Predictors of postpartum contraceptive use in rural Tigray region, northern Ethiopia: a multilevel analysis

Background: Postpartum family planning services is one of the recommended public health intervention aimed at reducing maternal and child morbidity and mortalities. However, there is a paucity studies in rural Tigray region. Therefore, determining the level and associated factors of contraceptive use among postpartum women has the potential to contribute in achieving the Ethiopian Health Sector Transformation Plan and to the Sustainable Development Goals on maternal and infant survival. Methods: A community-based cross-sectional study was done among 1109 postpartum women from March 29, 2017 to April 29, 2017. Face-to-face interview was used for data collection. The collected data were entered and cleaned using EPI-INFO version 7statistical software and later exported to and analyzed using STATA version 12. Mixed-effects multilevel logistic regression analysis was used to identify the individual and community-level factors associated with contraception adoption. A two side p-value<0.05 was considered to be statistically significant. Results: The level of contraceptive use was 38.3%. Individual-level variables such as women belong to fourth (AOR=1.2; 95% CI: 1.1-3.2) and fifth (AOR = 1.5; 95% CI: 1.3-2.5) wealth quintiles were identified as key predictors of contraception use. In addition, partner secondary (AOR = 2.3; 95% CI: 1.8-3.5) and diploma (AOR = 1.2; 95% CI, 1.1-2.6) educational-level and postnatal care (AOR = 2.0; 95% CI: 1.9, 4.3) were also significantly affected contraception use. Community-level variables such as high community-level antenatal care services use (AOR = 2.1; 95% CI: 1.9-4.2) and proximity of women to health facility (AOR = 3.0; 95% CI: 2.7-4.6) were also determinants of contraception uptake. Conclusions: The status of contraceptive use in rural Tigray region was found to be low. It was found that both individual and community-level variables showed a marked determinant on postpartum contraception use. This study suggested that in order to increase contraceptive use the government should focus on increasing postnatal care, antenatal care services use and reduction of poverty level are important avenues for intervention.