AbstractObjectiveTo determine pregnancy, pregnancy loss and fertility rates in a rural community of Ethiopia.DesignA prospective population‐based pregnancy surveillance.SettingKersa Demographic Surveillance and Health Research Center, a demographic surveillance site in Eastern Ethiopia.PopulationFor pregnancy rates, the study included 7738 women of reproductive age permanently residing in the field research site. For pregnancy loss, 2072 pregnant women were included.MethodPregnancy screening was done every third month from 1 December 2009 to 30 November 2010 using a questionnaire and a urine pregnancy test. Descriptive analysis was done to calculate the pregnancy rate and pregnancy loss.Outcome measuresPregnancy rate and pregnancy loss.ResultThe pregnancy rate was 227/year/1000 women of reproductive age. During the study period, 1438 pregnancies ended, with 1295 live births and 143 pregnancies that did not yield a live birth (116 due to bleeding and 27 stillbirths). The incidence of pregnancy loss was 220/year/1000 pregnancies. Based on the one‐year data, the total fertility rate was found to be 5.52. The overall pregnancy loss and stillbirth ratio were 11 and 2.1/100 live births, respectively.ConclusionsThe study identified a high fertility rate that is probably accentuated by a high proportion of pregnancy loss in the study population. Improving access to family planning service to limit the number of pregnancies and access to antenatal care (to identify higher risk women) is essential.