Immediate Postpartum Family Planning Utilization and Associated Factors Among Postpartum Women at Public Hospitals in Addis Ababa,Ethiopia

Abstract

Introduction

Immediate postpartum family planning refers to the provision of family planning counseling and contraception methods to a woman within the first 48 hours after childbirth. This provision of family planning fills gaps in terms of Knowledge (limited evidence on overall IPPFP utilization beyond single methods inadequate data on how women’s empowerment, partner involvement and counseling quality jointly influence IPPFP utilization), practice (poor understanding of health facility- and provider-related barriers such as;- counseling practices, staff training, method availability and documentation), Methodologically, the study generates, the current status of IPPFP utilization, and identify the barriers of IPPFP utilization.

Methods

An institution-based cross-sectional study was conducted at public hospitals in Addis, Ababa, from February to March 2025 with a total of 442 study participants. Systematic random sampling technique was used to select the study participants. Pretested, structured interviewer-administered questionnaire was used to collect the data. Collected data were entered into Epi-data version 3.1 and analyzed using the Statistical Package for the Social Sciences (SPSS). Bi-variable logistic regression analysis was carried out and Statistical significance was declared at a p value <0.05 with a 95% confidence interval.

Results

The prevalence of immediate postpartum family planning utilization was 17.5% (95% CI: 14.3–21.5). Factors significantly associated with IPPFP utilization included good knowledge (AOR = 4.8; 95% CI: 1.73–13.3), receiving postnatal counseling (AOR = 2.11; 95% CI: 1.07–4.17), awareness of contraceptive contraindications (AOR = 2.82; 95% CI: 1.02–3.23), and having 2–4 living children (AOR = 2.7; 95% CI: 1.35–5.40).

Conclusions

IPPFP utilization was low compared to the national target (40%). Key factors influencing utilization included knowledge, postnatal counseling, awareness of contraindications, and parity. Strengthening counseling before discharge, improving community awareness, and ensuring providers consistently offer IPPFP to all eligible women are recommended to enhance utilization.

Keywords

Addis Ababa associated factors family planning immediate post-partum women

1. Introduction

IPPFP is the practice of offering family planning (FP) services and counseling to women within 48 hours of birth (Emmerance et al., 2024; Silesh et al., 2023). This practice plays a vital role in improving the health and well-being of both mothers and their children. Family planning is known as a key life-saving intervention for mothers and their children (Demissie, 2021). The core components of IPPFP include methods (implants, injectable, and PPIUCD and LAM transition), emphasis on counseling requires trained providers for method availability and documentation before discharge. The World Health Organization (WHO) recommends for better maternal and child health outcomes, postpartum women should wait for an interval of at least 2 years following a live birth before becoming pregnant again (Silesh et al., 2022).

Globally, 225 million women desire modern contraception to delay or prevent future pregnancy, but they do not have access (Gahungu et al., 2021). In another study conducted in Pakistan, the prevalence of PPFP was 39.7% and couple joint decision-making, number of living children, wife’s formal education and husband education were significantly associated with PPFP uptake (Khurram et al., 2025). Additionally in the globe, approximately 810 deaths associated with pregnancy and childbirth are recorded daily, and approximately 94% of the maternal deaths are in low- and middle-income countries (Silesh et al., 2023). The immediate postpartum period provides a unique opportunity to meet the reproductive health needs of women particularly the need for family planning after child birth. This is because some women resume ovulation and menstruation as early as 25 days of post-delivery (Adeniyi et al., 2020). The Demographic health survey data from 57 countries revealed that 62% of women in the first year after birth have an unmet need for FP (Wudineh et al., 2023). There is low utilization of IPPFP in the study area, and no multicenter studies have been conducted previously, and misconceptions about family planning by immediate post -partum women, so this study fills this gaps. The main reason of studying on immediate post-partum family planning was to address the pressing need of post-partum women, to avoid unintended and closely spaced pregnancy during the first 48 hours of childbirth. And IPPFP offers unique opportunity to provide family planning counseling and services when women are in the healthcare setting (Gudeta et al., 2025). Studying IPPFP also reduces the risk of maternal morbidity and mortality, improves birth spacing and prevents the negative outcomes of short inter-pregnancy intervals like preterm labor, IUGR and stillbirth. Additionally it improves sustained contraceptive use and empowers women to make informed reproductive choice and contributes to broader public health goals like reducing unplanned pregnancies and improving maternal and child health outcomes (Mba, 2024). The current study has several contributions by addressing gaps through improving counseling services quality,providing more comprehensive national picture, addressing facility based health education in all health institutions and integrating intervention based evidences (Geltore et al., 2024). The rationale for studying IPPFP utilization was to address the high unmet contraceptive needs during post-partum period, which used to preventing unintended pregnancy, maternal morbidity and mortality, and short birth spacing in resource limited countries like Ethiopia (Gudeta et al., 2025). There were also public health gaps due to low uptake of IPPFP despite raising facility based deliveries, due to barriers like poor counseling, attitude and socioeconomic factors.it also have policy and practice benefits as evidence based findings indicates that integrated family planning counseling at maternal care points and community campaigns aligning with the Ethiopian health system for better maternal and child outcome (Silesh et al., 2023).

