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Permission letters was obtained from Tigray regional health bureau to selected hospitals and health centers to undertake the study before the start of data collection. The aim and purpose of the study was explained to each study participants. Unique identification number was used to ensure confidentiality of individual client information. They were informed that data were not used for other purposes other than the objective of the study. After securing necessary permissions from two hospitals namely; Mekelle and Quiha and five health centers namely; Mekelle,Aynalem,Kasech, Adishumdhun and Lachi respectively. Written informed consent was obtained from all participants. Sixteen of the study participants were between the ages of 16 to 19. These women may be considered as minors and consent might have been required from their parents or legal guardians. However, these women are women who gave birth and visited health facility for maternal and child health services on their own decision. Thus, we considered these women as adult and took written consent from themselves. This approach is advised for postpartum women under 18 to secure their privacy.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Publisher\u2019s Note"}}],"article-number":"78"}}