From integration to use: a qualitative study of barriers and facilitators to postpartum family planning use in northeast Ethiopia-a multistakeholder perspective.

BACKGROUND: Although postpartum family planning (PPFP) is widely implemented in every health facility, many pregnancies are still unintended and closely spaced, contributing to maternal mortality. This study aimed to explore the barriers and facilitators of postpartum contraceptive use in northeast Ethiopia. OBJECTIVE: To explore barriers and facilitators to PPFP use in northeast Ethiopia. STUDY DESIGN: A qualitative study was conducted in northeast Ethiopia. A total of 13 in-depth interviews and 12 key informant interviews were conducted among different stakeholders. Participants were recruited using a heterogeneous purposive sampling technique. Data were collected through semi-structured interview guides until data saturation was achieved. The study was conducted from March to April 2023. All audio recordings were transcribed into Amharic, and the verbatim transcripts were translated into English. The data were coded, subcategories identified, and organized into main themes-conventional content analysis with an inductive approach using ATLAS. TI version 7 software was done. RESULTS: The barriers to postpartum contraceptive use were health system constraints, service provider attitudes and competencies, limited knowledge and misconceptions among women, socio-cultural challenges, obstacles to health service utilization, and security problems, whereas the facilitators were strong community support, use of women's development groups and conferences, regular offsite mentorship, donor support, and involvement of satisfied role model family planning users. CONCLUSION: The barriers to contraceptive use identified were service provider-related gaps, limited knowledge, security problems, misconceptions, inconsistent contraceptive supply, socio-cultural problems, health system, and community barriers. Regular offsite mentoring, donor support, and engagement of women's development groups were the facilitators of PPFP use.