2. Literature Review

Immediate post-partum family planning utilization remains low globally and in Ethiopia, despite the high unmet need for contraception in the first year after birth (Silesh et al., 2022). Different literature concludes that IPPFP is a high impact intervention to reduce short inter-pregnancies intervals and unintended pregnancy, but its coverage in low and middle income countries is still suboptimal. Approximately 75% of births worldwide occur within 24 months, which is a pregnancy gap of less than 18 months and linked to a greater risk of low birth weight and a small size at delivery (Gahungu et al., 2021). Facility-based delivery services can reach more women and their partners. A trained birth attendant assists in four out of every five births globally, and an increasing number of these deliveries take place in medical facilities (Kiondo et al., 2020). For example, the proportion of births in Bangladeshi hospitals increased from 17% to 37% between 2007 and 2014. Over a similar period, facility deliveries increase from 43% to 64% in Kenya and from 39% to 72% in Burkina Faso (Gahungu et al., 2021). As countries seek to enhance facility-based delivery care by providing family planning services to women and their partners, this platform will become increasingly important (Kiondo et al., 2020).Ethiopia is among the least developed African countries in which maternal and prenatal morbidity and mortality rates remain very high (Hedegaard et al., 2014; Hiluf & Assefa, 2015). According to the Ethiopian Demographic Health Survey, maternal and neonatal mortality rates were 412 deaths per 100,000 live births and 30 deaths per 1,000 live births, respectively). The Ethiopian Mini Demographic Health Survey revealed a high and unacceptable death rate in relation to WHO standards (Ethiopian Public Health Institute (EPHI), 2017; Ethiopian Public Health Institute (EPHI) & ICF, 2021). This impedes efforts to achieve sustainable development goals (Johnston, 2016). The percentage of postpartum women in various regions of Ethiopia who use IPPFP varies from 12.9% to 30.7%, but the overall pooled prevalence of IPPFP utilization among postpartum women is only 21.04% (Silesh et al., 2023). Variables such as marital status, the amount of time spent postpartum, anxiety about adverse effects, prenatal care monitoring, infant death, religion, and lack of knowledge are among those influencing women’s use of postpartum contraceptives during the first few months after giving birth (Demissie, 2021; Emmerance et al., 2024; Silesh et al., 2023). The lower utilization of IPPFP indicates that there may be a sizable unmet need for family planning services immediately after giving birth (Gahungu et al., 2021). Therefore, the main objective of this study was to assess the level and associated factors of IPPFP utilization among postpartum women in public hospitals in Addis Ababa, Ethiopia.

3. Methods and Materials

3.1. Study Area and Period

The study was conducted at four public hospitals in Addis Ababa, Ethiopia, Addis Ababa is the capital city of Ethiopia and the headquarters of the African Union, and had a population of 3,384,569 according to the 2007 census. In the year 2017; the population was approaching 5 million, with an annual growth rate of approximately 2.9%. The city has eleven sub cities and 116 woredas. There are six hospitals owned by Addis Ababa health bureau, 4 by ministry of health, 1 by Addis Ababa University, 3 by non-governmental organization, 3 by defense force and police and also 34 by private owners. There are 100 public health centers and around 700 private clinics out of which 75 are higher clinics and there were 1.2 million women in the reproductive age group (15-49). From the twelve public hospitals in Addis Ababa, four of these hospitals were randomly selected for this study. All the selected hospitals offer a range of services, including family planning, antenatal care (ANC), labor and delivery, postnatal care, comprehensive abortion care (CAC), neonatal intensive care unit (NICU) services, and other services. The hospitals are also staffed by intern physicians, midwives, resident physicians, obstetricians, and a range of other healthcare professionals and supporting staff. The study was conducted from 03 February to 03 March 2025.

3.2. Study Design

An institution-based cross-sectional study was employed.

