Assessing antenatal care service satisfaction and associated factors among pregnant women at health facilities in East Shewa Zone, Ethiopia: a facility-based cross-sectional study

Antenatal care (ANC) is a critical component of maternal health services, playing a vital role in ensuring the well-being of both mothers and their unborn children. Particularly in Ethiopia, where maternal and child health indicators remain concerning, improving the quality of antenatal care is essential for reducing maternal morbidity and mortality rates. Understanding mothers’ satisfaction is vital for enhancing maternal health services and building trust in the healthcare system. This study aimed to assess Antenatal care service satisfaction and identify associated factors among pregnant women in East Shewa Zone, Ethiopia. A facility-based cross-sectional study was conducted with 534 pregnant women attending ANC at health facilities. Participants were recruited using stratified sampling, and data were collected through structured face-to-face interviews. Binary logistic regression was employed to identify factors associated with satisfaction, with statistical significance set at p < 0.05. Among 534 pregnant women during their first antenatal care (ANC) visit, the overall satisfaction rate was 81.09% (95% CI 77.50%–84.32%). Women with secondary education were 88% less likely to be satisfied (AOR = 0.12), while those with higher education were 96.6% less likely (AOR = 0.034). Ratings of service quality significantly influenced satisfaction, with women rating service as fair and good being five times (AOR = 5.01) and nearly four times (AOR = 3.85) more likely to be satisfied, respectively. Furthermore, ratings of provider knowledge as fair (AOR = 3.81) and good (AOR = 4.05) significantly increased satisfaction. Respect from providers (AOR = 10.34) and involvement in decision-making (AOR = 3.03) also positively influenced satisfaction levels. The study indicates that a significant proportion of pregnant women reported satisfaction during their first antenatal care (ANC) visit, though those with secondary and higher education levels showed lower satisfaction rates. Key predictors of ANC satisfaction included educational status, quality of service, provider knowledge and skills, respect, clarity of explanations, involvement in decision-making, waiting time, helpfulness, and confidentiality. To improve patient satisfaction, healthcare providers should focus on enhancing service quality, ensuring timely care, and fostering respectful interactions, ultimately enriching the ANC experience for women.