Fitsum Tariku Fantaye

Women´s emotional fertility intentions to conceive are an integral part of Reproductive Health (RH) right which can also be considered as decision-mak

In Ethiopia, numerous efforts have been undertaken to control the rapid growth of the population and decrease the average number of births per woman, in the last ten years, though it has not been possible to achieve as much change as was planned and intended in the National Health Sector Transformation Plan (HSTP II) and reproductive health (RH 2015–2020) strategies. The annual growth of the population and fertility rates remained at 2.7 and 4.6, respectively. Fertility is one of the fundamental aspects influencing population dynamics, while women fertility desire to have a child plays a crucial role in determining actual fertility rates and can be acts as an indicator for future reproductive behavior, an insightful tool for grasping broader fertility patterns, and a key element in understanding overall demographic trends. Women’s fertility desire refers to the number of children they want to have in the near future, based on their evaluation of the cost and benefits of childbearing. This analysis used cross-sectional data from Performance Monitoring for Action Ethiopia (PMA-ET) 2021. A total of 4138 married or cohabiting individual women between the ages of 15 and 49 who were not pregnant were included in this analysis. Sampling weighting factor and design were applied in this analysis, and chi-square test statistics were computed to determine the overall association and to assess the adequacy of the cell sample size. Multilevel binary logistic regression was used to identify important predictors of women’s fertility desire. The results were presented as percentages and odds ratios with 95% confidence intervals (CIs). Statistical significance was declared at a significance level of 0.05. Approximately three-quarters (74.1%, 95% CI; 71.5%—76.6%) of reproductive-aged married/cohabiting women in Ethiopia desired to have a child. Remarkably, even among women aged 40 and above and those with six or more children, nearly 40% still reported wanting more children. Fertility desire was also positively associated with having secondary or higher education which is the finding that contrast with previous studies in similar settings. In multivariable analysis, fertility desire was also significantly higher among women who had experienced a forced pregnancy, identified as Muslim, or initiated sexual activity at age 19 or older. Conversely, lower odds of fertility desire were found among older women, those with older partners, higher parity, larger family size, or a history of contraceptive use. The persistently high fertility desire observed in Ethiopia highlights the complex interplay between cultural, religious, and socioeconomic factors, and suggests that simply expanding access to family planning information may not be sufficient to shift reproductive intentions. Policy and program efforts should move beyond a narrow focus on fertility reduction and instead center women’s voices, reproductive autonomy, and contextual realities. Our findings suggest that fertility desire in Ethiopia is shaped more by deeply rooted sociocultural and religious norms than by lack of access to family planning information. Accordingly, policy interventions should focus on engaging communities in meaningful dialogue, understanding and addressing the motivations behind high fertility preferences, and supporting reproductive autonomy for all women, including those who wish to have large families

Women´s index pregnancy emotional fertility intention was measured by asking the pregnant women how they would felt when they learned about their index pregnancy. Emotional health and couples´ communication are key during pregnancy and child birth with simultaneous minimization of reproductive coercion. Emotional fertility intention is critical for healthy and spaced pregnancies, as well as for better maternal and newborns outcomes. Besides, intentions to conceive and emotional fertility intention on pregnancy are the integral parts of women reproductive health (RH) right and can be considered as women decision-making ability over their fertility. Moreover, in low and middle-income countries including Ethiopia where the sole male´s dominance is culturally accepted and socially constructed, males take the lead in each decision making process including household-level decision, determining the family´s fertility and reproductive health service use. This dominance interferes with women fertility intention and their health status including their emotional feeling towards conception. In such a scenario, women are less likely for their say to be heard. Hence, this study aimed to determine pregnant women index pregnancy emotional fertility intention and to identify the associated covariates contributing to it in Ethiopia. This is a very critical step to generate and make actionable evidence available for the health ministry and relevant partners working on reproductive and women´s psycho-social health. This evidence could serve as an action point to empower women regarding their reproductive health right and the control over their fertility. Nationally representative cross sectional baseline data from the Ethiopian performance monitoring for action (Ethiopian PMA) cohort one survey, which enrolled and collected data from currently pregnant and 6 weeks postpartum women were used for this study. This study collected real time data on various sexual, reproductive, maternal and new born nationwide priority indicators using customized Open Data Kit Mobile application. These data were collected using standard pretested questionnaire prepared in English and the three local languages (Amharic, Afan Oromo and Tigrigna) by well experienced resident enumerators. This study was restricted to 2,236 pregnant women at the enrollment. Frequencies were computed to characterize pregnant