3.3. Study Populations, Sample Size and Sampling Procedure

All immediate postpartum women who gave birth at public hospitals in Addis Ababa and all immediate postpartum women in the four selected public hospitals of Addis Ababa during the study period composed the source and study populations, respectively. The sample size needed for this study was calculated using a single population proportion formula and double population proportion formula for the factors, and the largest sample size was obtained from the first objective by a single population proportion formula considering the following assumption: from the previous study, the proportion (P) = 21.3% (Silesh et al., 2022), Z-the standard normal distribution value at the 95% confidence level of Zα/2 = 1.96, 4% absolute precision, and 10% nonresponse rate.

n = \frac{{(Z \frac{α}{2})}^{2} * P (1 - P)}{d^{2}}

({(1.96)}^{2} * (0.213 * (1 ‐ 0.213)) = 402

(0.0016)

When the nonresponse rate was 10% * 402 = 40, the final sample size was 442. The study was carried out in four selected public hospitals. The final sample size was proportionally allocated to the selected public hospitals on the basis of the number of deliveries reported in each facility over the past six months. A systematic random sampling technique was employed to enroll 442 postpartum women in the study area. Using the assumptions of N (the estimated number of postpartum women in the four hospitals in a month was 1850) and n (the required minimum sample size including a 10% nonresponse rate) = 442), we calculated the sampling fraction (k): where k = N/n⇒ the sample interval for each hospital was 3, 4, 4 and 5 respectively. Thus, the study participants were selected based on the sampling interval of each respective hospitals.

3.4. Inclusive and Exclusive Criteria

All postpartum women who were born at public hospitals of Addis Ababa and who were eligible for at least one IPPFP method according to the Medical Eligibility Criteria (MEC) were included. However, postpartum women who were critically ill and developed emergency cases were excluded.

3.5. Study Variables

In this study, the dependent variable was IPPFP utilization, and the independent variables included socio-demographic characteristics, family planning-related characteristics, and obstetric and maternal health service-related characteristics.

3.6. Operational Definition

IPPFP utilization:- refers to the use of a contraceptive method by a postpartum woman within 48 hours after childbirth (Gezume et al., 2024).

Contraception:- refers to any method or pharmaceutical agent employed to prevent unintended or unplanned pregnancy (Demissie, 2021; Silesh et al., 2023; Wudineh et al., 2023).

Family planning:- is defined as the ability of persons and couples to employ contraceptive methods to predict and achieve their desired number of children as well as the spacing and scheduling of their deliveries (Demissie, 2021; Silesh et al., 2023; Wudineh et al., 2023).

Good knowledge:- a women is well informed and correctly answers at least half of the knowledge questions (Emmerance et al., 2024; Silesh et al., 2023; Wudineh et al., 2023).

A positive attitude:- if a woman who scored above the mean in the attitude measurement questions, was considered to have a positive attitude toward PPFP (Emmerance et al., 2024; Silesh et al., 2023; Wudineh et al., 2023).

Ever use of modern IPPFP methods: A woman was considered ever using modern FP methods if she had used any modern FP methods before the survey (Demissie, 2021; Silesh et al., 2023; Wudineh et al., 2023).

3.7. Data Collection Tools and Procedures

Data was gathered from primary and secondary (chart review) sources through in-person interviews using a standardized questionnaire. Questionnaire was modified to fit the goals of the study after being adapted from several relevant works of literature (Tilahun et al., 2022). The questionnaire was initially prepared in English, then translated into the local language, Amharic, and subsequently back-translated into English to ensure consistency. A pretested structured interviewer-administered questionnaire was used to collect data on maternal socio-demographic profiles(such as age and educational status), data related to family planning (such as ever heard about IPPFP, source of information, ever counseled on IPPFP, counseled during ANC and PNC, ever used FP, discussion with husband, partner support to use FP, knowledge on FP and attitude towards FP) and obstetric and maternal health related characteristics (such as number of pregnancies, number of children alive, history of abortion, mode of delivery, current birth outcome, planning status of pregnancy, reproductive intention, plan when to have the next child, history of ANC for current pregnancy, number of ANC visits and maternal satisfaction with intra-partum care). Data collection was conducted by eight health professionals (midwives) who were not staff members of the study site and were supervised by assigned supervisors.

3.8. Data Quality Control

The supervisors and data collectors received training on the study’s objectives, data gathering techniques and instruments, and ways to minimize bias. Throughout the data collection period, the investigators and supervisors monitored and supervised the field activity; and also verified the completeness and consistency of each completed data collection form. Additionally, the instrument was pretested on 5% of the sample size at Abebech Gobena Mothers and Children’s Health Hospital (AGMCHH), a public hospital in Addis Ababa that is affiliated with Yekatit 12 Hospital Medical College, with a reliability value of 0.668. Meetings were held between the data collectors and the principal investigator to discuss any issues that arose during data collection and to address any errors encountered. The collected data were reviewed and checked for completeness prior to data entry.

