Prevalence and predictors of khat chewing among pregnant women in Ethiopia: Insights from a national health survey

Background Khat (Catha edulis) consumption has been associated with a range of biological, social, and psychological complications. Despite these known risks, national estimates of prevalence, patterns, and factors associated with khat use among pregnant women in Ethiopia remain poorly understood. This study aimed to address this gap by examining the prevalence and predictors of khat chewing among pregnant women using nationally representative data. Methods We analyzed data from the 2016 Ethiopian Demographic and Health Survey (EDHS), focusing on the couples’ recode file. A total of 727 pregnant women with complete data on khat use and partner information were included. Khat chewing status was defined as ever having chewed khat. Descriptive statistics and chi-square tests were used to examine bivariate associations. Multivariable logistic regression was performed to identify independent predictors. Results The prevalence of khat chewing among pregnant women was 12.5%. It was higher among women aged 25–34 years, Muslims (89.0%), and those whose partners chewed khat (87.9%). In adjusted analysis, women aged 25–34 had twice the odds of khat chewing compared to those aged 15–24 (AOR = 2.02; 95% CI: 1.10–3.81; p = 0.025). Women in the middle wealth category had higher odds than those in the poor category (AOR = 2.31; 95% CI: 1.11–4.80; p = 0.025). Partner khat chewing was strongly associated with maternal use (AOR = 15.55; 95% CI: 6.54–43.11; p < 0.001). Maternal smoking showed a large but statistically non-significant positive association (AOR = 5.40; 95% CI: 0.78–35.82; p = 0.078). Conclusion Khat chewing during pregnancy is influenced by maternal age, middle household wealth, and particularly partner behavior. These findings highlight the need for targeted, culturally sensitive interventions integrated into maternal health programs that engage couples, address relationship dynamics, and consider socioeconomic and age-specific risk factors to reduce khat use and improve maternal and fetal outcomes.