women, and chi-square statistics was used to assess cell sample size adequacy. Multinomial logistics regression statistical modeling was fitted to identify correlates affecting index pregnancy women´s emotional fertility intention. Results were presented in the form of percentages and odds ratio with 95% Confidence Intervals. Candidate variables were selected using a p-value of 0.25. Statistical significance was declared at p-value of 0.05. The overall proportion of index pregnancy emotional fertility intention of being happy was found to be 67.81%: (95%CI: 65.38, 70.13). The proportion of pregnant women who felt very unhappy was 8% (95%CI: 6.64, 9.5) while 8.45% (95%CI: 7.13, 10.0) and 15.79% (95%CI: 14.01, 17.76) of the pregnant women reported that they felt a sort of unhappy and mixed feelings respectively. Besides, older women, those from the well to do households, those who wanted to have another child were found to have (AOR 95%CI: 2.82 (1.30, 6.13), (AOR 95%CI: 2.05 (1.04, 4.04) and (AOR 95%CI: 2.96 (1.95, 4.52) times increased likelihood of index pregnancy emotional fertility intention of being happy when they have learned about their index pregnancy. The likelihood of index pregnancy emotional fertility intention was found to be AOR 95%CI: 0.34 (0.19, 0.62), (AOR 95%CI: 0.50 (0.32, 0.78), (AOR 95%CI: 0.26 (0.17, 0.40) and (AOR 95%CI: 0.38 (0.25, 0.58) lower among women with high birth order, those who intended to have no more child, among residents of Oromiya and among the residents of the former Southern nations, nationalities and peoples regions. Moreover, the likelihood of index pregnancy women emotional fertility intention of being in a mixed feelings was found to be (AOR 95%CI: 0.62 (0.41, 0.95), (AOR 95%CI: 0.30 (0.13, 0.67) and (AOR 95%CI: 0.33 (0.14, 0.77) among women who attended primary education, those whose desired birth attendant was health professional and family member respectively. The finding that 2/3 of the pregnant women felt happier calls us up to work on intended and spaced pregnancies by ensuring women reproductive and economic empowerment. Region specific and age sensitive activities and efforts that promote intended pregnancy, empower women economically; increase women´s enrollment to secondary education or above and assisting them in identifying their desired birth attendant as part of birth preparedness and complication readiness are hoped to enhance pregnant women index pregnancy emotional fertility intentions. Empowering women economically and improving women educational enrollment were found very critical to address women emotional fertility intention. Installing inter pregnancy preconception care packages in the health care system and postpartum contraceptive counseling’s and provision were found to be the main implications of the study´s findings.

In Ethiopia, despite different attempts to manage rapid population growth and reduce the average number of births per woman, the expected changes outlined in the National Health Sector Transformation Plan (HSTP II) and Reproductive health (RH 2015 2020) strategies have not been fully realized over the past decade. The population continues to grow at a rate of 2.7 and fertility rates remain at 4.6. Fertility is one of the three key aspects in shaping population dynamics, as women’s fertility intention for children play a significant role in determining actual fertility rates. In addition, it can be an instructive tool for discovering more about overall fertility patterns, which is important for understanding future reproductive behaviors. In women, fertility intention refers to their preferences regarding the number of children they wish to have in the future, considering factors such as the costs and benefits associated with childbearing. This study used cross-sectional data from Performance Monitoring for Action Ethiopia (PMA-ET) 2020.The hypothesis tested in this analysis was adapted and used TPB constructs as a guiding behavioral theoretical model. The study included 3916 women aged 15–49 years who were not pregnant. Frequencies and percentages were commuted to characterize women. Chi-square tests were conducted to evaluate associations and assess sample cell size adequacy across categories. Multilevel binary logistic regression statistical modeling was employed to identify important factors influencing women’s fertility intention. The findings were reported in terms of percentages and odds ratios, with 95% confidence intervals. Statistical significance was established at a significance level of 0.05. Three-quarters 74.9% (95% CI; 72.5%—77.1%) of married reproductive-aged women in Ethiopia intended to have a/another child. Women who reported having a forced pregnancy by partner, Muslim and Protestant religion, 19 years and above old at first sex, and secondary or higher education were found to increase the likelihood of fertility intention to have a child. However, women who reported 30 years of age or older, had three or more live births, had a family size of five or more members, had a moderate family planning (FP) knowledge, positive subjective social norm towards FP and living in Addis and Dire Dawa were found to have lower odds of women’s fertility intention. The prevailing strong intention for high fertility in Ethiopia delays efforts to quickly decrease fertility and calls for implementation of multifaceted strategies that maintain high fertility intention rates. Accordingly, demographic and socio-physiological factors were found to affect women’s intention to have children. Awareness of these influencing factors is crucial for designing fertility programs and policies tailored to demographics strategies. Specifically, these strategies should be sufficiently diverse to create a positive social norm toward FP use, which can lead to information sharing, reduced stigma, and community support that can play significant importance in shaping individuals’ fertility intention and reproductive behaviors.