3.9. Ethical Considerations

The IRB granted authority for data collection and ethical clearance. Respondents were fully informed of their right to decline, to participate, and to not answer any questions prior to seeking permission to conduct an interview. Each interview took place in private, at the time and place of the respondent’s choice. The questionnaires were recorded anonymously, coded, and kept in a secure location to guarantee complete confidentiality.

3.10. Data Processing and Analysis

After being verified for accuracy, the data was input into Epi-Data version 3.1 and examined using SPSS version 25. Before analysis, the assumptions of logistic regression were evaluated using descriptive statistics. The relationships between each independent variable and the outcome variable were examined using bivariable logistic regression. Multivariable logistic regression analysis was an option for independent variables whose P values in the bivariable logistic regression analysis were less than 0.25. Variance inflation factor (VIF) and tolerance values were used to measure multicollinearity and no collinearity effect was found. Model fit was assessed using the Hosmer–Lemeshow goodness-of-fit test, which produced a non-significant result (p = 0.668), suggesting good model fit. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were computed in the multivariable logistic regression analysis to evaluate the impact of independent variables on IPPFP consumption. Statistical significance was defined as a p value of less than 0.05. Following that, the findings were shown as texts, tables, and figures.

4. Results

4.1. Socio-Demographic Characteristics

From the total 442 postpartum women who were invited, 434 responded to the questionnaire, with a response rate of 98.2%. More than half of the study participants (257; 59.2%) were in the age group of 25-34 years, with a mean age and standard deviation of 27.87 ±5.28 years respectively. Among the respondents, the majority, 395 (91%), were married, and 374 (86.2%) lived in Addis Ababa, and 60 (13.8%) lived outside Addis Ababa. With respect to educational level and employment status, 322 (74.2%) and 173 (39.9%) had attended Secondary and above education and were government employed, respectively (Table 1).

Table 1.

Socio-Demographic Characteristics of Respondents at Public Hospitals in Addis Ababa, Ethiopia, 2025 (n=434)

Background characteristics	Category	Frequency	Percent
Age of the mothers	18-24	124	28.6
	25-34	257	59.2
	≥35	53	12.2
Place of residence	Addis Ababa	374	86.2
Place of residence	Out of Addis Ababa	60	13.8
Marital status	Single	25	5.8
	Married	395	91
	Others ^a	14	3.2
Educational status	No formal education	22	5.1
	Primary education	90	20.7
	Secondary and above education	322	74.2
Husband educational status	No formal education	15	3.5
	Primary education	76	17.5
	Secondary and above education	318	73.3
Occupational status of the women	House wife	116	26.7
	Government employee	173	39.9%
	Private employee	116	26.7%
	Others ^b	29	6.7

Others ^a= Divorced and widowed, others ^b student and daily labor.

4.2. Family Planning-Related Characteristics

The majority (377, 86.9%) of the study participants had information on IPPFP, and the main source of information was health care providers, reported by 312 (71.9%) participants, followed by mass media (240, 55.3%) and friends (192, 44.2%). Approximately two-thirds (67.5%) of postpartum women received counseling during their current pregnancy. Among these, 255 (58.8%) received integrated counseling through both antenatal care and postnatal care services. Majority (352, 81.1%) of the study participants were aware of the benefits of family planning methods, and the most commonly known benefits among the study participants were prevention of unwanted pregnancy, mentioned by 257 (59.2%), and limiting the number of children, mentioned by 68 (15.7%) respondents. Among the study subjects, 284 (65.4%) identified possible side effects of using IPPFP methods, and the most commonly mentioned side effects were back pain and Headache, which were mentioned by 86 (19.8%) and 71 (16.4%) respondents, respectively (Table 2).

Table 2.

Family Planning-Related Features of the Study Participants at Public Hospitals in Addis Ababa, Ethiopia, 2025 (n=434)

Background characteristics	Category	Frequency	Percent
Information about IPPFP	Yes	377	86.9
Information about IPPFP	No	57	13.1
Source of information (n=377)	Health care providers	312	82.8
	Mass media	240	63.7
	Family members	178	47.2
	Friends	192	50.9
	Social media	145	38.5
Counseled on IPPFP	Yes	293	67.5
Counseled on IPPFP	No	141	32.5
Counseling during at PNC	Yes	232	53.5
Counseling during at PNC	No	61	46.5
Knowing IPPFP Methods	Yes	355	81.8
Knowing IPPFP Methods	No	79	18.2
Methods known by women	Injectable	257	59.2
	Implants	65	15
	Pills	22	5.1
	IUCD	11	2.5
Benefits of IPPFP	Yes	352	81.1
Benefits of IPPFP	No	82	18.9
Benefit mentioned	Prevent unwanted pregnancy	277	63.8
	Health timing & spacing pregnancy	27	6.2
	Limits number of children	68	15.7
Side effects of IPPFP	Yes	284	65.4
Side effects of IPPFP	No	150	34.6
Side effects mentioned	Back pain	86	19.9
	Head ache	71	16.4
	Heavy vaginal bleeding	59	13.6
	Weight gain	15	3.5
	Weakness	6	1.4
	Abdominal pain	47	10.8
Knowledge on FP	Good knowledge	260	59.9
Knowledge on FP	Poor knowledge	174	40.1
Attitude on FP	Positive attitude	246	56.7
Attitude on FP	Negative attitude	188	43.3

