Tilahun et al.

Archives of Public Health (2022) 80:27

[Link]

RESEARCH Open Access

Barriers and determinants of postpartum

family planning uptake among postpartum
women in Western Ethiopia: a facility-based
cross-sectional study
Temesgen Tilahun1* , Tariku Tesfaye Bekuma2, Motuma Getachew2, Rut Oljira2 and Assefa Seme3

Abstract
Background: Despite Ethiopia’s efforts to avail postpartum family planning (PPFP) services, the unmet need for
family planning among postpartum women remains high. Therefore, this study is aimed to assess barriers and
determinants of postpartum family-planning uptake among women visiting Maternal, Neonatal, and Child Health
(MNCH) services in public health facilities of western Ethiopia.
Methods: A facility-based cross-sectional study design with a quantitative method was conducted on 989
postpartum women in Western Ethiopia from September 1 to October 30, 2020. Data were collected through face-
to-face interviews using pretested structured questionnaires, entered using EPI-INFO version 7.0, and analyzed by
SPSS version 25. Descriptive analysis and logistic regressions were performed. The adjusted odds ratio with a 95%
confidence interval was used and statistical significance was declared at P-value < 0.05.
Result: In this study, 56.1% of participants had used PPFP in the last year. The most commonly used method was
injectable (51.7%). Family planning use before the index pregnancy (AOR = 2.09;95%CI:1.29,3,41),counselling on PPFP
during antenatal care and delivery (AOR = 4.89;95%CI:2.31,10.37),health facility delivery (AOR = 7.61;95%CI:4.36,13.28),
skilled birth attendance (AOR = 4.99;95%CI:2.88,8.64),COVID-19 restrictions (AOR = 0.59;95%CI:0.39,0.90) were factors
associated with PPFP utilization. Being breastfeeding and amenorrhea were major reasons for not using postpartum
family planning.
Conclusion: Post-partum family planning utilization among study participants was low. Given the associated
factors, it is recommended that health facilities should make postpartum family planning one of their top priorities
and focus on these factors to improve its utilization.
Keywords: Post-partum, Family planning, Barriers, Western Ethiopia

* Correspondence: ttamuko@[Link]
1
Department of Obstetrics & Gynecology, School of medicine, Institute of
Health Sciences, Wollega University, Nekemte, Ethiopia
Full list of author information is available at the end of the article

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Tilahun et al. Archives of Public Health (2022) 80:27 Page 2 of 11

