The COVID-19 pandemic has had significant negative impacts on global healthcare systems, the world economy, and societal structures (1, 2). Measures such as nationwide lockdowns and fear of seeking healthcare have disrupted services, potentially affecting the well-being of mothers and their babies (3, 4). Maternal and child health services are facing considerable challenges as a result of the pandemic (5, 6). A study conducted in low and middle-income countries estimated that a modest decline of 10% in essential maternal and newborn healthcare coverage could lead to 28,000 maternal deaths due to the pandemic (7). This reduction in services, coupled with changes in healthcare-seeking behavior, has been linked to worsened maternal health outcomes, including an increase in maternal deaths, ectopic pregnancies, maternal depression, ruptured pregnancies, and stillbirths (8). Additionally, there is emerging evidence suggesting that fetal outcomes have also worsened, with higher rates of preterm birth and stillbirth observed during the COVID-19 pandemic (9, 10). The pandemic has therefore posed significant challenges to maternal and child health globally.

The COVID-19 pandemic has posed significant challenges for many countries in maintaining essential maternal, newborn, and child health services. Women may face difficulties accessing maternal healthcare due to issues such as transportation problems, restrictions, anxiety, and fear of potential exposure to the coronavirus (6, 11). A systematic review and meta-analysis have shown a significant decrease in the utilization of essential maternal healthcare services (12, 13). The diversion of resources towards the pandemic response has led to the disruption of basic maternal, newborn, and child health services, increasing the risks of maternal illness and death (14). This situation presents a further challenge in providing essential services throughout the entire maternity continuum of care while simultaneously dealing with COVID-19 (15). Recent evidence suggests that government measures implemented to combat COVID-19, such as stay-at-home guidance, women’s healthcare-seeking behavior, community perception, perceived poor quality of care during the pandemic, and fear of contracting the virus, have all influenced the maternity care provided to mothers during pregnancy, childbirth, and the postpartum period (11, 16). Ethiopia reported its first confirmed case of COVID-19 on March 13, 2020. Following the declaration of the pandemic, local mobility was restricted in Ethiopia, gatherings in all settings were prohibited, and individuals suspected of having acquired the virus were advised to report to the nearest health authority (17, 18). The ongoing pandemic has resulted in a range of mental and psychological problems for individuals, which can have negative effects on their self-care practices, appetite, sleep, immunity, and ability to follow healthcare guidelines. Anxiety, depression, panic attacks, and even psychotic symptoms have been frequently reported. These impacts have been particularly high among healthcare professionals and communities (19, 20). Despite the high costs associated with neglecting the mental health impact of disease outbreaks, it is often overlooked during pandemic management. Early evidence suggests that healthcare workers directly involved in treating COVID-19 patients are at risk of developing mental health symptoms (20). In Ethiopia, some research’s (21–23) were conducted to assess the impact of COVID-19 while the previous one never included the current impact and most were done immediately after the COVID-19 pandemic declared. The COVID-19 pandemic has created gaps in our knowledge about the impact on mental health and maternal health service. Understanding how lockdown measures affect maternal health services and mental health is crucial. Despite extensive literature on impact of COVID-19 on mental health during COVID-19, there is no systematic review focusing solely on perinatal women’s experiences and mental health during lockdown and after the lockdown. This understanding is essential for better support during and after the pandemic. We need to comprehend the effects of restrictions on women’s perinatal mental health to improve best practices in supporting them. To mitigate the maternal and mental health service after the pandemic pooled and synthesized evidences were highly crucial. In addition the health impact of COVID-19 in Ethiopia never synthesize with the current evidences. In Ethiopia, there is a lack of nationwide evidence on the impact of COVID-19 on individuals and healthcare services. Existing studies are fragmented and provide varying reports. To address this gap, a systematic review and meta-analysis were conducted to estimate the overall impact of COVID-19 on the health of individuals and healthcare services in Ethiopia.

