Barriers and facilitators of maternal health service utilization in urban settings of Ethiopia: A Qualitative explanatory study

Background Disparities in maternal healthcare utilization are unacceptably high in urban Ethiopia. However, little is known about underlying barriers and facilitators to maternal health services utilization, especially among low socioeconomic and marginalized urban subgroups. This study aims to identify barriers to and facilitators of maternal health service utilization in urban Ethiopia. Methods A qualitative study using in-depth interviews (IDIs), key-informant interviews (KIIs), and focus group discussions (FGDs) was conducted in three purposively selected urban settings: Addis Ababa, Jimma, and Gambella. A total of seven IDIs and six FGDs were conducted among reproductive-age women who ever had a pregnancy or childbirth and reside in urban settings, and seven KIIs with health professionals at various healthcare levels from July 1 to 30, 2025. The information was collected based on the principle of idea saturation. All IDIs, KIIs, and FGDs were audio recorded, and complementary notes were taken. Each interview and FGD data were transcribed word-for-word in the local Afaan Oromo and Amharic languages and then translated into English. Finally, the data were analyzed thematically using ATLAS. ti 9 software and narrated in the linked pattern of maternal health service utilization. Results This study identified eight major themes that explain barriers and six facilitators of maternal healthcare utilization. The main barriers include low knowledge and awareness, socioeconomic status, physical and geographic inaccessibility, health system capacity constraints, quality of care and provider behavior, cultural and social norms, women’s perceptions of safety, trust, and experience, as well as gender dynamics and household decision-making power. In contrast, good knowledge, awareness, and risk perception, family and social support, positive health system experience, health system readiness and accessibility, policy and institutional support, and community empowerment and engagement were found to facilitate maternal health service utilization. Conclusion This study demonstrates that ongoing inequities in maternal healthcare utilization persist as a significant public health challenge in urban Ethiopia, stemming from interconnected socioeconomic, health system, geographic, and sociocultural barriers. Addressing these disparities requires pro-poor, equity-focused health policies and stronger urban health systems that provide respectful, affordable, and accessible care.