To improve the health outcomes of its citizens, Ethiopia must take steps to meet SDG3.4 and decrease the number of premature deaths caused by non-communicable diseases (NCDs). NCD deaths are preventable by tackling their risk factors: unhealthy diets, physical inactivity, and air pollution. These risk factors are becoming increasingly prevalent in urban sites and have their origins in fetal life, and focusing prevention policies on pregnancy can yield significant benefits. Pregnancy is a unique opportunity for lifestyle interventions and antenatal care (ANC) has long been a key strategy for health promotion, disease prevention, early diagnosis, and treatment. The high ANC coverage in urban Ethiopia makes it an ideal program to support access and utilization of quality NCD services for prevention and risk reduction in urban populations. Guided by the immediate need for high-quality implementation research and evaluations in real-word settings to tackle the multisectoral and complex challenges of NCD prevention, we will fill the implementation knowledge gaps by developing, implementing, and assessing the impact of a novel prevention program in four diverse urban sites. We will apply user-centered approaches to adapt effective evidence-based WHO guidelines and implementation strategies with beneficiaries and stakeholders. Our approach for achieving behavior change in pregnant women is twofold: i) thorough assessments of women’s environments and environmental risks, as wider determinants of health; ii) integration of implementation strategies into the National Health Information system of Ethiopia. We will provide real-word evidence for the impact of implementation for behavior change, NCD risk reduction and better maternal and child health. ENABLE will support care providers for continuity and quality of overall healthcare and of NCD care and surveillance, and ultimately strengthen the Ethiopian public health system towards better health for all.