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The overall pooled prevalence of adverse fetal outcomes in Ethiopia was 26.88% (95% CI; 20.73-33.04). Low birth weight 10.06% (95% CI; 7.21-12.91) and prematurity 8.76% (95% CI; 5.4-12.11) were the most common adverse birth outcome at the national level. Rural in residency (AOR = 2.31; 95% CI 1.64-3.24), lack of antenatal care follow up (AOR = 3.84; 95% CI 2.76-5.35), pregnancy-induced hypertension (AOR = 7.27; 95% CI 3.95-13.39), advanced maternal age ≥ 35(AOR = 2.72; 95% CI 1.62-4.58, and having current complication of preg