Background <p>Nowadays globally a woman dies every two minutes, and a neonate dies even in every 12&#xa0;s, and more than two-thirds of these maternal deaths are preventable. Preconception care is a continuum of maternity care which is one of the proven strategies to reduce not only maternal mortality and morbidity but also neonatal mortality and morbidity by improving women’s health. Therefore, this study aimed to assess the pooled magnitude of preconception care utilization and its associated factors among women in Ethiopia.</p> Methods <p>Searching of studies done through PubMed, Medline, Embase, Cochrane Library, List of References, and Google Scholar. Duplication of records was removed through the Endnote software manager. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) godliness was adhered to. A Newcastle- Ottawa Scale (NOS) assessment tool was used to evaluate the quality of studies. Analysis was performed using a random effect model with STATA 17 version software. Egger’s weighted regression and I² test were used to evaluate publication bias and heterogeneity respectively.</p> Results <p>In this systematic review and meta-analysis, a total of 6,808 women from 14 primary studies were included. The overall pooled magnitude of preconception care utilization in Ethiopia was 26% (95% CI: 18, 34). Educational status (OR = 2.18, 95%CI 1.54, 2.82), adequate knowledge of women regarding preconception care (OR = 2.69, 95%CI 1.90, 3.48), pre-existing medical illness (OR = 4.79, 95%CI 2.61, 6.06), history of adverse pregnancy outcome (OR = 3.18, 95%CI 2.74, 3.62), and husband /partner support (OR = 3.26, 95%CI 1.55, 4.97) were the identified predictors of utilization of preconception care.</p> Conclusion <p>The overall magnitude of preconception care utilization among Ethiopian women was significantly low. Educational status of women, knowledge of women regarding Preconception care, history of adverse birth outcome, pre-existing chronic medical illness, and either psychological or financial husband support were the identified predictors of preconception care utilization. Thus, healthcare organizations should work on strategies to improve the utilization of preconception care. Moreover, advocating for better women’s education, awareness creation, and encouraging male involvement is very essential to optimize service utilization.</p> Prospero registration <p>CRD42023492995 registered on 23/12/2023.</p>