Cognitive and psychosocial determinants of adherence to eight-contact antenatal Care in Ethiopia: a systematic review and Meta-analysis.

OBJECTIVE: To determine the pooled prevalence of adherence to the WHO-recommended eight-contact antenatal care (ANC) model in Ethiopia and identify cognitive and psychosocial determinants. METHODS: . Protocol registered in PROSPERO (CRD420251218932). RESULTS: = 98.9%). Four determinants were significantly associated: secondary or higher maternal education (AOR = 3.93; 95% CI: 2.95, 6.90), good ANC knowledge (AOR = 2.32; 95% CI: 1.81, 2.83), awareness of pregnancy danger signs (AOR = 3.66; 95% CI: 2.83, 4.49), and planned pregnancy (AOR = 2.71; 95% CI: 2.30, 3.13). CONCLUSIONS: Adherence to eight-contact ANC in Ethiopia is low (37.5%) but varies widely. The pooled estimate should be interpreted as an average of divergent regional realities, not a uniform national rate. Cognitive factors (education, knowledge, danger signs) and planned pregnancy are modifiable determinants associated with adherence. However, due to high heterogeneity and predominantly cross-sectional designs, causal inferences cannot be drawn, and social desirability bias may affect self-reported estimates. Context-specific, equity-focused interventions are needed, particularly in low-performing regions.