4.3. Reproductive History and Maternal Health Service-Related Characteristics

The mean number of pregnancies and living children among the respondents were 2.44 (SD ± 1.265) and 2.2 (SD ± 1.796), respectively. The majority of the study participants, 408 (94%), had at least one ANC contact, and 362 (88.7%) of them had four or more ANC contacts during the current pregnancy. In terms of mode of delivery, 205 (47.2%) of the study participants delivered by cesarean section, and three-fifths (60.6%) of the study participants were satisfied with the care they received during intra-partum care (Table 3).

Table 3.

Reproductive History and Maternal Health Service-Related Characteristics of the Study Participants at Public Hospitals in Addis Ababa, Ethiopia, 2025 (n=434)

Background characteristics	Category	Frequency	Percent
Number of pregnancy	<2	244	56.2
Number of pregnancy	≥2	190	43.8
History of abortion	Yes	115	26.5
History of abortion	No	319	73.5
Birth to birth interval	<24 months	148	48.4
	24-35 months	100	32.7
	≥36 Months	58	18.9
Number of live children	1	142	32.7
	2-4	277	63.8
	≥5	15	3.5
Planning status of pregnancy	Planned	371	85.5
Planning status of pregnancy	Unplanned	63	14.5
ANC contact	Yes	408	94
ANC contact	No	26	6
Number of ANC contacts (n=408)	less than Five ANC contacts	46	11.3
Number of ANC contacts (n=408)	five and above ANC contacts	362	88.7
Mode of delivery	SVD	197	45.4
	IVD	32	7.4
	C/D	205	47.2
Current birth outcome	Alive	426	98.2
Current birth outcome	Died	8	1.8
Reproductive intention	Want to delay	180	41.5
	Want to limit	66	15.2
	Un decided	188	43.3
Maternal satisfaction during intra-partum care	Satisfied	263	60.6
Maternal satisfaction during intra-partum care	Not satisfied	171	39.4

Note. SVD; spontaneous vaginal delivery, IVD; instrumental vaginal delivery, C/D; cesarean section delivery.

4.4. Magnitude of Immediate Postpartum Family Planning Utilization

Among the 434 interviewed postpartum women, 76 [17.5%, 95% CI (14.3–21.5)] used immediate postpartum family planning. Among those, more than half 41 (54%) used implants, 21 (27.6%) used injectable, and 14 (18.4%) used IUCDs (Figure 1).

Figure 1.

Magnitude of IPPFP utilization among postpartum women at public hospitals in Addis Ababa, Ethiopia, 2025 (n=434)

4.5. Factors Associated With IPPFP Utilization

The number of living children, knowledge of IPPFP side effects, receiving counseling during both ANC and PNC visits, awareness of IPPFP contraindications, knowledge and attitudes toward IPPFP, and maternal satisfaction were all linked to IPPFP use at a p value of <0.25 in the bivariate logistics regression analysis. Multivariate logistic regression analysis was used to find factors that showed a statistically significant association with IPPFP at a p value of less than 0.05 after controlling for confounders in the final model. Accordingly, women who had 2–4 living children were more than two times (AOR: 2.7, 95% CI (1.35, 5.40); p=0.005) more likely to use IPPFP than women who had one living child. Postpartum women who knew about contra indications to use the immediate postpartum family planning method were nearly two times (AOR: 1.82, 95% CI (1.02, 3.23); p= 0.041) more likely to utilize IPPFP than women who did not know contra indications to receive IPPFP. On the other hand, women who were counseled at PNC within 48 hours of the postpartum period were two times (AOR: 2.11, 95% CI (1.07, 4.17); p= 0.032) more likely to use IPPFP than women who were not counseled. Finally, postpartum women who had knowledge of family planning methods were almost five times (AOR: 4.8, 95% CI (1.73, 13.33); p=0.003) more likely to use IPPFP than those who had no knowledge of family planning methods (Table 4).

Table 4.