Background affecting uptake being sociodemographic characteristics,

The postpartum period is a critical time to address the antenatal care (ANC) attendance, resumption to sexual
high unmet need of family planning and to reduce the activities, postnatal care (PNC) attendance, the return of
risks of closely spaced pregnancies [1]. Contraception is menses, and duration after delivery [3, 9–11]. These
particularly important during the postpartum period to studies tried to measure magnitude and factors that are
deter terrible maternal, neonatal, and child morbidity positively associated with PPFP uptake and, none of
and mortality. Since 2010, the World Health these studies so far have well-addressed barriers to PPFP
Organization (WHO) has been receiving an increasing uptake.
number of requests from country programs for strategies In general, studies in Ethiopia were conducted in
to create or strengthen voluntary family planning pro- towns and might not represent postpartum family plan-
grams for women in the first year after childbirth [2]. As ning uptake and possible associated factors in a rural
many as 50–90% of women from 17 low- and middle- community. Governmental attention, health facilities’
income countries (LMICs) report an unmet need for concerns, and readiness, and health professional factors
postpartum family planning (PPFP) [2]. Women fre- were not well investigated. Thus, the current study will
quently return to fertility before initiating contraception address associated factors of postpartum family planning
after delivery and do not necessarily understand the risk utilization in a rural part of Ethiopia.
of pregnancy before the return of menses [3]. WHO rec-
ommends PPFP as a critical component of health care Methods
that has the potential to meet women’s desire for contra- Study setting and design
ception and save millions of maternal and infant lives in A cross-sectional quantitative study design was con-
low- and middle-income countries [4]. ducted in Western Ethiopia (Western Oromia and
The uptake of postpartum family planning in sub- Benishangul Gumuz Regional State) public health
Saharan Africa remains low, especially with the lowest facilities from September 1 to October 30, 2020. From
use observed in East Africa which varied from 10.3% in Western Oromia, the zones included were East wollega,
Ethiopia to 73.7% in Uganda [5]. Perceptions of low Horroguduru wollega, and west Wollega. Benishangu
pregnancy risk due to breastfeeding and postpartum Gumuz Regional State is one of the 10 regional states in
amenorrhea, fear of method-related side effects, and Ethiopia. It is adjacent to the Western part of Oromia
poor family planning counseling were factors associated regional state. Assosa is the capital city of this region
with the low uptake of PPFP while women who received and is located 670 km from the west of Addis Ababa.
good PPFP counseling during antenatal and postnatal Assosa zone is included in this study. The study is con-
care were more likely to use PPFP [4, 5]. ducted in five hospitals and ten health centers in western
The Ethiopian Health Sector Development Program Oromia, and two hospitals and five health centers from
(HSDP) IV sets a goal of improving maternal health and Benishangu Gumuz Regional State.
increasing family planning coverage. However, the first
year after birth is given less emphasis regarding contra- Study design
ceptive utilization [6]. In Ethiopia, nearly half of all non- A cross-sectional study design with a quantitative
first pregnancies occur less than 24 months following method was conducted.
the preceding birth [7].
Studies have revealed that the first year following de- Source population
livery is so complex and different from other times in a The source population for this study was all postpartum
woman’s life cycle due to the additional burden to care mothers aged between 15 to 49 years who were living in
for her infant and the series of emotional and physical the catchment population of the study facilities.
changes [5–7].
The prevalence of contraceptive use among postpar- Study population
tum women varies from region to region in Ethiopia, as The study population was postpartum mothers who
most women do not start taking contraceptives at the have given birth in the last 12 months of the study
recommended time [7, 8]. Even those who use PPFP rely period and visiting the selected study hospitals and
on traditional, mainly lactational amenorrhea (LAM) health centers for any maternal, neonatal, and child
that might pose the risk of unintended pregnancy. health services.
Therefore, initiating appropriate contraception in the
postpartum period is important to avoid negative health Eligibility criteria
outcomes [8]. Inclusion criteria
Few studies conducted in Ethiopia indicated that PPFP Postpartum women who gave birth in the last 12
uptake is low with the most common determinants months.
Tilahun et al. Archives of Public Health (2022) 80:27 Page 3 of 11

Postpartum mother who gave her consent to the and well trained female BSC nurses,who were not work-
study. ing in the same facility/study area, for data collection.

