Effect of pregnancy intention on postpartum contraceptive use in Ethiopia: a national longitudinal study using propensity score methods.

BACKGROUND: Unintended pregnancy continues to be a major global public health challenge, with over three-fifths resulting in induced abortion. To reduce unintended pregnancies and associated consequences, providing effective postpartum contraception is crucial. Despite the high rates of unintended pregnancies and low postpartum contraceptive use in Ethiopia, the influence of pregnancy intention on postpartum contraceptive use remains inadequately explored. This study aimed to examine the effect of pregnancy intention on postpartum contraceptive use in Ethiopia at six weeks, six months, and one year postpartum. METHODS: Longitudinal survey data from the Performance Monitoring for Action (PMA) Ethiopia survey were used for this analysis. The analysis included randomly selected pregnant women and those in the early postpartum period who participated in the baseline survey and completed the follow-up surveys. The data were collected from selected regions of Ethiopia between 2019 and 2021. We used inverse probability of treatment weighting based on propensity scores to address the imbalance of baseline confounders between women with intended pregnancies and those with unintended pregnancies. Odds ratios (OR) with 95% confidence intervals (CI) were estimated using a logistic regression model with inverse probability of treatment weights. RESULTS: Women with intended pregnancies had higher odds of using postpartum contraceptives at six weeks (OR = 1.51, 95%CI: 1.05-2.17), and at six months postpartum (OR = 1.29, 95% CI: 1.06-1.57). Similarly, women with intended pregnancies had a higher likelihood of using postpartum contraceptives at one year postpartum (OR = 1.49, 95% CI: 1.13-1.96) compared with women with unintended pregnancies. CONCLUSION: Postpartum modern contraceptive use remained suboptimal across the postpartum period, regardless of pregnancy intention. Women with intended pregnancies demonstrated higher odds of contraceptive uptake at six weeks, six months, and one year postpartum. Sexual and reproductive health services, particularly family planning access for all women, should be strengthened. Targeted strategies such as early identification and linkage to care are needed to address the specific contraceptive needs of those who have experienced unintended pregnancy.