Effectiveness of women-centred participatory learning and action approach on maternal and newborn healthcare utilisation: a quasi-experimental embedded implementation research

Introduction Despite notable improvements in maternal and newborn health (MNH) in Ethiopia over the past three decades, significant disparities remain, especially among agrarian and pastoralist populations. Socioeconomic, geographic, and gender barriers continue to hinder access to essential MNH services. Hence, a community-led, women-focused Participatory Learning and Action (PLA) model was introduced to assess the effectiveness of PLA-MNH in enhancing health service utilisation. Methods A quasi-experimental study was conducted in five woredas using a mixed-method, embedded implementation research design. Baseline (n = 1581) and endline (n = 1803) household surveys, and 90 qualitative interviews were conducted across 87 kebeles using two-stage cluster sampling. The PLA intervention delivery strategy involved eleven consecutive group meetings, which were categorised in four phases. delivered by 242 PLA groups from July 2024 to June 2025. The PLA intervention job aids were co-developed using a human-centered design approach, engaging key stakeholders to enhance usability and effectiveness. Data were analysed using mixed-effects logistic regression to compute difference-in-differences and thematically organised. Results The PLA-MNH groups reached 96,476 people during the 11 meetings. Institutional delivery increased by 28.4% points in intervention compared to 4.0 in comparison areas. Child vaccination coverage rose by 21.3% points, ANC4 attendance by 10.4% points, and postnatal care improved significantly in the intervention communities. PLA enhanced community trust, enhanced health knowledge, stronger links with providers, and community ownership. Conclusion The PLA-MNH intervention significantly improved MNH service uptake and equity in underserved Ethiopian. The approach was feasible, trusted, effective and well-embedded with local PHC system to improve MNH.