Exclusion criteria Data processing and analysis

Postpartum mothers who were severely sick and unable The data were checked, entered, and cleaned using EPI-
to talk were excluded from the study. INFO version 7.0 and then exported to Statistical Pack-
age for Social Sciences (SPSS) software package version
Sample size determination 25 for analysis. Using the odds ratio (OR) with a 95%
The single population proportion formula was used to limit of the confidence interval, the association of
calculate the sample size with the following assumption. dependent and independent variables was identified, and
The proportion of postpartum women who utilized post- their degree of association was computed. Potential con-
partum family planning which was 48.11% was taken founding variables were controlled by using multiple lo-
[10]. The marginal error of 4%, design effect 1.5, and gistic regression.
95% confidence level. After adding a 10% non-response Descriptive statistics (like frequencies, percentages)
rate, the final sample size was 990. were used to describe the study population in relation to
dependent and independent variables. Results were pre-
sented in text, graph, charts, and tables.
Sampling techniques
In this study, the East Wollega zone, Horroguduru Wol-
Data quality control
lega, and West wollega zones were included from west-
The training was given for the data collectors and super-
ern Oromia while the Assosa zone was included from
visors on the objective of the study, how to conduct in-
Benishangul Gumuz. All types of hospitals and district-
terviews. The data collection was regularly monitored
level health centers that are currently providing postpar-
daily for completeness. Data collection was done in the
tum family planning services were considered in the
local language. Moreover, the field teams were provided
study. The total list of hospitals and health centers in
the necessary personal protective equipment during the
the study zones was obtained from zonal health depart-
training, pretest, and actual data collection. As a precau-
ments of the study zones. Then, the study hospitals and
tion for COVID-19, the study participants were also pro-
health centers were selected by simple random sampling.
vided face masks during the interview process.
The weekly average client load of the target age group in
the MNCH department of study health facilities was
Results
taken from registry books and the respective sample size
Socio-demographic characteristics of participants
for each selected health facility was allocated proportion-
In this study, 989 postpartum women were participated
ally to their MNCH department client flow. Finally, an
making a response rate of 99.89%. Six hundred thirty
eligible postpartum woman who had been selected by
(63.70%) and 359(36.30%) of participants were from
systematic random sampling was interviewed at an entry
Western Oromia and Beneshangul Gumuz Regional
point.
States respectively. Regarding the age group of partici-
pants, the result indicated that more than two-third, 649
Study variables (65.62%) were those aged between 20 to 29 years. The
Dependent variable majority, 599 (60.57%), of the participants were from
Postpartum family planning uptake. rural areas. Six hundred eight nine (69.7%) of the partici-
pants were Oromo (69.67%) followed by Amhara 151
Independent variables (15.3%)(Table 1).
socio-demographic characteristics, husband education
and occupation, obstetric factors, family planning related Reproductive characteristics of study participants
factors, breast feeding, facility readiness, place of deliv- In this study, the majority of study participants, 48.6%,
ery, and COVID-19 pandemic restrictions. were para 2 and 3. Most of the participants, 817 (82.6%),
had ANC follow-up for the index pregnancy. From
Data collection procedures these, more than half, 459 (56.18%) had at least four
Data were collected by 25 data collectors who know antenatal care visits. One hundred thirty-six (13.8%) of
Afan Oromo and Amharic. The quantitative data were study participants had a history of abortion. One hun-
collected through interviewer-administered interviews dred nine (11%) had ever encountered unintended preg-
using adopted questionnaires from reviewed literature nancy and 63 (6.40%) had a history of stillbirth. Three
on postpartum family planning [3, 10–25]. Inorder to fourth, 744(75.2), of the study participants, had attended
minimize potential bias, the authors used precise tools postnatal care. Among them, the majority 341(45.8%)
Tilahun et al. Archives of Public Health (2022) 80:27 Page 4 of 11

Table 1 Sociodemographic characteristics of study participants, Western Ethiopia, 2020

Characteristics Frequency Percentage
Region Oromia Regional State 630 63.7
Benshangul Gumuz Regional State 359 36.3
Age in years 15 to 19 36 3.6
20 to 24 235 23.7
25 to 29 414 41.8
30 to 34 209 21.1
> 35 95 9.6
Residence Urban 599 60.5
Rural 390 39.4
Religion Protestant 484 48.9
Orthodox 245 24.7
Muslim 234 23.6
Adventist 15 1.5
Catholic 6 0.6
Wakefata 5 0.5
Marital status Married 955 96.5
Never married 17 1.7
Others 17 1.7
Ethnicity Oromo 689 69.6
Amhara 151 15.2
Berta 95 9.6
Others 46 4.6
Participant education Cannot read and write 189 19.1
Can read and write 79 7.9
Grade 1–8 255 25.7
Grade 9–12 239 24.1
College & above 227 22.9
Participant occupation Farmer 376 38.0
Government employee 309 31.2
NGO employee 26 2.6
Merchant 81 8.1
Daily laborer 143 14.4
Student 25 2.5
Husband education Cannot read & write 110 2.5
Read & write 80 11.1
Grade 1 to 8 181 8.1
Grade 9 to12 245 18.3
College & above 344 24.7
Husband occupation Farmer 405 40.9
Government employee 309 31.2
NGO employee 26 2.6
Merchant 81 8.2
Daily laborer 143 14.4
Student 25 2.5
Tilahun et al. Archives of Public Health (2022) 80:27 Page 5 of 11