Background: Perceived paternal emotional fertility intentions were measured by asking pregnant women how their husbands felt when they have learnt about the index pregnancy. Paternal emotion during pregnancy and childbirth is imperative for better maternal and newborn health outcomes, though policy and strategic framework has been lacking in Ethiopia. Therefore, this study aimed to explore perceived paternal emotional fertility intentions of their husbands and/or their male partners and examine its correlates among a panel of pregnant women in Ethiopia. Methods: Nationally representative data from cohort one baseline cross-sectional survey were used. A total of 2,115 pregnant women from a total of 217 enumeration areas were included in this further analysis. Frequencies were computed to describe pregnant women. Multinomial logistics regression statistical modeling was fitted to identify correlates of perceived paternal emotional fertility intentions. Results were presented in the form of percentages and odds ratio with 95% Confidence Intervals. Statistical significance was declared at a p-value of 0.05. Result: The proportion of perceived paternal emotional fertility intentions of being a sort of happy and very happy were found to be (35.40%; 95%CI: 33.00%, 37.87%) and (49.03%; 95%CI: 46.48%, 51.6%) respectively. The likelihood of perceived paternal emotional fertility intentions of being very happy was (AOR: 95%CI: 5.06: (1.73, 14.85) and (AOR: 95%CI: 2.65: (1.67, 4.20) times higher among older pregnant women and those who intended having another child respectively. On the contrary, those with higher birth order, who wanted no more another child, those living as a partner and; those residing in Addis Ababa and SNNPR had (AOR: 95%CI: 0.25: (0.15, 0.40), AOR: 95%CI: 0.14: (0.07, 0.27); (AOR: 95%CI: 0.54: (0.33, 0.90), (AOR: 95%CI: 0.34: (0.17, 0.67), (AOR: 95%CI: 0.27: (0.14, 0.53) and AOR: 95%CI: 0.25: (0.15, 0.40) times lower likelihood of perceived paternal emotional fertility intention of being very happy about the index pregnancy respectively. The likelihood of perceived paternal emotional fertility intentions of being a sort of happy was found to be (AOR: 95%CI: 1.93 (1.21, 3.10) times higher among those wanting to have another child. This likelihood was found to be (AOR: 95%CI: 0.62 (0.43, 0.89), (AOR: 95%CI: 0.43 (0.22, 0.85) and (AOR: 96%CI: 0.45 (0.28, 0.74) times lower among those whose desired place of delivery was health facility, with higher birth order and residents of Oromiya region respectively. Conclusion: Half of the pregnant women perceived that their husband felt very happy with calls up on a region specific age sensitive interventions in improving couples communication, and discussion on the spacing and timing of pregnancies as well as to work on improving childbirth preparedness and complication readiness. The ministry and relevant partners need to work strategically on male’s involvement in fertility desire along with emotional care and support. Women with future fertility intention, lower birth orders and those who have not legally married need to be targeted. Installing inter pregnancy preconception care package; improving counseling and provision of postpartum contraceptives; increasing men fertility knowledge and their emotional readiness; and lifestyle adjustment before pregnancy to improve psycho-social health during the perinatal period and paternal emotional fertility intentions are imperative.

