Companionship care and associated factors among childbirth women in Ethiopia: a systematic review and meta-analysis

Introduction: Companionship-based care is essential for enhancing maternal and neonatal health services. Despite its importance, studies have shown inconsistent findings regarding the utilization of companionship during childbirth in developing countries, including Ethiopia. Objective: To evaluate the pooled utilization of companionship and identify the factors influencing this practice among women giving birth. Design: A systematic review and meta-analysis Data sources and methods: We conducted our review by searching common databases, including PubMed, Scopus, Wiley Online Library, ScienceDirect, and Epistemonikos, between February 1, 2025, and April 1, 2025. In addition, Google Scholar and unpublished theses from Ethiopian university research repositories were included. Data extraction was performed using an Excel data extraction form and subsequently imported into STATA version 11 for analysis. We employed forest plots, Cochran’s Q tests, subgroup analyses, sensitivity analyses, and meta-regression models to assess the heterogeneity among the included studies. Publication bias was evaluated through funnel plots and Egger’s regression tests. A random-effects model was used to estimate the pooled utilization of companionship. Results: From the 13 studies analyzed, which included a total of 8100 participants, we found that the utilization of companionship during childbirth was 28.86% (95% CI: 22.23, 35.48). Factors associated with higher utilization included the following: higher education level (prevalence and odds ratio (POR): 2.87, 95% CI: 1.81, 4.57), being primiparous (POR: 2.21, 95% CI: 1.82, 2.67), expressing a desire for companionship during delivery (POR: 2.77, 95% CI: 1.79, 4.28), having a history of obstetric complications (POR: 2.77, 95% CI: 1.79, 4.28), access to comfortable healthcare facilities (POR: 2.66, 95% CI: 1.97, 3.59), and possessing good knowledge about companionship care (POR: 2.35, 95% CI: 1.25, 4.41). Conclusion: The utilization of companionship during childbirth in Ethiopia remains low. The factors influencing this practice include higher education levels, being primiparous, the desire for a delivery companion, experiences of complications during pregnancy and labor, access to adequate healthcare facilities, and awareness of the benefits of having a birth companion. To improve this situation, healthcare management teams and providers should prioritize educating expectant mothers about the advantages of companionship during antenatal care. Trial registration: PROSPERO registration: CRD420251020204.