Assessing metrics for evaluating the maternal continuum of care in Ethiopia: A scoping review

Despite Ethiopia's remarkable progress in reducing maternal mortality between 2000 and 2023, more effort is needed to achieve the Sustainable Development Goal (SDG) target. The government outlined a continuum of care framework for reproductive, maternal, and child healthcare service delivery to positively impact maternal health outcomes. Therefore, it is important to measure and monitor progress in improving women's access to the continuum of care. However, there is no standardized metric to evaluate whether women receive comprehensive, coordinated care throughout pregnancy, childbirth, and the postpartum period. This absence makes it difficult to assess service integration, identify gaps in care transitions, and inform policy decisions aimed at strengthening the maternal healthcare system. This review aimed to assess the maternal continuum of care measurement metrics. The review used the Joanna Briggs Institute (JBI) scoping review framework. Relevant studies were searched on MEDLINE (via PubMed), Scopus, Web of Science (WOS), and Google Scholar. Reference lists of the included articles were also reviewed for additional studies. Screening was carried out by two reviewers, and disagreements were resolved through consensus. Definitions of the maternal continuum of care were extracted from the included studies. Moreover, the definitions were compared with national maternal healthcare service recommendations. A total of 496 studies were identified, of which 29 were included. All definitions of the 'maternal continuum of care' focused on coverage of maternal healthcare services across three periods: pregnancy, childbirth, and postpartum. Few studies (n = 2) defined the continuum of care in line with the national maternal healthcare service recommendations. Our findings indicate a need for a consistent, holistic measurement metric that addresses both coverage and quality of services and is aligned with maternal healthcare service recommendations. By introducing a new standardized metric, efforts to improve the continuum of care will be strengthened with the necessary data to track progress and guide evidence-based interventions, ensuring a more integrated and effective maternal healthcare system. The development of this metric should leverage existing frameworks for assessing the quality of maternal healthcare services.