Client satisfaction with antenatal care and associated factors among pregnant women attending three teaching hospitals in Addis Ababa, Ethiopia: a cross-sectional study

Abstract Background Antenatal care gives pregnant women a structured point of contact with the health system, and client satisfaction is a key measure of whether that contact is working. Satisfied women are more likely to keep visits, follow advice, deliver in a facility, and recommend the service. Evidence from Addis Ababa teaching hospitals, which differ from primary-level facilities in caseload and case mix, remains limited. This study assessed satisfaction with antenatal care and its associated factors among pregnant women at three teaching hospitals in Addis Ababa. Methods A facility-based cross-sectional study included 325 pregnant women at Tikur Anbessa Specialized Hospital, Zewditu Memorial Hospital, and Gandhi Memorial Hospital (December 2024-February 2025), selected by systematic random sampling proportional to each hospital's caseload. Data were collected by interviewer-administered questionnaires adapted from the WHO Maternal Satisfaction on Health Care (Part IV) tool and analysed in SPSS version 26. Satisfaction, measured on 12 Likert-scale items, was dichotomised using a demarcation threshold. Binary logistic regression screened variables at p < 0.2 for a multivariable model; associations are reported as adjusted odds ratios (AOR) with 95% CI, significance at p < 0.05. Results Overall, 177/325 women (54.6%) were satisfied, below the WHO benchmark of 80–90%. Satisfaction was lowest for waiting time (51.1%) and latrine/water adequacy (56.3%), and highest for cost fairness (96.6%). Women on their first antenatal visit were more likely to be satisfied than those on repeat visits (AOR = 3.55, 95% CI 1.49–8.42); women with an abortion history were less likely to be satisfied (AOR = 0.28, 95% CI 0.16–0.51); and higher-income women were more likely to be satisfied (AOR = 2.57, 95% CI 1.35–4.88). Conclusions Just over half of participants were satisfied with antenatal care, well below the WHO benchmark. Long waiting times and inadequate sanitation drove dissatisfaction, while abortion history, income, and visit number were independently associated with satisfaction. Expanding outpatient capacity and staffing, improving latrine and water provision, and keeping counselling substantive at every visit could narrow this gap.