Table 2 Maternal health service utilization among study had attended postnatal care from 2 to 6 weeks. Two
participants, Western Ethiopia, 2020 hundred eight (37.6%) of participants attended postnatal
Variables Frequency Percent care before the end of one week. More than 99% of these
Parity women attended postnatal care at health facilities. Eight
1 277 28.0 hundred thirteen (82.2%) of the women are reported to
be currently breastfeeding (Table 2).
2 to 3 481 48.6
≥4 231 23.4
Family planning methods used before the index
Unintended pregnancy pregnancy
Yes 109 11.0 The participants were asked whether they had used any
No 880 89.0 methods of the family before index pregnancy and it
Abortion showed that the majority, 68.80%, of postpartum
mothers had used at least one method of family planning
Yes 136 13.8
methods before the index pregnancy. Injectable forms
No 853 86.20
and implants were the commonly used methods (Fig. 1).
ANC during the index pregnancy
Yes 817 82.6 Post-partum family planning use among study
No 172 17.4 participants
Place of delivery Five hundred thirteen (51.9%) of the study participants
didn’t discuss family planning with their husbands in the
Health Facility 808 81.7
last year. However, more than half the participants 555
Home 181 18.3
(56.1%) had used family planning in the last year. The
Postnatal care most common family planning methods used by partici-
Yes 744 75.2 pants were injectable form 287(51.7%) followed by im-
No 245 24.8 plants (24.5%) (Fig. 2).
Time of Postnatal care visit Among those who used the postpartum family plan-
ning method majority, 267(48.1%) started the family
Within the first week 280 37.6
planning method on the 45th day while those who
2 to 6 weeks 341 45.8
started within a week and between six weeks to six
> 6 weeks 123 16.5 months were 136(24.5%) and 91(16.4%) respectively. The
Currently breastfeeding main source of family planning method was health cen-
Yes 813 82.20 ter 409(73.7%) followed by hospital 94(16.9%).
No 176 17.80 Four hundred one (72.3%) of postpartum family plan-
ning users reported as they were using the method they

Fig. 1 Family planning utilization before the index pregnancy among study participants, Western Ethiopia, 2020
Tilahun et al. Archives of Public Health (2022) 80:27 Page 6 of 11

Fig. 2 Postpartum family planning utilization among study participants, Western Ethiopia, 2020

Table 3 PPFP uptake among study participants, Western Ethiopia, 2020

Characteristics Frequency Percentage
Received counseling on PPFP during ANC and delivery Yes 753 76.1
No 236 23.9
Previous history of PPFP uptake Yes 342 48.2
No 368 51.8
Currently using PPFP Yes 555 56.1
No 434 43.9
Time of initiation of PPFP uptake Within 24 h 30 5.4
Within a week 136 24.5
2 to 6 weeks 267 48.1
6 weeks to 6 months 91 16.4
After 6 months 21 5.5
Source of family planning Hospital 94 16.9
Health center 409 73.7
Health post 33 5.9
Private clinic 16 2.9
Pharmacy 3 0.5
Availability of the preferred method Yes 424 76.4
No 131 23.6
Reason for preference of the method Convenient to use 172 40.6
No need to remember 33 7.8
Advised by friends 39 9.2
Comfortable for health 180 42.5
Reason for using non-preferred methods Medical reason 78 59.5
Not available 53 40.5
Faced difficulty during COVID-19 restrictions Yes 345 34.8
No 644 65.2
Tilahun et al. Archives of Public Health (2022) 80:27 Page 7 of 11

