| Sumario: | Background: Women's empowerment significantly influences maternal and child health by enhancing access to healthcare and enabling autonomous reproductive decisions, including timely family planning during postpartum. However, in Ethiopia, the specific role of contraceptive empowerment in postpartum family planning (PPFP) use remains insufficiently studied despite the low level of women's empowerment. Objective: To assess the effect of contraceptive empowerment on PPFP use in Ethiopia. Design: A community-based panel study design. Methods: We used the panel data from Performance Monitoring for Action Ethiopia (2021–2023), which followed 1759 pregnant women aged 15–49 years from four regions of Ethiopia. The analytic sample is restricted to non-pregnant women who completed the interview at 1 year postpartum. Contraceptive empowerment was assessed using five items on a 5‑point Likert scale, whereas PPFP use was measured through yes/no question regarding modern contraceptive use at 1 year postpartum. A mixed-effect multilevel multivariable logistic regression model was employed, and p -value of 0.05 was used to determine the statistical significance. Result: PPFP use at 12 months of postpartum is significantly higher among women reporting high and medium contraceptive empowerment during pregnancy, compared to low contraceptive empowerment (AOR: 1.8, 95% CI: 1.3–2.6) and (AOR: 1.7, 95% CI: 1.2–2.3) respectively. In addition, women whose birth was attended by a skilled birth attendant (AOR: 1.7, 95% CI: 1.3–2.4), lower parity (1: AOR: 4.5, 95% CI: 2.5–8.1, 2–4: AOR: 2.1, 95% CI: 1.3–3.3 compared to ⩾5), and those who previously used contraception (AOR: 3.8, 95% CI: 2.8–5.4) were more likely to use PPFP; women residing in Amhara (AOR: 0.4, 95% CI: 0.1–0.8) and Oromia regions (AOR: 0.4, 95% CI: 0.1–0.8) had significantly lower use of PPFP. Conclusion: Contraceptive empowerment during pregnancy predicted PPFP use at 12 months of postpartum. Higher contraceptive empowerment at pregnancy significantly increases the use of PPFP at 1 year postpartum in Ethiopia. The findings highlight the need for targeted interventions to enhance contraceptive empowerment prior to, during, and after pregnancy; strengthen skilled birth attendance and address regional disparities for equitable and sustained PPFP use. Plain language summary: Contraceptive empowerment and post-partum family planning in Ethiopia This study explored how women's empowerment in making contraceptive decisions influences the use of family planning after childbirth in Ethiopia. Family planning during the postpartum period is critical for maternal and child health, yet uptake remains uneven across the country. Using data from the Performance Monitoring for Action Ethiopia project (2021–2023), researchers followed 1,759 pregnant women across four regions and analyzed their contraceptive use one year after delivery. The findings show that women who reported medium or high levels of contraceptive empowerment during pregnancy were significantly more likely to adopt family planning methods postpartum compared to those with low empowerment. Empowerment here refers to women's confidence, autonomy, and ability to make informed choices about contraception. Other factors also played a role: women attended by skilled birth attendants, those with fewer children, and those with prior contraceptive experience were more likely to use postpartum family planning. In contrast, women living in Amhara and Oromia regions had lower rates of use, highlighting regional disparities. Overall, the study demonstrates that strengthening contraceptive empowerment during pregnancy can have lasting effects on family planning uptake after childbirth. It suggests that interventions should focus not only on expanding access to services but also on building women's decision-making power, supporting skilled birth attendance, and addressing regional inequalities. These efforts could contribute to more equitable and sustained improvements in maternal and child health outcomes in Ethiopia.
|
|---|