Women’s postpartum family planning use and intention in Ethiopia: Disparities in the agrarian and pastoral contexts from a community-based cross-sectional study

Despite the substantial improvement on maternal health service use and impactful intervention to reduce the risk of maternal and child deaths, uptake of Postpartum Family Planning (PPFP) has remain a critical gap in Ethiopia. There is a paucity of context-based evidence is crucial in addressing these gaps to inform policies. We assessed women's current use and intention on postpartum contraception in the agrarian and pastoral contexts of Ethiopia. A community-based house-to-house survey was conducted in ten selected Woredas from the agrarian and pastoral contexts of Ethiopia, for baseline assessment to design a community-based lifesaving package delivery model. Data were collected among randomly selected 3,097 women using structured web-based tool and analyzed using Stata/SE 18.0. A multi-level mixed-effect logistic regression was used to identify factors associated with women's current PPFP use and intention for future use in the agrarian and pastoral contexts. Only a quarter of women (25.3%, 95%CI:23.8%-26.9%) used PPFP with significant variations in agrarian (60.6%) and pastoral (0.9%) contexts. More than one-third (37.5%, 95%CI:35.8-39.2%) of women had the intention to use modern PPFP. Factors influenced both current and future PPFP use include women's antenatal care visits (AOR:3.46; 95%CI:2.25-5.32), strong social support (AOR:1.75; 95%CI:1.23-2.49), autonomy on FP use (AOR:3.25; 95%CI:1.89-5.59), and favorable attitude towards equitable gender norms (AOR:1.51; 95%CI:1.12-1.71). Nevertheless, women who had no access to health facilities (AOR:0.70; 95%CI:0.49-0.99), history of home birth (AOR:0.53; 95%CI:0.39-0.72), being from pastoral communities (AOR:0.03; 95%CI:0.01-0.06), and Muslim women (AOR:0.29; 95%CI:0.19-0.46) were less likely to current PPFP use and intention to use contraception. Women's current use and intention to modern PPFP was found to be low with significant disparities between agrarian and pastoralist communities. Improving antenatal care, social support, women's autonomy and transforming gender equitable-norms are crucial facilitators for PPFP use. Culturally-tailored interventions are required to promote women's autonomy to enhance use of PPFP.