preferred. The foremost mentioned reasons for prefer- the uptake of postpartum family planning services. After
ence of the methods were a convenience for use adjusting for confounding factors in the multivariate ana-
172(40.6%) and being comfortable to health 180(42.5%). lysis, factors that significantly associated with utilization of
On the other hand, the reasons mentioned by those par- postpartum family planning services were history of using
ticipants who were using the non-preferred method were family planning before the index pregnancy, previous his-
medical condition 78(59.5%) and lack of the preferred tory of postpartum family planning utilization, counseling
method in the health facility 58(40.5%). during delivery on postpartum family planning utilization,
Participants were asked if they did face difficulty acces- place of delivery, a skilled birth attendant at birth and
sing the family planning service during COVID-19 pan- COVID-19 restrictions. The number of parties and ANC
demics and one hundred fifty-seven (15.9%) responded attendance for the index pregnancy were not significantly
as they did. The most common stated difficulties we’re associated with the service utilization in this study.
unable to get transportation 100(63.7%) and absence of Participants who had been counseled during antenatal
health extension workers 68(43.31%) while fear of care and delivery about postpartum family planning were
acquiring coronavirus accounts for 19(12.1%) (Table 3). 4.89 times more likely to use the service compared to
Moreover, 434(43.9%) of the study participants didn’t their counterparts [AOR = 4.89 (2.31, 10.37)]. Postpar-
use any form of family planning method. A quarter of tum mothers who gave birth at the health facility were
them mentioned the reasons for not using were breast- more than 7,61 times likely to use the postpartum family
feeding 114(26.3%) and menses not yet resumed planning service compared to those delivered at home
109(25.1%) [Fig. 3]. [AOR = 7.61 (4.36, 13.28)]. It was also checked whether
a skilled birth attendant is associated with the service
Factors affecting uptake of postpartum family planning utilization and the multivariable logistic regression result
service utilization indicated that those mothers who were assisted by
In bivariate analysis, utilization of postpartum family plan- skilled birth attendants at birth were around 4.99 times
ning services was significantly associated with variables more likely to uptake the service compare to those
like great or equal to para two, history of using family assisted by non-skilled attendants [AOR = 4.99 (2.88,
planning before the index pregnancy, previous history of 8.64)]. Postpartum family planning utilization was also 2
postpartum family planning utilization, counseling given times higher among mothers who had used family
during antenatal follow-up, and delivery on postpartum planning before the index pregnancy [AOR = 2.09 (1.29,
family planning utilization, place of delivery, a skilled birth 3.41)].
attendant at birth, and ANC attendance for the index COVID-19 restrictions were checked whether it af-
pregnancy. However, currently living with husband, his- fected uptake of the service and the result indicated that
tory of abortion, history of unintended pregnancy, and those postpartum mothers who faced restrictions of
COVID-19 restrictions have no positive association with COVID-19 were by 39.5% less likely to use postpartum

Fig. 3 Reasons for not using family planning among study participants, Western Ethiopia, 2020
Tilahun et al. Archives of Public Health (2022) 80:27 Page 8 of 11

