Postpartum family planning use and women’s intention on contraception in Ethiopia: Disparities in the agrarian and pastoral contexts from community-based cross- sectional study

Background Postpartum family planning (PPFP) is the initiation of contraceptive methods immediately after childbirth. It is impactful intervention to reduce the risk of maternal and child deaths through spacing pregnancies. However, the magnitude of women’s access to and use of modern PPFP methods remains low, context-based evidence is crucial in addressing these gaps to inform policies. Therefore, this study aimed to assess women’s current use and intention on contraception in agrarian and pastoral contexts of Ethiopia. Methods A community-based house-to-house survey was conducted as a baseline study to embedded implementation research in 10 selected woredas from the agrarian and pastoral contexts of Ethiopia. Data were collected among randomly selected 3097 women using a structured questionnaire through a SurveyCTO platform and analyzed using Stata 18. A multi-level mixed-effect logistic regression was used to identify the factors associated with women’s current of PPFP uses and intention to use contraception it in agrarian and pastoral contexts. Results The overall current modern PPFP use was 25.3% (95%CI: 23.8%-26.9%), with significant variations in agrarian (60.6%) and pastoral (0.9%) contexts. Additionally, 37.5% (95%CI: 35.8–39.2%) of women had the intention to use modern PPFP. Injectable and implant contraceptives were the most preferred PPFP methods. Factors influencing both current and future PPFP use included 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 have no access to health facilities (AOR:0.70; 95% CI:0.49–0.99), history of homebirth (AOR:0.53; 95% CI:0.39–0.72), being from pastoral communities (AOR:0.03; 95% CI:0.01–0.06), and being Muslim women (AOR:0.29; 95% CI:0.19–0.46) are less likely to current PPFP use and intention to use contraception. Conclusions Women’s current use of modern PPFP and intentions to use contraception are extremely low in Ethiopia with significant disparities between agrarian and pastoral communities. Improving antenatal care, increasing social support, promoting women's autonomy and transforming gender equitable norms are crucial facilitators for increasing the contraceptive use. Addressing low utilization of PPFP requires culturally tailored interventions for agrarian and pastoral contexts, and promote women's autonomy, and improve service accessibility.