Background: Emotional fertility intention and couples communication are key during pregnancy and childbirth with simultaneous minimization of reproductive coercion. Intention to conceive is an integral part of the reproductive health (RH) right and can be considered as decision making on fertility, family wellbeing and the country’s population demographic dividend and composition. However, in low and middle income countries including Ethiopia where males dominance is culturally constructed and socially accepted, males took the lead in every decision making process. In the aforementioned context, women are less likely for their voices to be heard, hence, this study aimed at determining the level of womens´ emotional fertility readiness and its correlates. The finding provided actionable evidence for the ministry and developmental partners working on reproductive and womens´ health so as to be used as an action point to empower women in terms of their reproductive health right to have control over their fertility. Methods: Linked community and facility data with nationally representation from Performance Monitoring for Action (PMA Ethiopia) 2020 Survey Ethiopia except Tigray Region were used for this study. A total of 2,069 current and/or recent contraceptive user women of child bearing age who are currently married/living together as a partner were included in this analysis. Frequency was computed to describe the study participant’s characteristics. Generalized Ordered logistics regression modeling was employed to identify correlates of the hierarchical variation in women fertility intention if they became pregnant. Results were presented in the form of percentages and odds ratio with 95% Confidence Intervals. Candidate variables were selected using p-value of 0.25. Statistical significance was declared at p-value of 0.05. Results: The proportion of womens´ emotional fertility intention of feeling unhappiness was 48.73% (95%CI: 46.21%, 51.23%). On the contrary, 22.88%, 11.36% and 17.03% of them reported that they felt sort of happy, very happy and mixed feeling. An increase in age,10 and above years marriage duration, the type of decision maker for contraceptive use were found to increase the odds of women emotional fertility intention across the higher level categories by (AOR: 95% CI: 6.75 (3.11, 14.62) times higher among elder women aged 35 to 49 years, (AOR: 95% CI: 3.79 (1.72, 8.31) times higher for women with a 10 or more years of marriage duration; and 1.83 (1.03,3.24) times higher for women whose contraceptive use was decided by the health care provide alone. A higher birth order lowered the cumulative odds of womens´ emotional fertility intention symmetrically across the higher level categories by 86% (AOR: 95% CI: 0.14 (0.07, 0.29). Women who wanted to have additional child and whose nearest facility provided 5 or more methods had an increased odds of being in the higher level categories of women emotional fertility intention with disproportional association across the cumulative logit. Accordingly, women whose nearest health facility provided 5 or more methods had an 49% (AOR: 95%CI:1.49 (1.01, 2.19) increased likelihood of being in the mixed or happy category than being very/sort of unhappy category of the emotional fertility intention while the number of methods had no significant association with emotional fertility intention at higher cumulative logit: 1.34 (0.87,2.10). Those who wanted to have an additional child had a 3.16 (2.28, 4.36) higher odds to be in the mixed or happy category than being in unhappy category. Further, this tendency was even stronger at higher categories of emotional fertility intention: 4.83 (3.23, 7.23). Conclusion: Nearly one in two women reported being unhappy while 17.03% felt mixed emotion calling up on intended and spaced pregnancies by ensuring women reproductive and economic empowerment to empower women to have control over their fertility. Activities and efforts that promote intended and spaced pregnancies; and diversifying access to contraceptive methods in the nearest health facilities are likely to improve women emotional fertility intention; and activities that enable women to decide their contraceptive as well. The finding that health care provider decides on women current/recent contraceptive use calls for activities to improve quality of contraceptive use counseling to enable women to decide their contraceptive use by the themselves while the access of diversified methods in the nearby health facility create an opportunity for women to obtain the method they preferred to use and make them emotionally well. These activities are hoped to enable women to plan their fertility thereby increasing their emotional well-being. These activities and interventions need to be tailored across regions and need to be age sensitive.

