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ANC counselling provides expectant mothers crucial information early in pregnancy on maintaining a healthy pregnancy and ensuring safe childbirth. Postnatal counselling covers topics such as exclusive breastfeeding, birth preparedness, and support for future pregnancy plans. This comprehensive approach of ANC counselling enhances the mother’s knowledge and awareness there by contributing to better health outcomes for both mothers and newborns. The aim of this study was to assess the adequacy and quality of provider counselling during antenatal care (ANC). The level of counselling in seven ANC topics revealed the adequacy of counselling and quality of counselling was assessed through agreement between observation and exit interview report. This study used the 2021-2022 Ethiopian service assessment survey. Descriptive statistical analysis was conducted for observed counselling and the agreement variables for all ANC topics. In addition, Cohen’s Kappa estimate was used to evaluate the level of agreement between observation and client report. Unadjusted and adjusted regression analysis were conducted to explore the relationships between the background variables (client, provider, facility characteristics) and observed counselling for three ANC topics (danger sign, nutrition, how to take iron pill). This study revealed that counselling levels on ANC topics were notably low, particularly concerning iron side effects (13.2%), family planning after delivery (5.4%), exclusive breastfeeding (4.1%) and early initiation of breastfeeding (2.6%). Additionally, the study uncovered inconsistency between observers' and clients' reports on counselled ANC topics. This was more evident at a case when a client reported that counselling was given even though the provider was not observed to give the counselling. A more interesting finding is the disagreement when a client reported that counselling has not occurred even if counselling was observed to be provided. This was more prominent for counselling in danger sign (18.7%) and nutrition (11.2%). Adjusted regression analysis revealed that client, provider, and facility factors as significant predictors for clients receiving counselling from healthcare provider. Not all clients received equal levels of counselling, and not all providers offered counselling to their clients. The type and location of the facility were significant predictors of whether providers delivered ANC counselling.