The impact of COVID-19 on maternal health services has been assessed by examining the pooled prevalence of reductions in these services. The findings indicate that antenatal care (ANC), institutional delivery, postnatal care (PNC), safe abortion, and family planning have all been affected. Among these services, PNC, institutional delivery, family planning, and safe abortion have experienced the highest impact due to COVID-19. Specifically, in the country under study, COVID-19 has resulted in a 25% reduction (95%CI 8–83) in postnatal care services. Similarly, institutional delivery has seen a reduction of 16% (95%CI 10–26) compared to the pre-pandemic scenario. Safe abortion services have also been significantly affected, with a 14% reduction (95%CI 10–18) in Ethiopia. Furthermore, institutional delivery during the pandemic has experienced an 11% reduction in service utilization. These impacts of COVID-19 on maternal health services are summarized in Table 1. It is important to note that ANC services in Ethiopia have also been affected, with a 5% reduction attributed to COVID-19. These findings highlight the considerable impact of COVID-19 on maternal health services, emphasizing the need for appropriate measures to mitigate these effects and ensure the continued provision of essential care to pregnant individuals.

This study aimed to assess the impact of COVID-19 on mental health and maternal health services in Ethiopia. Our review explores the effects of COVID-19 on mental health and maternal health, as well as the factors associated with these impacts in Ethiopia. We found that the pandemic has significantly affected psychiatric outcomes and maternal health services, with a noticeable reduction compared to pre-pandemic times. The prevalence rates varied among different studies, which could be attributed to differences in measurement scales, reporting patterns, and cultural factors (25–27). Regional disparities were also observed in terms of the psychological well-being of the general public during the outbreak. These differences can be attributed to variations in the severity of the outbreak, the national economy, government preparedness, availability of medical resources, and the effective dissemination of COVID-related information. Furthermore, the stage of the outbreak in each region also influenced the psychological responses of the public. At the beginning of the outbreak, individuals faced challenges such as mandatory quarantine, unexpected unemployment, and uncertainty, which led to a higher prevalence of adverse psychological symptoms (27, 28). When evaluating the psychological impact of the coronavirus outbreak, it is crucial to consider the duration of psychiatric symptoms. Acute psychological responses to stressful or traumatic events can sometimes serve as protective mechanisms and have evolutionary significance (29).

This systematic review examined the impact of COVID-19 on anxiety in Ethiopia, drawing from 50 different articles. Out of these, 15 articles reported anxiety as a consequence of the pandemic in various regions of the country. The pooled prevalence of anxiety as a result of COVID-19 was found to be 40% (95% CI; 33–47). This finding is consistent with other systematic studies, which also reported anxiety as one of the impacts of COVID-19 (30, 31). The study highlights that the pandemic has led to an increase in anxiety among individuals, indicating a rise in mental health problems during this period (32). This implies mental health problem increase during the pandemic. The sub-group analysis revealed that healthcare workers experienced higher levels of anxiety compared to others, with a pooled prevalence of 46% (95% CI; 35–62). This suggests that the work environment has a significant influence on the mental impact of COVID-19 (33). Overall, this study underscores the need for mental health support and interventions for individuals and healthcare workers in particular, to mitigate the negative impact of COVID-19 on mental health.

In our systematic review and meta-analysis, we discovered a significant determinant that affects anxiety levels during the COVID-19 pandemic in Ethiopia. Specifically, we found that age and income play a crucial role in determining anxiety levels. Notably, individuals with lower income levels experienced a more pronounced impact on anxiety. This finding aligns with similar studies conducted in various regions around the world (34–36). It suggests that the COVID-19 pandemic has had a significant impact on resource-limited settings and individuals in third-world countries. Consequently, it is imperative to implement program interventions and economic support measures to effectively mitigate the effects of the pandemic. Numerous reports have indicated that individuals with poor economic status, lower education levels, and unemployment face significant risk factors for experiencing symptoms of mental disorders, particularly depressive symptoms, during the ongoing pandemic. The global outbreak of the coronavirus has necessitated strict stay-at-home orders and has caused a decline in the demand for services and goods, which has had a detrimental impact on local businesses and industries worldwide (37–40). The decrease in quality of life and the uncertainty resulting from financial hardships can further increase the vulnerability of individuals to developing adverse psychological symptoms (41).

