Immediate postpartum long acting reversible contraceptive uptake and associated factors at Asella Referral and Teaching Hospital, Ethiopia

Utilizing postpartum long acting reversible contraceptive (LARC) is a key tactic for reducing unwanted pregnancies and increasing birth spacing. The immediate postpartum period is an ideal time to offer LARC methods, as their provision during this period is both safe and effective. Despite these benefits, LARC utilization remains low in Ethiopia. This study aimed to determine the prevalence of immediate postpartum LARC uptake and identify factors associated with its use at Assela Referral and Teaching Hospital (ARTH), Ethiopia. A cross-sectional study was conducted through exit interviews with postpartum mothers in the postnatal and post-operative wards of ARTH from August 1 to October 30, 2024. Participants were selected using systematic random sampling from sampling frame. Data were collected via face-to-face interviews using a pretested structured questionnaire administered by trained data collectors with the Kobo Collect tool. The data were then exported to Statistical Package for the Social Sciences (SPSS) version 26 for analysis. Categorical variables were summarized using frequencies and percentages, while means and standard deviations described continuous variables. Descriptive statistics, bivariable, and multivariable binary logistic regression analyses were performed, with statistical significance set at a p-value of less than 0.05. Out of the targeted sample, 317 respondents completed the study, yielding a response rate of 99.06%. The Magnitude of immediate postpartum LARC uptake was 35.3% (95% CI: 30.3–40.7). The most frequently used postpartum LARC method was Nexplanon (80.4%), followed by Cooper intrauterine devices (IUDs) at 14.3%. Factors such as having ≥ 4 children (AOR = 2.31; 95% CI: 1.01–6.28; p = 0.041), cesarean delivery (AOR: 2.14, 95% CI: 1.19–6.72, P = 0.032), heard about LARC (AOR = 2.44; 95% CI: 1.43–6.05; p = 0.033, previous LARC use (AOR = 5.04; 95% CI: 1.56–9.08; p = 0.023), counseling about contraceptives use (AOR = 3.51; 95% CI: 1.45–8.83; p = 0.041), and discussions with partners about contraceptives (AOR = 4.03; 95% CI: 2.05–9.41; p = 0.024) were significantly associated with LARC utilization during immediate post-partal period. This study found that approximately one in three women delivering at Asella Referral and Teaching Hospital initiated immediate postpartum long-acting reversible contraceptives (IPPLARC). Factors significantly associated with uptake included having ≥ four children, cesarean delivery, prior awareness and use of LARC, contraceptive counseling, and Male partner involvement in LARC discussions. To improve uptake, health policymakers and hospital administrators should integrate structured contraceptive counselling into routine maternal care, particularly during antenatal care and both cesarean and vaginal deliveries. Health professionals should actively involve male partners and implement targeted awareness campaigns to address misconceptions, especially regarding IUCDs. Context-specific strategies like these can enhance informed decision-making and contribute to higher and more balanced utilization of postpartum LARC.