Table 4 Multivariable Logistic Regression of factors affecting PPFP uptake among study participants, Western Ethiopia, 2020
Variables PPFP utilization COR at 95% C. I AOR at 95% C. P-value
I
Yes No
Parity
1 219 (79.1%) 58 (20.9%) 0.24 (0.17, 0.34) 1.21 (0.80, 1.82) 0.36
2 to 3 231 (48%) 250 (52%) 0.22(0.15, 0.33) 1.18(0.71,1.73)
≥4 105 (45.5%) 126 (54.5%) 1
Family planning utilization before the index Pregnancy
Yes 491 (68.5%) 226 (31.5%) 7.06 (5.12, 9.74) 2.09 (1.29, 3.41) 0.03*
No 64 (23.5%) 208 (76.5%) 1
Previous history of PPFP utilization
Yes 277 (51.0%) 266 (49.0%) 1.90 (1.33, 2.73) 1.07 (0.55, 2.07) 0.89
No 59 (35.3%) 108 (64.7%) 1
Counseling on PPFP during ANC & delivery
Yes 447 (59.4%) 306 (40.6%) 1.73 (1.29, 2.32) 4.89 (2.31, 10.36) 0.00*
No 108 (45.8%) 128 (54.2%) 1
Place of delivery
Health facility 525 (65.0%) 283 (35.0%) 9.34 (6.15, 14.18) 7.61 (4.35, 13.28) 0.00*
Home 30 (16.6%) 151 (83.4%) 1
Skilled birth attendance
Yes 450 (53.5%) 391 (46.5%) 2.12 (1.45, 3.10) 4.99 (2.87, 8.63) 0.00*
No 105 (70.9%) 43 (29.1%) 1
Faced difficulty during COVID-19 restrictions
Yes 185 (53.6%) 160 (46.4%) 1.17 (0.9, 1.52) 0.59 (0.39, 0.9) 0.01*
No 370 (57.5%) 274 (42.5%) 1
ANC during the index pregnancy
Yes 430 (58.8%) 301 (41.2%) 1.52 (1.14, 2.02) 1.03 (0.65, 1.65) 0.89
No 125 (48.4%) 133 (51.6%) 1
*statistically significant

family planning services compared to those who did face finding is higher than studies conducted in Pakistan (24.6%)
restrictions [AOR = 0.59 (0.39, 0.90)] (Table 4). [26], Nigeria (40.6%) [14], Liberia(11.9%) [15], Uganda (28%)
[16], and Aroressa district in Southern Ethiopia (31.7%) [13].
Discussion However, postpartum family planning uptake in this study is
This study is aimed to assess barriers and determinants lower than studies conducted in Kenya (78.4%) [17], Debre
of postpartum family planning uptake among postpar- Tabor town in Ethiopia (63%) [18], and Hosanna town in
tum women in western Ethiopia. The study identified Ethiopia (73.9%) [12]. The low uptake in the current study
numerous factors that affect its uptake among postpar- might be explained by perceptions of low pregnancy risk due
tum women in western Ethiopia. to breastfeeding and postpartum amenorrhea.
Nearly all of the study participants, (98.5%), had heard In this study, the most common type of postpartum
of at least one method of family planning. This is similar family planning used by participants was injectable
to studies conducted in Hossana town, Southern (51.7%) followed by Implants (24.5%]. This finding is
Ethiopia (98.6%) [12], and Aroressa (99.7%) [13]. How- similar to different studies conducted in Aroressa district
ever, the finding of the current study is higher compared [13], Hossana town [12], Debretabor town [18], and the
to the study conducted in Bahirdar town, Northern Tigray region [34] in Ethiopia. This might be due to the
Ethiopia [11]. This discrepancy could have resulted from similarity of the socio-cultural status of the community
differences in the study setting and period. and user preferences. However, studies conducted in
In the current study, despite the high level of awareness, Pakistan [28], China [29], and Nigeria [21] showed con-
the uptake of postpartum family planning was 56.1%. This doms as the preferred method among study participants.
Tilahun et al. Archives of Public Health (2022) 80:27 Page 9 of 11