The COVID-19 pandemic has had a significant impact on mental health, particularly in terms of depression. A systematic review was conducted, analyzing fifty primary articles from various regions. The pooled prevalence of depression was found to be 41% (95% CI: 34–50), with the highest prevalence observed in the Amhara region at 46% (95% CI: 31–69). These findings are consistent with other studies conducted worldwide (27, 30, 42–45), suggesting that depression may be one of the most common impacts of COVID-19 post-pandemic. The review also identified several sociodemographic factors that contribute to depression in the context of COVID-19. Being female, married, or living in prison were found to increase the likelihood of experiencing depression. Specifically, females were 2.25 times more likely to experience depression compared to males. This aligns with previous research (43, 44), which suggests that women may be more affected due to their higher representation in industries negatively impacted by the pandemic, such as retail, service, and healthcare. Additionally, women may exhibit differential neurobiological responses to stressors, potentially contributing to higher rates of mental disorders.

Living in prison was also found to significantly increase the risk of depression, with individuals in prison being 5.87 times more likely to experience depression compared to those living in their own homes. This finding is consistent with previous studies and highlights the need to consider the mental health implications for incarcerated individuals when designing programs and policies. Marital status was another factor identified in the review, with individuals who were married being 3.64 times more likely to experience depression compared to their counterparts. This finding aligns with previous research conducted in different parts of the world, emphasizing the importance of considering sociodemographic characteristics in program and policy design.

Furthermore, working in the emergency department was found to increase the impact of COVID-19 on mental health. Health workers in this setting were 2.17 times more likely to experience depression during the pandemic. This finding is consistent with previous studies and underscores the need to address the mental well-being of healthcare professionals in emergency settings.

Overall, this systematic review provides valuable insights into the impact of COVID-19 on depression and identifies various factors that contribute to its occurrence. These findings have important implications for the development of targeted interventions and policies aimed at mitigating the mental health effects of the pandemic.

Moreover, stress has been identified as one of the significant consequences of the COVID-19 pandemic in Ethiopia. A comprehensive analysis comprising 11 articles was conducted to evaluate the impact of COVID-19 in Ethiopia. The pooled analysis of this systematic review and meta-analysis revealed that the prevalence of stress was estimated to be 23% (95% confidence interval: 18–30). This finding aligns with previous studies (27, 44, 45) conducted in various regions across the globe, indicating a similar impact of the pandemic on stress levels. The impact of COVID-19 is not only evident in terms of physical health but also in psychological and maternal health services. A systematic review was conducted, analyzing seven articles from various regions of different countries. The findings revealed that in Ethiopia, the pooled prevalence of psychological impact due to COVID-19 was 41%. Furthermore, the subgroup analysis indicated that Oromia had the highest prevalence of psychological impact among the regions in the country. These findings were consistent with studies (44) conducted in other parts of the world, suggesting that COVID-19 significantly affects the mental well-being of individuals and communities. The systematic synthesis of evidence also explored the sociodemographic factors contributing to the psychological impact of COVID-19 in Ethiopia. The analysis identified that being female and lacking social support were significant factors. These findings align with studies conducted in different areas worldwide, highlighting the disruption of sociocultural bonds within communities caused by the pandemic. Therefore, it is crucial for pandemic control and impact mitigation strategies to consider the social structure and sociodemographic situation of the affected communities.

As the COVID-19 pandemic continues to affect individuals worldwide, those with pre-existing chronic conditions are particularly vulnerable and may experience heightened anxiety and distress. This is due to their compromised immunity, which makes them more susceptible to the virus and increases their risk of mortality. For example, patients with systemic lupus erythematosus may face significant health challenges in the face of COVID-19. Reports have also indicated that individuals with common chronic conditions such as diabetes, hypertension, and coronary heart disease may experience a higher death rate if infected with the virus. However, the exact causes of this phenomenon remain unknown, leaving those with these conditions feeling uncertain and afraid. In addition to the health risks posed by COVID-19, patients with pre-existing conditions may also face practical concerns such as postponement or inaccessibility of medical services and treatment. As COVID-19 affect patients, preventative care for other diseases may unintentionally, increasingly utilize hospitals and medical resources. Furthermore, individuals with a history of mental disorders or current diagnoses of psychiatric illnesses may be particularly sensitive to the external stressors associated with the pandemic, such as social isolation. It is important to recognize and address the unique challenges faced by individuals with pre-existing conditions during this difficult time (28, 46–48).

