Introduction: In Ethiopia, few studies investigated  time dimension of maternal health continuum of care but lack data regarding place dimension and its effect on continuum of care. The aim of this study is to estimate effect of place of ANC-1 visit and adherence to MOH’s recommendations of MOH for ANC visits on continuum of care rural in Ethiopia.

Method: We used data collected from 1431 eligible women included in the National HEP assessment survey that covered 6364 households from 62 woredas in nine regions. Following descriptive analysis of the collected data, outcome variables were modelled using Propensity Score Matching, and Zero inflated Poisson regression.

Result: Only 13.9% of eligible women completed the continuum of care and place of first antenatal care (ANC) visit was not significantly associated with the completion of continuum of care (β=0.04, 95%CI= -0.02, 0.09). Adherence of ANC visit to the MOH recommendation (at least 4 ANC visits at higher HFs than HPs) increased the likelihood of higher intensity of continuum of care (aIRR=1.29, 95%CI: 1.26, 1.33). Moreover, the intensity of continuum of care was positively associated with being in agrarian areas (aIRR=1.17, 95%CI: 1.06, 1.29), exposed to HEP (IRR = 1.22, 95%CI: 1.16, 1.28), being informed about danger signs (aIRR=1.14, 95%CI: 1.11, 1.18) and delivery of 2nd youngest child at HF (IRR=1.16, 95%CI: 1.13, 1.20). Increasing age of women was negatively associated with use of services (IRR=0.90, 95%CI: 0.87,  0.94).

Conclusion: Completion of maternal health continuum of care is very low in Ethiopia, however most of the women use at least one of the services. Completion of continuum of care was not affected by place of first ANC visit. Adherence to MOH recommendation  of ANC visit increased the intensity of continuum of care. Intensity of continuum of care was positively associated with residing in agrarian areas, HEP exposure, danger sign told, delivery of 2^nd youngest child at health facility. To boost the uptake of all maternal health services, it is crucial to work on quality of health facilities, upgrading the infrastructures of HPs and promoting adherence to MOH recommendations of ANC visit.