Pharmacological and Non Pharmacological Labor Pain Management among Licensed Obstetric Care Providers in Ethiopia: Practice Patterns and Predictors from a Systematic Review and Meta-Analysis

<title>Abstract</title> <p>Background Labor pain is a distinctive physiological and psychological experience requiring effective management to ensure respectful maternity care. Global guidelines recommend both labor pain management approaches, yet implementation in Ethiopia remains inconsistent. This review assessed the pooled prevalence and predictors of labor pain management practices (LPMPs) among licensed obstetric care providers (OCPs). Methods A comprehensive search was conducted across major databases and institutional repositories for studies published between 2018 and 2025. Critical appraisal used the Joanna Briggs Institute checklist and the modified Newcastle–Ottawa Scale. Meta‑analysis was performed in STATA 17, with heterogeneity assessed using Cochran’s Q and I². Pooled adjusted odds ratios (AORs) with 95% CI were calculated, and certainty of evidence rated using GRADE. Results Twenty studies were included, comprising 5,272 participants for non‑pharmacological LPMP (N‑PLPMP) and 3,586 for pharmacological LPMP (P‑PLPMP). The pooled prevalence of N‑PLPMP was 42.8%, whereas P‑PLPMP was 21.1%, decreasing to 15.2% after adjustment for publication bias. Knowledge, favorable attitudes, supportive environments, and managment protocol availability were consistently associated with N‑PLPMP. Certainty of evidence was moderate for N‑PLPMP and low for P‑PLPMP. Conclusions Both P&amp;NPLPMPs remain suboptimal. Adoption of standardized protocols, strengthened training, and systemic support is essential to advance evidence‑based intrapartum care.</p>