One Year Postpartum Emotional Fertility Intentions among a Cohort of Pregnant Women followed for 2 Years and its Correlates in Ethiopia: Community based longitudinal data from Performance Monitoring for Action; Generalized Ordered Logistics Regression Modeling

One Year Postpartum Emotional Fertility Intentions among a Cohort of Pregnant Women followed for 2 Years and its Correlates in Ethiopia: Community based longitudinal data from Performance Monitoring for Action; Generalized Ordered Logistics Regression Modeling | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article One Year Postpartum Emotional Fertility Intentions among a Cohort of Pregnant Women followed for 2 Years and its Correlates in Ethiopia: Community based longitudinal data from Performance Monitoring for Action; Generalized Ordered Logistics Regression Modeling Solomon Abrha Damtew, Solomon Shiferaw, Mahari Yihdego Gidey, and 11 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4414137/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Emotional health and couples communication are key during pregnancy and childbirth with simultaneous minimization of reproductive coercion which should be maintained in the postpartum period to maintain inter pregnancy period healthy and make the next pregnancy planned and successful. The postpartum period is key in the newborn development milestone and maintain maternal health. Women intentions to conceive are an integral part of Reproductive Health (RH) right and can be consider as decision making on their fertility control. However, in low and middle income countries including Ethiopia where male dominance is culturally constructed and socially acceptable, males take the lead in every decision making process for the family ranging from house level decision including to determine number of children that the family and new born RH rights and RH health service use. In such a scenario women may say not have heard likely hence, this study aimed at determining the level of women emotional fertility readiness and its correlates so as to avail actionable evidence for the ministry and partners working Reproductive and women health so as to be used as an action point to empower women on their reproductive health right to control their fertility. Methods: Nationally representative 2-year cohort data collected from pregnant women in four rounds were used. Frequency was computed to describe the study participant’s characteristics. Generalized ordered logistics regression was employed to identify correlates of the hierarchical variation in one year postpartum women fertility intention if they became pregnant. Results were presented in the form percentages and odds ratio with 95% Confidence Intervals. Candidate variables were selected using p-value of0.25. Statistical significance was declared at p-value of 0.05. Results: One in 20, (4.63% (3.60%, 5.94%)) postpartum women have reported that they felt very happy. Nearly two third 64.87% (62.20%, 67.45%) of one year postpartum women have reported that they very or a sort of unhappy by one year post-partum when asked what do they feel if they became pregnant. Nearly one in 6, (17.12% (15.15%, 19.29%)) women reported mixed feeling in the same period. Women who reported they have ever used contraceptive and those who reported that they have started contraceptive use one year postpartum had a proportional cumulative logit of 0.66 (0.44, 0.97) and 0.43 (0.29, 0.63) respectively across the higher level categories of one year postpartum women emotional fertility intention compared with their counter parts. The likelihood of one year postpartum emotional fertility intention among women with higher birth order and those who do not wanted additional child was found lower and asymmetrically across the higher level categories. Conclusion: Nearly 2/3 of one year post-partum women have reported very unhappy or a sort of unhappy if they became pregnant while one in 6 and one in five felt mixed feeling if they became pregnant one year postpartum respectively calls up on intended and spaced pregnancies by ensuring women reproductive decision making to control over their fertility. Activities and efforts that promote intended and spaced pregnancies; and diversifying access to contraceptive methods are likely to improve the level of one year postpartum women emotional fertility intention. Activities that enable women to decide their contraceptive use along with patient centered contraceptive use counseling as well. The implication the findings is that awareness creation on preconception and availing the service is also hoped to address the varying level of one year postpartum emotional fertility intention. Women Health Cohort Study One year postpartum Fertility Intention PMA Ethiopia Figures Figure 1 Background Emotional health and couples communication are key (1) during pregnancy and child birth with simultaneous minimization of reproductive coercion (2). It should be maintained in the postpartum period to maintain inter pregnancy period healthy and make the next pregnancy planned and successful in particular and women reproductive health and child health in general (3, 4). The postpartum period is key in the newborn development milestone and maintain maternal health and an serves as an entry point to provide the inter pregnancy maternal and newborn heath continuum (5) as well as preconception care in the inerter pregnancy period (6). In low and middle income countries fertility desired is determined by the husband (7).and male dominance in decision making as far sexual and reproductive health concerned (7-10) which negatively affects women intentions to conceive. Further evidence also showed that discordance in fertility desire among couples (11). Women intentions to conceive is an integral part of reproductive health (RH) right and can be consider as decision making over their fertility. However, in low and middle income countries including Ethiopia where males dominance is culturally accepted and socially constructed, males take the lead in every decision making process for the family; ranging from household level decision including to determine the family size; women and new born reproductive (RH) rights and RH health service use. In such a scenario women may not have their say heard and voice respected. As a result women are likely to hold negative and unpleasant feeling and emotion when every they thought if they became pregnant of or learned they become pregnant (9). The unproportional huge burden of raising children experienced most women in developing