Factors Associated With Immediate Postpartum Family Planning Utilization at Public Hospitals in Addis Ababa, Ethiopia, 2025

Variables	Category	IPPFP utilized		COR(95%CI)	AOR(95% CI)	P-value
		Yes	No
		N (%)	N (%)
Number of alive children	1	12 (8.5)	130 (91.5)	1	1
	2-4	61 (22)	216 (78)	3 (1.59-5.90)	2.7(1.35-5.40)	0.005*
	≥5	3 (20)	12 (80)	2.71(0.67-10.94)	2.1(0.46-9.52)	0.34
Ever heard IPPFP	Yes	71 (18.8)	306 (81.2)	2.4(.93-6.26)	0.68 (0.21-2.15)	0.51
Ever heard IPPFP	No	5 (8.8)	52 (91.2)	1	1
Knowing side effects of IPPFP	Yes	60 (21.1)	224 (78.9)	2.2 (1.23, 5.2)	1.03(0.50-2.14)	0.94
Knowing side effects of IPPFP	No	16 (10.7)	134 (89.3)	1	1
Counseling received at PNC	Yes	59 (25.4)	173 (74.6)	3.7 (2.08-6.62)	2.11(1.07-4.17)	0.032*
Counseling received at PNC	No	17 (8.4)	185 (91.6)	1	1
Counseling received at ANC	Yes	50 (19.6)	205 (80.4)	0.4(0.01-2.61)	2.12(0.97-4.63)	0.06
Counseling received at ANC	No	15 (39.5)	23 (60.5)	1	1
Knowing contraindication about IPPFP	Yes	37 (26.1)	105 (73.9)	2.3(0.38-3.78)	1.82(1.02-3.23)	0.041*
Knowing contraindication about IPPFP	No	39 (13.4)	253 (86.6)	1	1
Knowledge on FP	Good knowledge	65 (25)	11(6.3)	4.9 (2.52-9.67)	4.8(1.73-13.33)	0.003*
Knowledge on FP	Poor Knowledge	195 (75)	163 (93.7)	1	1
Attitude on FP	Positive attitude	58(23.6)	188(76.4)	2.9 (1.65-5.14)	0.85(0.34-2.09)	0.72
Attitude on FP	Negative attitude	18(9.6)	170 (90.4)	1	1
Maternal satisfaction during intra-partum care	Satisfied	59 (22.4)	204 (77.6)	2.6 (1.47-4.67)	1.51 (0.79-2.89)	0.22
Maternal satisfaction during intra-partum care	Not-satisfied	17 (9.9)	154 (90.1)	1	1

Note. * represents P < 0.05, IPPFP=immediate postpartum family planning, ANC=antenatal care, PNC=postnatal care and FP=family planning.

5. Discussion

This study aimed to assess the level of immediate postpartum family planning (IPPFP) utilization and associated factors among postpartum women in the study setting. The level of immediate postpartum family planning (IPPFP) was 76 [17.5%, 95% CI (14.3–21.5)], and number of living children, counseling during PNC, and knowledge of family planning methods and their contraindications were significantly associated with IPPFP.

