Zewuditu Desalegn ¹ Wako Golicha Wako ^2,3 Nurye Sirage ^4,5* Belda Negesa Beyene ^2,6 ALI YIMER ^7,8 Fassikaw Kebede ^7,8 Sefineh Fenta ^7,8

• ¹ Bule Hora University Teaching Hospital, Bule Hora, Oromia, Ethiopia
• ² Institute of Health and Medical Sciences, Bule Hora University, Bule Hora, Oromia, Ethiopia
• ³ School of Public Health, Institute of Health and Medical Sciences, Bule Hora University, Bule Hora, Oromia, Ethiopia
• ⁴ Woldia University, Woldiya, Ethiopia
• ⁵ Department of Midwifery, College of Health Science, Woldia University, Woldia, Ethiopia
• ⁶ Department of Midwifery, Institute of Health and Medical Sciences, Bule Hora University, Bule Hora, Oromia, Ethiopia
• ⁷ College of Health Science, Woldia University, Woldia, Amhara, Ethiopia
• ⁸ Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia

Background: Contraception use remains low in Ethiopia, particularly within the first year after childbirth. While some women might have medical conditions that limit their contraceptive options, the primary obstacle to wider family planning adoption isn't a specific health problem. Instead, it's the lack of equitable access to high-quality family planning services. This barrier significantly hinders women's ability to make informed decisions about their reproductive health. This study identifies postpartum family planning utilization and its associated factors among postpartum mothers in Bule Hora District.We conducted a community-based cross-sectional study. A multistage sampling technique was employed to recruit a total of 630 women who had given birth. To collect the data, structured, standardized, and pretested questionnaires were used, and the collected data were coded and entered into Epi-data version 4.6. The data was analyzed via SPSS version 25. Both bivariable and multivariable logistic regressions were used to identify factors associated with postpartum family planning utilization.The study found that 71.3% of women utilized postpartum family planning.Significant associations were found between postpartum family planning utilization and various factors, including counseling on family planning during pregnancy (AOR = 1.79, 95% CI 1.61-2.82), delivery (AOR = 2.62, 95% CI 1.56-4.38), and the postpartum period (AOR = 2.71, 95% CI 1. 75-4.21). Women who resumed sexual activity after birth (AOR = 1.92, 95% CI = 1.25-2.96), and had at least four antenatal care visits (AOR = 3.09, 95% CI = 1.61-5.92) were also more likely to use postpartum family planning. Women with grand multiparity were 69% less likely to use family planning methods than primiparity women (AOR =.31, 95% CI.13-.73).Postpartum family planning use in this study was higher than national averages. Factors like parity, counseling during pregnancy, delivery, and postpartum and early resumption of sexual activity were linked to increased contraceptive use. These findings suggest that enhanced counseling during antenatal, delivery, and postnatal care could significantly increase contraceptive use.