trained doctors, and programs to encourage women to get care early and regularly.

The Quick Take

  • What they studied: How many pregnant women in a war-affected region of Ethiopia were getting good-quality prenatal care (check-ups during pregnancy)
  • Who participated: 2,340 mothers with babies under one year old, 32 health clinics, and 250 pregnant women receiving care at those clinics in 24 districts of Tigray, Northern Ethiopia
  • Key finding: While 87% of women had at least one prenatal visit, only 4% received truly effective care when considering the quality of clinics, staff training, and whether women completed all recommended visits
  • What it means for you: In conflict-affected areas, pregnant women may visit clinics but may not receive complete, high-quality care. This suggests that simply building clinics isn’t enough—they need proper equipment, trained staff, and programs to help women start care early and keep coming back

The Research Details

Researchers used a cross-sectional study design, which is like taking a snapshot of a situation at one point in time. They visited 24 randomly selected districts in Tigray between January and February 2024. They collected information from mothers at home using tablets and smartphones (a system called ODK), and they visited health clinics to check what equipment and supplies they had and how well staff were following proper procedures. This combined approach—looking at both what happens in homes and what happens in clinics—gives a complete picture of prenatal care in the region.

The researchers used a special method called multi-stage cluster sampling to choose their participants. This means they first randomly picked districts, then health clinics within those districts, then selected mothers and pregnant women from those areas. This approach helps make sure the results represent the whole region fairly.

They measured ’effective coverage’ by combining three things: whether women had enough visits, whether the clinics had the right equipment and supplies, and whether the care they received followed proper medical standards. This is more realistic than just counting visits, because a visit to a clinic without supplies or trained staff may not help much.

This research approach is important because it shows that simply counting how many women visit clinics doesn’t tell the whole story. A woman might go to a clinic, but if the clinic doesn’t have iron supplements, trained staff, or proper equipment, she may not actually get better care. By measuring ’effective coverage,’ the researchers revealed that the real problem in this region isn’t just getting women to clinics—it’s making sure those clinics can actually provide good care.

This study has several strengths: it surveyed a large number of mothers (2,340), visited many health facilities (32), and used a random selection method to avoid bias. The researchers collected data in a short, defined time period, which means the situation was consistent. However, the study was done in one region of Ethiopia, so results may not apply everywhere. The study was cross-sectional, meaning it’s a snapshot in time rather than following women over months or years, so it can’t prove that one thing causes another—only that they exist together. The researchers used standardized tools and checklists, which increases reliability.

What the Results Show

The study found that prenatal care in post-war Tigray faces major challenges at every level. First, while 87% of pregnant women attended at least one prenatal visit, this number drops dramatically when you look at quality. Only 11% of women had their first visit before 12 weeks of pregnancy (when early detection of problems is most important), and only 16% completed the recommended four or more visits. This means most women either started care too late or didn’t come back for follow-up visits.

Second, the health clinics themselves were not well-prepared. On average, clinics scored only 56% on readiness—meaning they were missing important equipment, supplies, and resources. When researchers checked the quality of care being provided, clinics scored 54%, indicating that staff weren’t consistently following proper procedures and protocols.

When researchers combined all these factors into an ’effective coverage’ score, the result was sobering: only 3.8% of pregnant women received truly effective prenatal care. This means that while most women were visiting clinics, the care they received was often incomplete or of poor quality. The study also found that when they adjusted for clinic readiness and care quality, the coverage dropped to 8.7% and 7.1% respectively, showing how much the lack of resources and training affects actual care.

The study revealed several other important problems. Iron-folate supplementation—a simple, inexpensive treatment that prevents anemia and birth complications—was not being given consistently. The fact that clinics lacked basic supplies suggests they were missing not just iron supplements but likely other essential items like blood pressure monitors, urine test strips, and basic medications. The low process quality scores indicate that healthcare workers weren’t consistently checking blood pressure, testing urine, counseling women about danger signs, or following other standard prenatal care steps. These gaps suggest that the region needs both better equipment and better training for healthcare workers.