The findings of the present study were in line with those of previous studies conducted in Ethiopia, such as Mekelle public hospital (17.8%) (James et al., 2023), a systematic meta-analysis performed in Ethiopia (17.8%) (AT et al., 2016), North Showa, Ethiopia (21.8%) (Wudineh et al., 2023) and Sidama (21.6%) (Tilahun et al., 2022). However, the level of Immediate post-partum family planning (IPPFP) in this study is lower than studies conducted in Thailand (73.3) (Kaewkiattikun, 2017), the United States of America (49%) (Imran Sohail Sheikh et al., 2023), South Africa (93.2%) (Shabiby et al., 2015), and Kenya (50%) (Adeniyi et al., 2020). The findings of the current study is also lower than those studies conducted in Jimma town in western Ethiopia (53.2) (Arero et al., 2018) and the Gurage Zone in southern Ethiopia (42.9%) (Gudeta & Terefe, 2025). This discrepancy may be due to differences in the study settings, counseling intensity, misconceptions and sociocultural and service differences and provider side barriers. This may be due to differences in study settings, which reflect that in Jimma and Garage studies often targeted facilities with stronger IPPFP programs and higher counseling rates, boosting uptake and focused on women counseled within 48 hours of post delivers and also in oromia (Jimma)and SNNPR(gurage) exhibited higher regional IPPFP prevalence due to potentially favorable attitude or partner support, contrasting Addis Ababa myths and lower counseling and other factors which less pronounced in capital constraints and also Many post-partum women practice postpartum abstinence and believe they cannot become pregnant immediately after childbirth. This creates a false sense of security, leading to a delay in initiating contraception until after the first menstrual cycle returns or after the traditional 40-day, 3-month, or 6-month checkup (Meskele et al., 2024). Additionally Misconceptions about low fertility during breastfeeding may lower the rate of IPPFP because many women believe that exclusive breastfeeding acts as a full contraceptive method, not understanding the risk of pregnancy before the return of menses(Id et al., 2024). The low uptake may arise from the patient refusal and also due to provider side barriers. Some health care providers often omit IPPFP counseling for women they perceive as low risk (example-those practicing post-partum abstinence), creating missed opportunity not by accident but by clinical selection (Silesh et al., 2022). However, some research on HIV-positive people in South Africa has shown increased use, which is explained by the deliberate integration of family planning with HIV treatment. In South Africa, integrating FP-HIV services reduces unmet need and increases contraceptive usage by 8% since women receive counseling in addition to ART refills and newborn follow-up. Opportunistic FP insertion is facilitated by WLHIV’s frequent attendance to HIV clinics, in contrast to general populations that require separate visits. By removing obstacles like stigma through one-stop care, high facilities delivery and provider training in integrated settings further increase acceptance. In contrast, the magnitude of IPPFP in the current study was slightly greater than that reported in other studies, such as studies conducted in Addis Ababa, Bole sub city (12.9%) (Gezume et al., 2024), St Paulo’s Millennium Medical College (12.7%) (Demissie, 2021), the Amhara region of Ethiopia (8.87%) (Silesh et al., 2022) and Somali, Ethiopia (12.7%) (Wudineh et al., 2023), in Pakistan (4%) and Tanzania (10.4%) (Abbasi et al., 2020; Kiondo et al., 2020). This difference might be due to comprehensive family planning counseling during ANC and Delivery, women’s’ empowerment, partner support, positive attitude towards contraception, and programmatic integrity of family planning into maternal health services, and also the population in the current study differed from those in other studies in terms of education level, residency, and previous contraceptive use and factors that are positively associated with higher IPPFP utilization. Additionally, the current study setting in public referral hospitals may have contributed to the higher uptake of IPPFP, as these facilities often serve as training centers where providers are more up-to-date on guidelines and counseling practices (Emmerance et al., 2024; Kiondo et al., 2020; Silesh et al., 2023; Wudineh et al., 2023).

With respect to the factors associated with IPPFP, this study revealed a significant association between having 2–4 living children and IPPFP utilization. Thus, women with 2–4 living children were more than twice as likely to use IPPFP as those with only one living child. This association was similar to the findings of studies conducted in the Rwanda Zone and Arsi Zone in Ethiopia (Moloro et al., 2024). This might be because women with more children are more likely to have achieved or be close to achieving their desired family size, which makes them more motivated to delay or prevent future pregnancies. Additionally, multiparous women often have increased exposure to health services, such as antenatal care, delivery, and immunization clinics, where they may receive repeated counseling on family planning. Furthermore, with multiple pregnancies and births, some women may be more aware of the health risks associated with short birth intervals, which can further motivate them to adopt contraception. Low postpartum contraceptive adoption is indicated by immediate postpartum utilization of 17.5%, which highlights inadequacies in hospital-based service delivery or counseling and shows a significant unmet demand for spacing or limiting births among Addis Ababa women. A low overall rate suggests that prenatal care and postpartum counseling should be intensified. Partner participation and attitude shifts to dispel beliefs could potentially prevent unwanted pregnancy and maternal dangers. The findings of the present study revealed a statistically significant association between the utilization of IPPFP and counseling during PNC. This finding aligns with studies conducted in Thailand, Kenya (Gudeta et al., 2025), and Ethiopia (Mickler et al., 2021). This is because counseling during the immediate postpartum period aligns with women’s current needs and concerns. It might also be that providing counseling within 48 hours after delivery while the woman is still in the facility creates an opportunity to offer a contraceptive method before discharge, making it easier for her to act on the information immediately. Women who were aware of the contraindications to using family planning methods were more likely to utilize IPPFP than were those who were not. This may be attributed to their proactive health-seeking behavior; knowledge of contraindications likely reflects better awareness, leading to improved adherence to IPPFP and reduced misconceptions about family planning methods (Abame et al., 2019; Silesh et al., 2023). There was also a significant association between women’s knowledge of postpartum family planning and IPPFP utilization. Compared with those with poor knowledge, women who had good knowledge of postpartum contraception were four times more likely to utilize immediate postpartum family planning. This may be because awareness and understanding of IPPFP methods significantly increase the likelihood of their utilization (Demissie, 2021). Women with comprehensive knowledge of contraceptive options are better equipped to make informed decisions. In contrast, gaps in knowledge, particularly regarding method availability, safety, and contraindications, serve as barriers to utilization (Mickler et al., 2021).

