Family planning (FP) is important throughout an individual’s and couple’s reproductive life. It is a key life-saving intervention for mothers and their children[1]. Modern contraceptive methods are defined as technological products or medical procedures that affect natural reproduction. The intrauterine contraceptive device (IUD), contraceptive pills, condoms (male and female), sterilization (male and female), injectables, diaphragms, spermicidal agents (foam/jelly), and emergency contraception are among the modern contraceptives[2, 3].
Initiation of modern family planning use during the postpartum period is most critical to improving maternal and child health. Postpartum family planning (PPFP) is defined as the prevention of unintended pregnancy and closely spaced pregnancies through the first 12 months following childbirth[4]. The World Health Organization (WHO) recommends PPFP counseling during antenatal, immediate postpartum, and postnatal services as a critical component of health care that has the potential to meet women’s desire for contraception and save millions of maternal and infant lives in low and middle-income countries[1, 4].
The postpartum period is an important intervention for improving access to family planning services. Postpartum women are among those with the greatest unmet need for family planning. Yet they often do not receive the services they need to support longer birth intervals or reduce unintended pregnancy and its consequences. PPFP helps to addresses the needs of those women who have an unmet need to space and limit future pregnancies while helping to lower rates of maternal and child death[4, 5].
During the postpartum period, family planning can prevent about 30% of maternal mortality and 10% of child mortality if couples space their pregnancies more than 2 years apart. On the contrary, closely spaced pregnancies within the first year postpartum increase the risks of preterm birth, low birth weight, and small-for-gestational-age babies. Short inter-pregnancy intervals can result in negative health outcomes for mother and child. The timing of the return of fertility after childbirth is variable and unpredictable. Women can get pregnant before the return of menstruation[4].
According to an analysis of Demographic and Health Survey data from 27 countries, 65% of women who are 0–12 months postpartum want to avoid pregnancy in the next 12 months but are not using contraception[6]. The uptake of PPFP remains low in Sub-Saharan Africa[7]. Significant factors influencing the uptake of family planning are likely to be: level of education, antenatal and postnatal family planning counseling, menses return, breastfeeding status, and return of sexual activity[6–8].
During this extended postpartum period, 95% of women in low and middle-income countries want to avoid pregnancy within the next 2 years, but 70% are not using contraception [9–11]. Pregnancies occurring closely spaced are associated with higher risks of abortions, bleedings, anemia, and poor pregnancy outcomes like preterm babies, small for gestational age babies. Despite this fact, the first 12 months after giving birth concerning family planning use is the time which is often given less attention by health care managers, health service providers, and users. Even, most women do not realize that they are at risk for subsequent pregnancy. Due to this, there is an increased substantial risk of unwanted conception and an often-frustrated desire for contraceptive protection[12].
Ethiopia is currently striving to become one of the fastest-growing economies in Africa. This trend will however not continue if measures are not put in place to control the fertility rate. Postpartum family planning is an effective way of dealing with this situation as it offers women in the reproductive age group (15–49 years) a means of effectively spacing or limiting their births and consequently avoiding complications of unwanted pregnancies. This will lead to an improvement in the health of women and their children, families will be more productive, save more and have better prospects for their children. The economy will grow and the pressure on natural resources and infrastructure will reduce[12].
Modern contraceptive use by currently married Ethiopian women has steadily increased over the last 20 years. In 2019, 41% of married Ethiopian women were using contraception, compared to just 29% in 2011 and 36% in 2016. However, this proportion is far below the targets for 2020 (55% for contraceptive prevalence rate)[13, 14]. In the capital city of Ethiopia, Addis Ababa, 80.3% of childbearing women adopted modern PPFP[15]. About 86% of the women in Ethiopia have an unmet need during their first year postpartum, but only 8% are using any method of family planning. Only 5% of women during the 12-month postpartum period desire another birth within two years. Though the WHO and the Ethiopian national family planning guideline recommends that pregnancies be spaced by at least 24 months to reduce adverse fetomaternal and neonatal complications, nearly half (47%) of postpartum women have short (< 23 months) birth-to-pregnancy intervals in Ethiopia [8, 16].
In Ethiopia, the risk of pregnancy among mothers who are sexually active in 12–23 months of the postnatal period is 72%, but it decreases to 64% and 37% for mothers in 6–11 and first 6 months of the postnatal period, respectively. Although the preponderance of postpartum mothers points out the need to utilize contraceptives, contraceptive uptakes are often not obtainable or in use by the first year of the postpartum period[17]. In Ethiopia, a lot of fragmented studies have been conducted to assess the prevalence and determinants of postpartum contraceptive use. These separated studies revealed that the prevalence of postpartum contraceptive use in Ethiopia ranged from 15–80.3% [12, 15, 18–21]. From the reports of these studies, there was a great variation and inconsistency related to the prevalence of postpartum contraceptive use throughout the country. In addition to prevalence, socio-demographic (mother educational level), and other determinants like antenatal care (ANC), resumed sexual activities, postnatal care (PNC), menses return, and duration after delivery were the most common determinants reported by the Ethiopian studies [22].
Despite studies conducted on postpartum family planning in certain towns of Ethiopia, there has been limited locally available evidence in the rural part of the country and hence this study provides locally available evidence on the magnitude of postpartum family planning and associated factors from a rural district in the central part of the country which helps health service providers and program managers to focus on appropriate interventions to mitigate the problem locally; moreover, it provided evidence for other rural districts in a similar situation especially for developing countries.