Effect of Women’s Empowerment on Immediate Postpartum Family Planning Utilization in Ethiopia: A Prospective Cohort Study

Abstract Background Immediate postpartum family planning provides an important opportunity to prevent unintended and closely spaced pregnancies and their associated maternal and neonatal risks. Women’s empowerment may influence women’s ability to make and act on reproductive health decisions. However, evidence on the effect of women’s empowerment on immediate postpartum family planning utilization is limited, particularly in Ethiopia. Objective To assess the effect of women’s empowerment on immediate postpartum family planning utilization in Ethiopia. Methods A facility-based prospective cohort study was conducted in selected public hospitals of Arsi Zone from April to June/2026. The study included 212 study participants: 72 in the exposed group and 140 in the non-exposed group. Participants were selected using a systematic random sampling technique. Data were collected using a structured interviewer-administered questionnaire and data extraction checklist. Data were analyzed using STATA version 17. A modified Poisson regression with robust variance was used to estimate adjusted risk ratios (aRRs) with 95% confidence intervals (CIs). Statistical significance was declared at a p-value < 0.05. Finally, the findings were presented using figures, tables, and text. Results Empowered women had a higher likelihood of utilizing immediate postpartum family planning compared with not-empowered women (aRR 2.37, 95% CI; 1.59, 3.52) after adjusting for potential confounding variables. Women’s empowerment was not significantly associated with contraceptive method selection. Conclusion Women’s empowerment was independently associated with immediate postpartum family planning utilization. Strengthening women’s participation in reproductive health decision-making may contribute to increased uptake of immediate postpartum family planning. Healthcare providers should support women’s informed participation in decisions regarding immediate postpartum contraceptive use.