Conventionally used coverage measures do not reflect the quality of care. Effective coverage assesses the extent to which health care services deliver potential health gains to the population by integrating concepts of utilization, need, and quality. We aimed to conduct a systematic review of studies evaluating effective coverage of maternal and child health services, quality measurement strategies, and disparities across wealth quantiles. A systematic search was performed in six electronic databases (MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and Maternity and Infant Care) and grey literature. We also undertook a hand search of references. We developed search terms having no restrictions based on publication period, country, or language. We included studies, which reported effective coverage estimates based on the World Health Organization framework of measuring effective coverage. Twenty-seven studies, all from low and middle-income settings (49 countries), met the criteria and were included in the narrative synthesis of the results. Maternal and child health intervention(s) and program(s) were assessed either at an individual level or as an aggregated measure of health system performance, or both. The effective coverage ranged from 0% for postpartum care to 95% for breastfeeding. When crude coverage measures were adjusted to account for the quality of care, the effective coverage values turned lower. The gap between crude coverage and effective coverage was as high as 86%, and it signified a low quality of care. The assessment of quality of care addressed structural, process, and outcome domains, individually or combined. The wealthiest 20% had higher effective coverage of services than the poorest 20%, an inequitable distribution of coverage. More efforts are needed to improve the quality of maternal and child health services and to eliminate the disparities. Moreover, considering multiple dimensions of quality and the use of standard measurements are recommended to monitor coverage effectively.

Maternal and child mortality remain unacceptably high in the Sustainable Development Goals era. Continuum of care has become a key strategy for improving the health of mothers and newborns. Previous research on the continuum of care in Ethiopia is often limited to maternal health services. Maternal and child health services are inseparably linked, and an integrated approach to care is essential. This study assessed the continuum of maternal, newborn, and child health care and associated factors in Ethiopia. The analysis was based on the 2016 Ethiopian Demographic and Health Survey data. We restricted our analysis to women with their most recent children—alive and living with their mother- aged 12–23 months at the time of the survey (n  =  1891). The modified composite coverage index, constructed from twelve maternal and child health services, was calculated as an indicator of the continuum of care. Bivariable and multivariable quantile regression were used to analyse the relationship between the predictors and specific quantiles of the composite coverage index. The effect of each variable was examined at the 10th, 25th, 50th, 75th, and 95th quantiles. The results showed that the average composite coverage index value was 39%. The overall completion rate of the continuum of care was low (2%). Four % of the women did not receive any of the services along the continuum of care. Postnatal care for newborns had the lowest coverage (12%). This study provides evidence that factors such as the educational status of women, region, residence, socio-economic status, perceived distance to a health facility, pregnancy intention, mode of delivery, parity, and early antenatal care initiation influence the continuum of care differently across levels of the composite coverage index. The findings call for integrated and targeted strategies that aim to improve the continuum of care considering the determinants.