This research adds important information about prenatal care in conflict-affected areas. Previous studies have shown that wars and conflicts disrupt health services, but this study provides specific numbers for one region. The finding that 87% of women attend at least one visit is actually higher than in some other conflict-affected areas, suggesting that women in Tigray are trying to access care. However, the very low ’effective coverage’ of 3.8% shows that simply having women visit clinics isn’t enough—the quality of those visits matters greatly. This aligns with global research showing that in many developing regions, the problem isn’t just access to clinics but the quality of care provided.

This study has several important limitations to keep in mind. First, it only looked at one region of Ethiopia during a two-month period, so results may not apply to other conflict-affected areas or to Tigray at different times. Second, the study asked mothers to remember details about their pregnancies, which can be inaccurate—people sometimes forget or misremember. Third, the study is cross-sectional, meaning it’s a snapshot in time; it can’t prove that poor clinic readiness causes poor outcomes, only that they exist together. Fourth, the study didn’t measure whether better prenatal care actually led to healthier babies, only whether women received the recommended care. Finally, the study was done shortly after the conflict ended, so the situation may have improved or worsened since then.

The Bottom Line

Based on this research, here are evidence-based recommendations with confidence levels: (1) HIGH CONFIDENCE: Equip health clinics with essential prenatal care supplies including blood pressure monitors, urine test strips, iron-folate supplements, and basic medications. (2) HIGH CONFIDENCE: Provide on-the-job training for healthcare workers on proper prenatal care procedures and protocols. (3) MODERATE CONFIDENCE: Start prenatal care programs at health posts (smaller clinics closer to communities) to encourage women to begin care earlier. (4) MODERATE CONFIDENCE: Create community education programs to encourage pregnant women to start prenatal care before 12 weeks and to complete all recommended visits. (5) MODERATE CONFIDENCE: Establish systems to track whether women complete their recommended visits and follow up with those who miss appointments.

This research is most relevant to: pregnant women and families in conflict-affected regions of Ethiopia and similar areas; healthcare workers and clinic managers in these regions; government health officials planning resources for post-conflict areas; international health organizations working in conflict zones; and researchers studying maternal health in developing countries. This research is less directly applicable to pregnant women in well-resourced countries with established prenatal care systems, though it highlights the importance of quality, not just access.

Improvements would likely take time. Equipping clinics with supplies could happen within weeks to months. Training healthcare workers might take 2-6 months. Changing community behavior and getting women to start care earlier and complete visits could take 6-12 months to show results. Actual improvements in baby health outcomes might not be measurable for 1-2 years. The key is that these are not quick fixes—they require sustained effort and resources.

Want to Apply This Research?

  • Users in conflict-affected areas could track: (1) Date of first prenatal visit and whether it occurred before 12 weeks of pregnancy, (2) Dates of all prenatal visits (aiming for 4+ visits), (3) Whether iron-folate supplements were received at each visit, (4) Blood pressure readings and urine test results when available, (5) Any warning signs discussed with healthcare provider (bleeding, severe headache, swelling)
  • The app could help users: (1) Set reminders for prenatal visits starting before 12 weeks of pregnancy, (2) Create a checklist of questions to ask at each visit, (3) Track whether they received all recommended tests and supplements, (4) Log any symptoms or concerns between visits, (5) Find the nearest health facility offering prenatal care, (6) Connect with other pregnant women for support and information sharing
  • Long-term tracking should include: (1) Monthly check-ins on visit completion, (2) Quarterly reviews of whether care quality is improving (checking if all recommended tests are being done), (3) Tracking of supplement adherence, (4) Documentation of any complications or concerns, (5) Post-delivery follow-up to assess outcomes, (6) Feedback to healthcare facilities about care quality to drive improvements

This research describes prenatal care in a specific region of Ethiopia and should not be used to diagnose or treat individual health conditions. Pregnant women should always seek care from qualified healthcare providers in their area. If you are pregnant, follow the prenatal care recommendations of your doctor or midwife, regardless of where you live. This study shows challenges in one region but doesn’t mean prenatal care is ineffective—rather, it highlights the need for better resources and training. If you have concerns about your pregnancy, contact your healthcare provider immediately. This information is for educational purposes and should not replace professional medical advice.