Community education and demand generation activities by involving family members, traditional and religious leaders in maternal health behaviours are potential solutions. Knowledge about maternal and neonatal health service utilization can be increased through community-based structures, such as religious organizations.

Religious and faith community health promotions have the ability to reduce health inequities, and religious institutions are among the most respected and trustworthy institutions that can considerably boost public health work. Similarly, Faith leaders, in addition to physicians and health care providers, are another category of people who have a big impact on other people's beliefs, feelings, and behaviors, according to research. Spiritual leaders have the ability to impact health behavior on a variety of levels, from personal to ecological, with "knock-on" implications on community health. This is achieved via health education and health promoting strategies. Furthermore, the influence of faith leaders on health behavior is in line with the tenets of the Ottawa Charter for Health Promotion since they are perceived as strengthening community action. That is, communities must be empowered to participate in and govern their own affairs. A faith leader is in a unique position to encourage behavior change since he or she is a vital component of the community. According to an evaluation of programs involving faith-based organizations, clergy were able to considerably aid behaviour change, particularly among hard-to-reach populations. Other studies have also identified the importance of faith leader's influence on health behavior. Similarly, faith leaders influence on behavior has been attributed to Scripture-based passages that espouse the virtues of healthy living. Although some studies have suggested that spiritual leaders play a role in influencing congregants' health behaviors, little information on the amount of this influence and the mechanisms involved available.

In Ethiopia, the majority of the population belongs to a religious group, and religion is an important part of society. Through places of worship, religious institutions have access to a large portion of the population. Religious leaders serve as community leaders as well as gatekeepers of information and access to the population and can help raise awareness about underutilized maternal and neonatal health services. Therefore this cluster-randomized trial is designed to evaluate the effects of trained religious leaders' engagement in maternal health education in improving maternal health service utilization and knowledge of major obstetric danger signs.

Inclusion Criteria:

• Pregnant women less than 20 weeks gestational age
• Living in selected kebele (small administrative unit in Ethiopia)
• Pregnant women willing to participate in the study

Exclusion Criteria:

• Pregnant women who are seriously ill and unable to communicate will be excluded from the study.

Baseline characteristics, outcome measure and statistical analysis

The intervention will be single-blinded. The outcome assessors will be masked.