The difference might be due to the study setting, aware- compare to those assisted by non-skilled attendants.
ness of the women about specific methods, and method This is similar to the study conducted in Burundi and
mix strategies that different countries follow. Rwanda where skilled birth attendance significantly af-
In this study, 72.3% of study participants were using fected the utilization of PPFP [16]. This could be be-
the method they preferred. The most preferred method cause of the counseling health providers do during
of contraceptive was injectable (64.39%.). However, be- delivery.
cause of the lack of the preferred method and medical The current study is conducted in the era of the
contraindications, only 72.3% of study participants were COVID-19 pandemic where there are restrictions. The
using the method they preferred. In Iran, the most pre- result indicated that those participants who faced diffi-
ferred method of family planning was minipills (29.3%) culties during the COVID-19 pandemic were 39% less
[19]. the study conducted in Turkey [35%] [20] and likely to use postpartum family planning services com-
Rwanda (52%) [21], showed LARC methods as the most pared to those who did not face it. This is in line with
preferred method. The difference could be due to differ- the projection that some 47 million women in 114 low-
ences in the study setting and the strategies different and middle-income countries are to be unable to use
countries are following. modern contraceptives if the average lockdown, or
In this study, 45.9% of the study participant did not COVID-19-related disruption, continues for 6 months
start using any form of family planning methods. The with major disruptions to services [25]. The authors rec-
major reasons mentioned were being breastfeeding ommended the health sector design an effective option
(26.3%) and failure of menses to resume 109(25.1%). to maintain postpartum family planning services during
This could lead postpartum women to unintended preg- COVID-19 restrictions or related health crises.
nancies, abortions, and unplanned births [22]. Poor male In this study, it is revealed that there is no associ-
engagement could also contribute to low utilization. ation between ANC attendance and uptake of post-
Postpartum women experience amenorrhea for varying partum family planning. This is consistent with
lengths of time, and their fertility can return before another finding in which no difference in PPFP use
menses resume, even when breastfeeding [2]. Therefore, was observed between women who received PPFP
health professionals better deal with these misconcep- counseling only in ANC and women who did not
tions during counseling. Other studies in other countries receive counseling at all [24].
identified different reasons. For instance, desire for more
children and husband objection, and post-partum ab-
Strengths and limitations of this study
stinence followed by fear of side effects of the methods
This study is the first of its kind invoving two regions,
and being breastfeeding were the dominant reasons in
Oromia and Benshangul Gumuz regions, in western
Turkey [20] and Liberia [15]. These differences might be
Ethiopia. The relatively large sample size and high re-
explained by differences in the study setting, cultural dif-
sponse rate could make the findings generalisable to
ferences, and health policies.
postpartum women in western Ethiopia. However, it was
In the current study, participants who used family
not without limitations. First, given the cross-sectional
planning before the index pregnancy were twice more
design of the study, it was not possible to establish
likely to use postpartum family planning than their
cause-effect relationships of postpartum family planning
counterparts. This is similar to the conducted in Addis
uptake with independent variables. Second, partners
Ababa where women who had no history of contracep-
(husbands) and health care provider perspectives were
tive use before their last birth were 88% less likely to use
not addressed.
the family planning method during the postpartum
period compared to those who had [23]. Therefore, pro-
moting family planning utilization before pregnancy is Conclusion and recommendations
essential to improve postpartum utilization. Post-partum family planning utilization among study
Participants who received counseling on postpartum participants was low. Given the associated factors, it is
family planning during antenatal follow-up and delivery recommended that health facilities should make postpar-
were five times more likely to utilize the services com- tum family planning one of their top priorities and focus
pared to those with not counseled. This is similar to the on these factors to improve its utilization.
study conducted in Southern Ethiopia [24]. Therefore,
strengthening counseling on postpartum family planning Abbreviations
is important to promote its uptake. ANC: Antenatal care; AOR: adjusted odds ratio; COVID-19: corona virus
This study showed that those participants who were disease 19; HSDP: Health Sector Development Plan; IUCD: Intrauterine
Contraceptive Device; LAM: lactational amenorrhea; LMICs: low and middle-
assisted by skilled birth attendants at birth were 7 times income countries; OR: odds ratio; PNC: postnatal care; PPFP: Postpartum
more likely to utilize postpartum family planning Family Planning; WHO: World Health Organization
Tilahun et al. Archives of Public Health (2022) 80:27 Page 10 of 11

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1
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