Background <p>Access to quality postnatal care for newborns is crucial to eliminating preventable neonatal deaths. While some studies have examined contact coverage, there is limited evidence on effective (quality-adjusted) coverage. This study aimed to evaluate the gaps between contact and effective coverage, as well as discrepancies between reported newborn postnatal checks and the interventions received.</p> Methods <p>The data were obtained from the Ethiopian Mini-Demography and Health Survey 2019, and a weighted sample of 2,105 women aged 15 to 49 who had given birth within the two years prior to the survey was included. A multivariable regression analysis was performed to identify factors associated with contact coverage and effective coverage.</p> Results <p>Contact coverage of newborn postnatal care was 34.8%, while effective coverage was 10.4%. The study found that geographical region, antenatal care contact, and place of delivery were significantly associated with both contact and effective coverage. Additionally, household wealth status was significantly associated with contact coverage, while age and educational status were associated with effective coverage. The study also revealed a discrepancy between the reported postnatal checks and the actual interventions provided. The percentages of women who reported that a healthcare worker provided breastfeeding counseling, observed breastfeeding, checked the umbilical cord, measured temperature, and counseled on newborn danger signs but answered “no” to having a newborn postnatal check were 15.4%, 12.7%, 7.5%, 7.3%, and 6.6%, respectively.</p> Conclusions <p>This study identified a significant gap between contact and effective coverage, underscoring the need to strengthen access to quality care. Additionally, a notable discrepancy was found between reported postnatal checks and the actual care received, emphasizing the importance of strengthening data quality and validation mechanisms.</p>