Abstract
Achieving equitable health and meeting the sustainable development goals commitment of "leaving no woman behind" requires high-quality antenatal care that ensures a positive pregnancy experience. However, limited studies have assessed the quality of antenatal care using the WHO's quality of care framework, encompassing both experience of care and structural dimensions. This cross-sectional study, conducted from September 1 to October 2, 2020, in the Western Hararghe Zone, Ethiopia, examined the quality of antenatal care among 340 participants selected through multistage stratified sampling. Data were analysed using descriptive statistics and binary logistic regression in SPSS version 27, with significance set at p < 0.05. Results showed that 51.5% [95% CI 46.6-56.8%] of women received quality antenatal care. The domains of effective communication had relatively low quality followed by supportive care then respect, and dignity. The quality of antenatal care was found to be 65.9% and 37.1% in private and public health facilities respectively. Public facilities lacked essential diagnostic equipment, particularly ultrasound. Factors associated with poor antenatal care quality are rural residency, low income, unplanned pregnancies, and public health facilities. Addressing inequities in experience of care coupled with structural attributes is crucial for improving the quality of antenatal care.