6. Implication of the Study

The current study finding has several implications that used for practice in immediate post-partum family planning utilization. The study identifies the level and predictors of IPPFP utilization, which helps for health care providers and policy makers to understand the current status and gaps in IPPFP uptake. It also gives information on integration of family planning counseling into maternal health service at all contact points (ANC, PNC and delivery).The study also used for nurses to integrate family planning counseling during antenatal care, labor and during immediate post-partum periods, as counseled women are used 2.5-3.6 times more likely to utilized IPPFP methods like implants or depo- Provera. This includes assessing attitudes, reproductive intentions and partner support to boost uptake, particularly in Ethiopia settings where utilization remains low, under 25%. The finding also used for nurses for integration of practice strategies like document IPPFP uptake in all delivery points using dedicated registers, promoting partner involvement and community awareness and also to train nurses to offer methods before discharge. Finally the outcome of the current study supports policy makers and the health system in designing of evidence based programs and policies to strengthen IPPFP services within MCH framework.

7. Strengths and Limitations

This study has several strengths that enhance the validity and applicability of its findings. First, the use of a relatively large sample size and a systematic random sampling technique improves the representativeness of the study population and reduces selection bias. Second, the inclusion of multiple public hospitals increases the generalizability of the findings within urban healthcare settings. Third, the use of a pretested and structured data collection tool, along with trained data collectors and supervisors, helped ensure data quality and consistency. Additionally, the study examined multiple dimensions of immediate postpartum family planning, including knowledge, counseling, and service-related factors, providing a comprehensive understanding of utilization.

Despite these strengths, the study has some limitations. The study was limited to public hospitals, which may not reflect the experiences of women attending private facilities or health centers. The cross-sectional design restricts the ability to establish causal relationships between variables. Furthermore, the exclusion of women with severe medical or obstetric complications may limit the generalizability of the findings to all postpartum women. There is also a possibility of recall and social desirability bias, as the data were collected through self-reported interviews.

8. Conclusion

In this study, only 17.5% of postpartum women used IPPFP. Number of living children, counseling during PNC, knowledge of family planning methods and their contraindications were significantly associated with IPPFP. Every postpartum woman should receive counseling prior to discharge, with a focus on timing, safety, and technique alternatives. Counseling and community outreach activities should include information regarding method availability, safety, and contraindications to increase knowledge and awareness. All eligible women should be consistently offered IPPFP by providers. In addition to engaging primi-parous women to encourage early adoption, counseling themes and tactics should be customized for mothers with more children, who are more likely to employ IPPFP. Furthermore, family planning should be better integrated with maternity and infant health services at all levels of the healthcare system.

Supplemental Material

Supplemental material - Immediate Postpartum Family Planning Utilization and Associated Factors Among Postpartum Women at Public Hospitals in Addis Ababa, Ethiopia

Supplemental material for Immediate Postpartum Family Planning Utilization and Associated Factors Among Postpartum Women at Public Hospitals in Addis Ababa, Ethiopia by Dawit Tarko Alamenie, Getinet Tilahun Simeneh, Gebrehiwot Gebremariam Gebretatiyos, Marew Abebaw, and Tesfu Zewdu Gemmeda in Sage Open Nursing.

Footnotes

Acknowledgements

The authors thank all scholars and researchers whose work contributed to the conceptual development of this article.

ORCID iDs

Dawit Tarko Alamenie

Gebrehiwot Gebremariam Gebretatiyos

Ethical Considerations

This study was conducted in accordance with the Declaration of Helsinki, and after ethical clearance was obtained from the Addis Ababa Public Health Research and Emergency Management Directorate, Department of Public Health Research Office and Ethical Review Committee with reference number of (Ref No: A/A/H/13001/227/17).

Consent to Participate

Written consent was obtained from each study participant after explaining the purpose and objectives of the study. For those participants who were illiterate, a fingerprint was used as a signature after trained interviewers had carefully explained the purpose, benefits, and potential risks before consent was obtained. The interview with study participants was conducted with strict privacy and confidentiality.

Consent for Publication

Consent for the publication of this original research article is not applicable.

Author Contributions

All the authors participated in the preparation of this paper. DTA searched the necessary materials, wrote the proposal, facilitated the data collection process, and analyzed the data. GTS, MA, GG, and TZ participated in each step of the design, analysis, and result writing. DTA and GTS wrote the manuscript. Finally, all the authors reviewed and approved the manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

This article is based on conceptual analysis and synthesis of published literature. No datasets were generated. Analyzed datasets are available from the corresponding author on reasonable request. All sources cited are publicly available through their respective journals and databases.*

Supplemental Material

Supplemental material for this article is available online.

Appendix

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