Introduction In this era of SDG countries relatively achieving maternal and newborn health geographic coverage are moving to a new paradigm called completion of maternal and new born care continuum (MN- CoC). Measuring the influence of significant others: partner/or husband and community engagement are considered as pivotal and one of the pillar strategies to achieve of completion of MN-CoC. Unfortunately, there is a lack of policy framework for partner and/or husband involvement in pregnancy, childbirth and postnatal care and when exists there is a gap in policy and practice in developing countries context. Articulating and endorsing such policy is likely to promote husband and/or partner encouragement and support during at the enrollment to maternal and newborn care continuum (MN-CoC). Hence, quantifying the level of MN-CoC partner dynamics on antenatal care visit and/or discussion about where to deliver the index child at and identifying its correlates among a panel of six weeks postpartum women provides evidence for the policy articulation endeavor by the Federal Health Ministry of the Federal Democratic Republic of Ethiopian and developmental partners working on reproductive and maternal and newborn health care. Methods Community based nationally representative longitudinal data collected from a panel of pregnant and six weeks postpartum women were further analyzed. A total of 2,207 six weeks postpartum women who were married and/or living a partner were included in this analysis which was adequate to yield an unbiased estimates for MN-CoC partner dynamics. Multinomial logistics regression was run to identify correlates of partner Dynamics. Results were presented in the form percentages and odds ratio with 95% Confidence Intervals. Statistical significance was declared at p-value of 0.05. Results The proportion of partner and/or husband dynamics on MN-CoC of among six weeks postpartum women who reported that their partner and/or husband encouraged them to go to clinic for ANC and discussed with them about place of delivery for the index child was nearly 2/3 (64.67%; 62.21%, 67.04%).Besides, nearly one in 5 of them reported that their husband and/or partner did not encourage (18.2%; 16.64%, 20.33) and encouraged either of the first two MN-CoC two domains (17.08%, 15.25%, 19.10%). The region women residing, being in a polygamy marriage, contraceptive ever use history, attainment secondary/higher education and index child delivery place were found to contribute for the variation in MN-CoC partner dynamics. The finding calls up on regionally sensitive activities and efforts with public-private partnership in service provision and targeting women with polygamy which in turn empower women to control over their fertility through increasing higher education enrollment, and diversifying access to contraceptive commodities are hoped to improve MN-CoC partner dynamics thereby enabling women in completing maternal and new born care continuum. Such endeavors and interventions are hoped to facilitate the ministry and other developmental partners’ comprehensive efforts to address the MN-CoC partner and/or partner dynamics in terms of policy articulation, advocacy, implementation, evaluation and revising it to fit its purpose and attain the desired targets. Purpose of Conducting the Study In every community, pregnancy and childbirth are expected to be joyful and positive experiences for the mother, the newborn and as well as for the families, however, neonatal, infant and maternal mortality is unacceptably high in low and middle income countries including Ethiopia. It is experienced not as the joyful event it should be, but as a dangerous and frightening time in their lives. In order to address such considerable problem, in the SDG era the focus of policy articulation, program concentration and research undertaking in maternal and newborn health care has shown a paradigm shift of measuring the completion of maternal, newborn care continuum (MN-CoC) by streamlining resources that were invested independently on each care continuum domains. Besides, WHO recommended completion of the three main domains of the maternal and newborn care continuum as pivotal strategy to improved maternal and new born health outcomes. Accordingly, partner encouragement, support and accompany during antenatal care, childbirth and postnatal care is one of the proposed strategy for pregnant women to be enrolled, retained and complete the maternal and new born care continuum including in sought care in the extended six postpartum period in particular and the inter pregnancy period in general. This is based on the evidence pool on the influence of significant others surrounding the women, notably; the community where they are residing and their partner and/or husband on health service use is considerably high. Determining the level of partner dynamics on the MN-CoC domains and identify its correlates is critical to track the progress of the proposed strategy. Nationally representative data collected from a panel of pregnant and six weeks the six post-partum women were used. Added Value of the Study Nearly 1 in 5 panel of women by their six week postpartum reported that they did not received any encouragement on the two first domains MN-CoC during their index pregnancy. Regional variation was observed in the level of partner dynamics at maternal and newborn care continuum enrollment domains (MN- CoC) and the variation was also explained by contraceptive ever use history as well. Women in polygamy marriage were less encouraged to go to clinic for ANC and lower opportunity to discuss where to deliver the index child with their partner and/or husband. . Implication of the Study The Federal Democratic Republic of Ethiopian Health Ministry and developmental partners need to articulate and endorse male involvement policy with region specific integrated public private strategies which improve women autonomy to control over their fertility and women higher education enrollment with a focus on women with polygamy so as to increase partner dynamics on MN-CoC. Partner encouragement on the first two domains of is key to enroll and retain pregnant women within the MN- CoC. There is a need to strengthen postpartum family planning counseling and diversifying the provision. Similarly women in polygamy needs attention. The need for installing preconception care in the health system to be provided in and around pregnancy and child birth; particularly the inter pregnancy preconception care package.