countries coupled with family leading burden including domestic chores women tend to hold negative emotion for every additional child they are going to bear. Unless evidence is generated action take such unpleasant filling exacerbates the fertility rate and population dynamics being in midst of rapid population growth (7, 12, 13). Male dominance in fertility control force women to give birth of many children contributing its share for the Ethiopian population to be one of the top growing population in Africa. The ministry of health and the government of Ethiopian have been showing commitments to make the population growth in line with the country´s economic growth and development through provision of contraceptive commodities free of charge and advocating spaced and intended pregnancies (14-16). Unfortunately, over the last decade or so it has not been feasible to achieve the desired level of change in fertility level as was planned and intended in the national health sector transformation plan (HSTP) and reproductive health (RH) strategies (3, 17, 18) (19). Lack of women emotional fertility intentions in general and in the postpartum period towards fertility and child bearing is likely to contribute for such sustained higher fertility rate and subsequent health and economic effects (20, 21). To this end, one year postpartum women fertility intention, how would they feel if they became pregnant in the inter pregnancy interval, one postpartum less explored and there is a dearth of evidence. Such an emotion or feeling in might be related with religion and culture acceptability of large families (22). Hence, determining the degree of one year postpartum women emotional fertility feeling and identifying its correlates contributing for such hierarchical variation will provide actionable evidence to mitigate the fertility surge by promoting continuum of care and preconception care in the postpartum period. Methods and Data Sources Study Design and Population and Sample Size Nationally Representative 2 year cohort data collected from pregnant women in four rounds was used. After the complete census was conducted in the selected enumeration areas all pregnant women with gestational age of 1 to 9 months who were either usual residents in the selected EAs or who came to the EA to deliver were enrolled and followed one year post from the selected randomly 35 households per EA were interviewed for the female questionnaire. A total of 1,703 pregnant women of child bearing age were included in this analysis. This analysis was restricted to women who were married or live together and completed all the three follow up interviews with complete response for the one year post-partum pregnancy reaction question (How would you feel if you became pregnant now). The overall sample size and cell sample size adequacy was checked and found adequate to generating unbiased estimates for the one year postpartum women emotional fertility intention variable. Data collection and Field Work. A merged cohort one data consisting baseline data, six week, six month and one year data from cohort one PMA survey conducted from 2019 to 2021 was used for this study (23). A two stage stratified cluster sampling method was used to select enumeration areas. The first field work of the pane baseline survey was screening pregnant women and women who were less than 6 weeks post-partum. A two stage stratified cluster sampling method was used to select enumeration areas. Complete census was conducted in the selected enumeration areas followed by selection of 35 households per enumeration area using simple random sampling. Data were collected at baseline and three follow up points, 6 week, 6 month and one year postpartum. It was executed by Addis Ababa University’s School of Public Health in collaborative efforts with the Ethiopian Public Health Association with assistance from the Federal Ministry of Health, Central Statistical Agency, Bill & Melinda Gates Institute for Population and Reproductive Health (Johns Hopkins Bloomberg School of Public Health), and the source of funding is from Bill & Melinda Gates Foundation. The main sample units or enumeration areas (EAs) were chosen using the frame to Ethiopia Population and Housing Census (PHC), which was performed in 2019 by the Ethiopia Central Statistical Agency. A total of 162 EAs were chosen in the first stage, with Independent selection in each sample stratum and a probability proportional to EA size. All pregnant women between the ages of 15 and 49 who were either long-term residents of the chosen households or who come to deliver there they were screened using enrollment criteria and those found eligible were consented to participate in the baseline line interview. The protocol Of PMA Ethiopia contains all the details on sample design and selection methods. More detail in the details on sampling design and selection procedures and field work implementation was described well elsewhere~. The protocol Of PMA Ethiopia contains all the details on sample design and selection methods. More detail in the details on sampling design and selection procedures and field work implementation was described well elsewhere (23). Variables: Outcome variable One year postpartum Women Emotional fertility intention/desire is the main outcome variable. It was measured by a single likert scale question with 5 scales as shown below in table ( Table 1 ). Women were asked if you get pregnant now how you would feel with the five response options show in the table below. For seek of getting a meaning out this specific scale of measurement the scale was reverse that the very happy category gets the larger value on the scale and the very unhappy labeled as the smallest value in the scale since women were asked in the reverse order and the question is asked in a positive way. Independent Variables Independent variables were classified into individual-level variables and enumeration area-level Variables. Individual-level independent variables further categorized into socio demographic/economic characteristics variables, parity and other RH characteristics, knowledge on contraceptive related characteristics, husband related characteristics. Group or enumeration area (EA) level variables included two integral variables namely, region and place of residence and “Region” was grouped into four categories 3= Amhara, 4=Oromia, 7= SNNPRs and 10= Addis Ababa city administration. Place of residence follows the default urban/rural classification. Analysis and Measurement A merged cohort one data consisting baseline data, six