The maternal health services are also one of the services impacted by COVID-19 during the pandemic. The maternal health service reduction was observed in this systematic review. The maternal health services reduced due to COVID-19 were family planning, safe abortion, institutional delivery, PNC, and ANC. The comprehensive review highlights the significant decrease in healthcare utilization worldwide, emphasizing the need to prioritize addressing the unmet needs of individuals with non-COVID-19 illnesses. Primary studies consistently emphasize the importance of monitoring the long-term consequences of missed care, launching public campaigns to encourage timely medical attention, and enhancing preparedness to minimize future instances of missed care during subsequent waves of the pandemic. The urgent calls to action are further reinforced by evidence of excess population mortality, including deaths unrelated to COVID-19, as well as notable increases in out-of-hospital cardiac arrests and emergency phone line contacts (49, 50). On the other hand, the review also reveals that reductions in healthcare utilization were often more pronounced for less severe or milder conditions. This, combined with existing evidence on the issue of overmedicalization, suggests that for some individuals, missing care may not have resulted in harm (51, 52). This unprecedented natural experiment, induced by the pandemic and its impact on healthcare utilization, presents a valuable opportunity to gain insights into the services that populations and healthcare systems considered of lesser priority when reallocating resources to essential services was crucial for minimizing mortality during a crisis. As previously suggested, the significant decrease in non-urgent visits (53, 54) to emergency departments worldwide indicates an opportunity to develop and implement new strategies and care models that optimize the appropriateness of such visits in the future.

This systematic review focused on the impact of the COVID-19 pandemic on the psychological well-being of the general public. It highlighted the high prevalence of adverse psychiatric symptoms and emphasized the need to prioritize mental health alongside efforts to control the spread of the virus. The review also identified sociodemographic factors such as age, sex, low income level, marital status, and living conditions as significant predictors of mental health impacts.

Furthermore, the review highlighted the reduction in maternal health services in Ethiopia due to the pandemic. It stressed the importance of collecting high-quality data and conducting long-term cohort studies to better understand the ongoing changes in healthcare utilization and assess the impacts on health, costs, and equity. The experiences of individuals affected by the pandemic, particularly the most vulnerable populations, should be taken into account when designing interventions and providing support.

For program designers, the identified determinants should be considered to reduce the impact of COVID-19 in the country. The Ministry of Health in Ethiopia and the health sector should give great emphasis to individuals from low-income levels, females, and all other predictors identified in this systematic review and meta-analysis. Additionally, rigorous qualitative research should be conducted to understand people’s experiences of avoiding or missing healthcare and to assess professionals’ responses to changes in processes and practices. Unfortunately, no studies were found that specifically examined changes in the utilization of low-value healthcare services during the pandemic.

Overall, this systematic review provides essential baseline data for policymakers and program implementers, highlighting the urgent need to address the mental health challenges posed by the COVID-19 pandemic and to integrate viral risk mitigation with measures to support mental well-being.

This systematic review was conducted at the country level and yielded highly credible findings. To ensure comprehensive coverage, multiple databases were searched manually and electronically for articles suitable for meta-analysis. The information was uniformly abstracted using a predetermined and pretested standard format by two independent reviewers, which helped minimize errors. The meta-analysis included studies from various regions of the country, examining the impacts of COVID-19 during the pandemic, lockdown, and post-lockdown periods. This extensive review and meta-analysis encompassed the period from the onset of COVID-19 until the recent years of 2024, providing robust evidence for program development and policy-making.

Despite its strengths, the review had some potential limitations. Firstly, all the included studies were cross-sectional and written in English, limiting generalizability. Moreover, there was substantial heterogeneity among the studies. Additionally, since the studies relied on self-reported data, there is a possibility of overestimation or underestimation of the prevalence of COVID-19 due to social desirability bias.

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

MA: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. DG: Conceptualization, Formal analysis, Funding acquisition, Project administration, Resources, Software, Writing – original draft, Writing – review & editing. YN: Conceptualization, Formal analysis, Funding acquisition, Methodology, Writing – original draft, Writing – review & editing. AA: Formal analysis, Investigation, Methodology, Validation, Visualization, Writing – original draft, Writing – review & editing. GA: Formal analysis, Funding acquisition, Investigation, Methodology, Software, Visualization, Writing – original draft, Writing – review & editing.