Women alone contraceptive decisions making has become one of the top burring public health agenda. Despite Contraceptive method options are available and accessible, contraceptive prevalence rate (CPR) in Ethiopia is not far beyond 41%. Evidences showed that the freedom of women to choose the contraceptive method they desired to use is one of the potential determinants for the sluggish pace of increase in contraceptive usage. In this era of sustainable development, determining the level of women own contraceptive use decision making and identifying its correlates is very critical for the ministries and relevant partners’ effort in tracking the achievement of Sustainable Development Goal (SDG) 5.2 by providing actionable evidence through informed decision-making with the aim of improving contraceptive uptake; reducing maternal mortality and improve newborn health. Nationally representative cross-sectional data from Performance Monitoring for Action (PMA) 2021 was used in this study. The sample was restricted among2446 married women who have been using or most recently used modern contraceptive method. Cell sample size adequacy was checked using a chi-square test. Frequency was computed to characterize the study participants. Multilevel binary logistics regression was used to identify factors associated with women own contraceptive use decision making. The findings were presented in a form of frequencies, percentage and as an odds ratio using 95% confidence interval. A p-value of 0.05 was used to declare significance. This study revealed that higher than one in two women (59.49%; 95% CI: 57.7-61.38%) decide their contraceptive use by themselves. What is more interesting is that 1 in 16 women (6.06%) reported that they did not participated in their contraceptive use decision-making.-. Women aged 20 to 24 years; (AOR: 2.51 (1.04, 4.45)), women who stayed10 and above years in marriage; (AOR: 1.73 (1.08, 2.77)), whose husband and/or partner age is 41 and above years; (AOR: 2.14 (1.06, 4.31)) and those who obtained contraceptive method they desired; (AOR: 2.49 (1.36, 4.57)) had higher odds of deciding their current and/or recent contraceptive use by their own. On the other hand, women mixed feeling if they became pregnant at the time of the survey; (AOR: 0.6 (0.44, 0.91)), women who started using contraceptive at younger age, 19 to 24; (AOR: 0.6 (0.44, 0.81)), those who use long acting and/or permanent method; (AOR: 0.54 (0.41, 0.71)) and those married at younger age, 10 to 19 years; (AOR: 0.28 (0.09, 0.86)) had lower odds of independently deciding their current and/or most recent contraceptive use. 59% of women independently decide their contraceptive use which calls up on further improvement to enable each woman to decide by their own, with directing special focus for the 6.06% of women who reported no say in their contraceptive use decision. Activities targeting on enabling women to use the method they preferred, spacing their pregnancy, encouraging women to discuss with their husband on the time and type of contraceptive method they used, advocating and promoting marriage at least to be at the minimum age as indicate by the law and maintain the marriage duration as much as longer are hoped to improve women alone contraceptive use decision making to the fullest.

Background: Family planning decision making is defined as women´s ability to determine the family planning methods that she wanted to use through the process of informed decision making. Despite the availability and accessibility of family planning methods, the utilization rate is not more than 41% in Ethiopia. Evidence and experts have consistently show that women decisions making ability on family planning method they desired to use is one of the possible reasons for this slow rate of family planning use increment. In consideration of this and further motives family planning use decision making has become one of the top sexual and reproductive health related sustainable development agendas. Hence, this study aimed at determining the level, trend and spatial distribution of family planning use decision making among married women and identify factors affecting it.Methods: This study was based on Performance Monitoring for Action (PMA) 2020 cross sectional national survey data. Married women who are currently using or recently used family planning method were included in this study. Frequency was computed to describe the study participants while chi-square statistics was computed to examine the overall association of independent variable with family planning use decision making. To identify predictors of family planning use decision making multinomial logistics regression was employed. Results were presented in the form of percentage and relative risk ratio with 95% CI. Candidate variables were selected using p value of 0.25. Significance was declared at p value 0.05.Results: This study revealed that one in two women (51.2%; 95% CI: 48.8%-53.6%) decide their family planning use by themselves while 37% (36.8%; 95% CI: 34.5%-39.2%) decide jointly with their husband and/or partner. Women alone family planning use decision making increased significantly 32.8% (95% CI: 29.4%, 36.4%) in 2014 to 51.2% (95% CI: 48.8%, 53.6%) in 2020. It also shows variation across regions from scanty in Afar and Somali to 63.6% in Amhara region and 61.5 Addis Ababa. Obtaining desired family planning method was found significantly to improve women alone and joint family planning use decision making. Women who have perceive control and feeling if they get pregnant now were found to be positively associated with women alone family planning use decision making. Discussion with husband, his feeling towards family planning were found positively to influence family planning use joint decision making. Moreover, women religion, was found reducing the likelihood of both women alone and joint family planning use decision making while experiencing side effect reduces the likelihood of joint family planning use decision making.Conclusion: Half of the women independently decide their family planning use which calls up on further improvement. Family planning use decision making ability is expected to be improved by efforts targeted on husbands’ approval on wife’s family planning use, discussion on family planning use with husband/partner, improving women psychosociological readiness and trust on her own to decide her desired family planning method; informing the possible side effects and what to do when they encountered during their family planning use visit. In addition, influencing women on the use of family planning via religious leader will help much in this regard. Monitoring and evaluating reproductive health policy 2021 to2025 and addressing bottlenecks which hinder women decision making health service use is hoped to improve women family planning use decision making. Further qualitative study to identify and address factors that contribute for the variation across regions also help much.