Background: Maternal health problems remain a major global concern since pregnancy and childbirth are the leading causes of morbidity and mortality among reproductive- age women who have recently given birth and are among the group with the highest unmet need for contraception. After a woman has given birth, she should stay for at least two years before the next pregnancy to reduce the risk of adverse maternal, pre-natal, and infant outcomes. However, postpartum modern contraceptive utilization was not studied in the study area. Objectives: It aimed to assess the postpartum modern contraceptive utilization and associated factors among women who gave birth at health facilities in Sude district, Arsi Zone, Oromia, Ethiopia, 2023. Methods: An institution-based cross-sectional study design was conducted from February 30 to April 30, 2023. The study participants were selected by systematic random sampling. An interviewer-administered structured questionnaire was used to collect data. After checking for its completeness, the data were entered, checked for missing values and outliers by Epi-info Version 7.2, and then exported to Statistical Package for Social Sciences (SPSS) version 25 for analysis. Data were analyzed using descriptive statistics to characterize the study participants. Binary logistic regression analysis was undertaken to identify factors associated with postpartum modern contraceptive utilization. Variables with p-value < 0.25 in bivariate analysis were considered for multiple logistic regression. Variables with a p-value < 0.05 were considered statistically significant. An adjusted odds ratio (AOR) along with 95% confidence intervals (CI) was calculated to estimate the magnitude of associations. Results: Out of 419 planned, 417 participated with a response rate of 99.5%. This study revealed that 57.6% [95% CI: (52.9, 62.4)] of postpartum women utilized modern contraceptives. Among the utilizers, injectables (50.8%), implants (39.2%), and pills (10%) were used. Having > 4 children [AOR = 2.02, 95% CI: (1.09, 3.77)], ≤ 2 hours far away from home to the health facility [AOR = 2.54, 95% CI: (1.49, 4.34)], between 6 to 12 months of postpartum period [AOR = 3.41, 95% CI: (1.89, 6.15)], resumption of menses [AOR = 8.24, 95% CI: (4.64, 14.64)], para 2-4 [AOR = 3.10, 95% CI: (1.53, 6.29)], and discussing postpartum family planning with a partner [AOR = 2.96, 95% CI: (1.72, 5.09)] were significantly associated with postpartum modern contraceptive utilization. Conclusion: Postpartum modern contraceptive use was low as compared to other studies. The factors associated with postpartum modern contraceptive use were: the number of children, distance from home to health facility, postpartum period, parity, and menses returning since birth, and discussing postpartum family planning with a partner. Healthcare providers should give health information about timely contraceptive usage, fortify the integration of modern contraceptive services with maternal and child health services, and encourage postpartum family planning discussions among couples.

The authors have declared no competing interest.

The author(s) received no specific funding for this work.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

First, ethical clearance was obtained from the Institutional Review Committee of Rift Valley University. Then, letters of permission were sought from the Sude Woreda Health Office. Following approval of ethical clearance and permission to conduct the research in the selected health facilities of the Sude District, verbal informed consent was obtained from each respondent, after giving a clear explanation about the objectives and procedures of the study before the actual data collection. A right thumbprint was received as a signature for respondents who couldn't read and write. Respondents under the age of eighteen had their consent obtained from their parents or legal guardians. The respondents were told that their participation was purely voluntary and that their rights to not respond at all were respected and their confidentiality and privacy were assured by arranging a suitable place for the interview and ensuring data were accessible to only the principal researcher.

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