The postpartum period is the most crucial phase for both the life of the mother and her newborn babies. Even though a large proportion of maternal and neonatal deaths occur during the first two days after delivery, this is the most neglected period for the provision of quality care especially in low-resource setting countries including Ethiopia [
1,
2]. Anemia is a condition in which the number of red blood cells or hemoglobin concentration within them is lower than the normal cut-off values, for this reason impairing the blood’s ability to transport oxygen to meet physiological needs. It is an indicator of both poor nutrition, and poor health, having a significant consequences for the women and their children [
3,
4]. Even though there is no consensus on the definition of postpartum anemia, it can be inferred from the definitions provided by different scholars depending on the duration of the postpartum period. Thus it can be defined as hemoglobin levels less than 10 g/dl, less than 11 g/dl, and less than 12 g/dl cut-off values within the first 48 h after delivery, at one week, and six weeks postpartum period respectively [
5‐
7]. Similarly, immediate postpartum anemia can be defined as hemoglobin level less than the cut-off values of 10 g/dl within the first 48 h after a woman gave childbirth [
8‐
10]. Even though progress has been made decreasing in maternal mortality and morbidity in many countries in the world; there is still evidence of no change or a continuous increment in the indirect causes of maternal mortality [
11‐
13]. Globally around 35% of all maternal deaths are attributable to indirect causes of maternal mortality; of which around 7% are due to anemia and anemia also contributed to 2.3% of maternal deaths among all causes [
14,
15]. The direct and indirect contribution of anemia to maternal death or near- miss has been demonstrated in countries with low resource setting [
16,
17] In addition to this, a severe form of postpartum anemia increases maternal death, and postpartum infection by threefold during the postpartum period [
18,
19]. Another evidence revealed that a severe form of anemia in the postpartum period increases maternal death by twofold compared with non-anemic women [
20]. Globally an estimated 500,000 maternal deaths occurred annually related to pregnancy, labor, and delivery; of which around 20% were due to postpartum anemia [
21,
22]. In our country Ethiopia, postpartum anemia is one of the leading indirect causes of maternal mortality. As evidenced by the Ethiopian Demography and Health Survey (EDHS 2016) postpartum anemia contributed to maternal mortality [
23]. Anemia in the immediate postpartum period is also strongly associated with poor quality of life, increased maternal infection, fatigue, reduced cognitive ability, and postpartum depression later on. The outcome of these may in turn affect or slow down the infant’s development [
24‐
26]. The magnitude of immediate postpartum anemia particularly two days after childbirth was relatively low in the developed world and varies from 10 to 30%: However, in low and middle-income countries it was as high as from 50–80% [
24]. Varies of studies were conducted across the world regarding with immediate postpartum anemia. A study done in Madrid Spain to determine anemia among women after childbirth shows that the overall magnitude of immediate postpartum anemia on the second day after delivery was 29%, of which 5% were classified as severe anemia [
9]. Similar studies conducted in Germany to determine early postpartum anemia shows 22% [
27], Kasturba Medical College in India 26.5% [
28], and Pakistan 47% [
29] of women were anemic.
Another study done in China revealed that the overall incidence of anemia among immediate postpartum women was 57% [
30]. Sub-Saharan Africa and Southeast Asia have one of the highest prevalence of anemia in the immediate postpartum period. A study conducted in Nigeria to determine the magnitude of immediate postpartum anemia shows that the overall magnitude of anemia immediately after 48 h of delivery was 46% [
25]. In Ethiopia contradicting the anemia reduction plan 2020; the magnitude of postpartum anemia among postnatal women increased from 18% in 2011 to 28% in 2016 [
23,
31]. The Ethiopian government launched an anemia reduction plan (below 12% by the end of 2025) and different strategies to reduce anemia among reproductive-age women while it is still a public health problem and unlikely to achieve the national targets [
32]. This is due to poor health service utilization, low socio-economic status of women, low adherence to iron and folic acid supplementation during pregnancy, and blood loss due to bleeding during childbirth [
33,
34].
The studies conducted around the world revealed that there are so many multiple and interlinked factors identified like poor quality health care services, poverty, low iron supplementation, inadequate micronutrient intake, nutritional deficiencies, and high infectious disease in developing countries attributed to the presence of higher rates of immediate postpartum anemia compared with developed countries [
35‐
37]. Moreover, factors like maternal age, low educational status of the mother, rural residence, ante-natal care follow-up (ANC) [
38], cesarean mode of delivery, anemia during pregnancy, antepartum hemorrhage (APH), postpartum hemorrhage (PPH) and malaria infection were factors associated with the immediate postpartum anemia [
25,
29,
39‐
41].
In Ethiopia, some studies are conducted to assess the magnitude and determinant factors of immediate postpartum anemia among women during the immediate postpartum period [
42‐
44]. However, these separate studies reported the magnitude of immediate postpartum anemia among immediate postpartum women in Ethiopia ranged from 21.6% study conducted at the east Gojam zone [
42] to 41.4% study conducted at Shewarobit health facilities, North Shewa. These showed that there was considerable variation and uncertainty related to the magnitude of immediate postpartum anemia and its associated factors among women who gave birth across the nation. Therefore, our study aimed to determine the pooled magnitude and associated factors of immediate postpartum anemia among women who give birth in Ethiopia to provide evidence-based information for policymakers and stakeholders to design and implement evidence-based interventions to avert anemia morbidity and associated mortality among immediate postpartum women in Ethiopia.