week, six month and one year data from cohort one PMA survey conducted from 2019 to 2021 was used for this study. The data was merged using a unique participant ID given at enrollment/baseline and recorded in each visit. Repeatedly asked questions in every follow up survey were renamed by giving a prefix 6W, 6M and OY for questions asked in all the six week, six month and the one year postpartum interviews during the data preparation stage before merging. Frequencies and percentages were computed to characterize the study population. Chi-square test statistics was computed to check cell sample size adequacy and the sample size was found to be adequate to provide unbiased estimates. Exploratory data analysis was run for data cleaning thereby checking item nonresponse rate for every variable and don’t know response which were later excluded from the analysis. Following this variable were recoded to create biological plausible categories along with checking distribution of the recoded variables using mean and proportion. Composite variable was created; namely, women perceived risk about contraceptive methods, and knowledge on contraceptive methods. Integral, facility related factors/group level variables such distance from the nearest health facility, type of the nearest facility, method type provide by the nearest health facility and method stock out in the nearest health facility. Generalized Ordinal logistics regression, (partial proportional odds model) was used to identify important correlates of one year postpartum women emotional fertility intention, what did they felt if they became pregnant one post-partum following the index birth. At bivariate analysis a p value cut of 0.25 was used to select candidate variable for multilevel multivariable logistics regression analysis. Results were presented in the form of percentage, and odds ratio with 95% CI. Significance was declared at a significance level of 0.05. Results were reported based on weighted count and One year follow up weight was applied.Unlike the conservative ordered logistics regression the GOLR is relaxes the assumption of proportional odds for some variables (24). Since practically the parallel line assumption is most of the time violated using the generalized ordered model entertains this practical phenomenon. It can be less restrictive than proportional odds models and more parsimonious than methods that ignore the ordering of categories altogether (24). Hence, generalized Ordinal logistic regression was utilized to determine the correlates of the women emotional pregnancy intention (24, 25). Data Quality Management and Control Data completeness for variables and items for creating composite variables was checked by exploratory data analysis following which any item nonresponse was excluded from the analysis. Frequency run to exclude responses with do not know (DNK) and no response (NR). PMA Ethiopia used of standard and pretested tool, intensive training with mock interviews for resident enumerators was provided, close supervisor during filed work, timely progress report and correction, 10% random check were some of the modalities used to maintain the quality of the collected data, the detail is reported somewhere else (23). Result Magnitude of One Year Postpartum Emotional Fertility Intention among a cohort of pregnant women followed for 2 years and its correlates in Ethiopia: using Community based longitudinal data from Performance Monitoring for Action 2019 to 2021 This study reported the proportion of one year postpartum emotional fertility intention when women were asked how they would feel if they became pregnant one postpartum among pregnant women who were enrolled and followed for 2 years. Nearly one third 31.0% (28.4%, 33.66%) and 34.0% (31.36%, 36.52%) of the women followed for 2 years reported that they felt very or sort unhappy by one year post-partum when asked what do they feel if they became pregnant respectively. Similarly 17.12% (15.15%, 19.29%) for mixed feeling while 13.38% (11.63%,15.34%) felt sort of happy and one in 20 women 4.63% (3.60%,5.94%) reported that they felt very happy when asked what would they feel if they become pregnant one year postpartum. The proportion of enrolled pregnant women followed for two women who felt a sort of or very of happy when asked if the they become pregnant by one year postpartum was 18.01% (16.00%, 20.20%. Nearly two third 64.87% (62.20%, 67.45%) reported that they very/a sort of unhappy by one year post-partum when asked what do they feel if they became pregnant. Nearly one in 6, 17.12% (15.15%, 19.29%) women reported mixed feeling one postpartum (Fig 1). Distribution of One Year Postpartum Emotional Fertility Intention among a cohort of pregnant women followed for 2 years and its correlates in Ethiopia: using Community based longitudinal data from Performance Monitoring for Action 201 to 21 This study reported the proportion of one year emotional fertility intention when women were asked how they would feel if they became pregnant one postpartum among pregnant women who were followed for 2 years. Among women in the age category 45 to 49 years 39.75%, 34.79%, 15.80%, 6.98% and 2.68% reported that they felt very unhappy, sort of un happy , mixed happy and unhappy, sort of happy an very happy respectively when asked how do you feel if got pregnant know. Similarly, of women in the secondary or above category the proportion of those felt very unhappy, sort of un happy , mixed happy and unhappy, sort of happy an very happy was 27.84%, 29.68%,24.42%, 17.73% and 6.33% respectively . This same figure for women belonging in the households with lowest wealth quintile was 25.62%, 37.39%, 14.43%, 17.14% and 5.42% for the respective feeling categories. For residents of Tigray region 62.87%.,12.25%, 8.18%, 13.74% and 2.95% of women were very unhappy, sort of un happy, mixed happy and unhappy, sort of happy an very happy respectively. Likewise, for urban residents this similar figure for the respective feeling categories was 27.92%, 29.61%, 24.26%, 14.34% and 4.83% For Muslim religion followers this respective figure stood 31.60%, 29.11%, 17.63%, 15.25% and 6.42% respectively. Likewise among those women who reported that they married more than once 1/3 (32.14%), 33.05%, 17.32%, 12.31% and 4.91% reported that they felt very unhappy, a sort of unhappy, mixed un/ happy, a sort of happy, very happy respectively by one year postpartum ( Table 2 ). The proportion of one postpartum women emotional fertility intention among those with higher birth order was 1/3 (37.22%),33.94%,13.44%, 12.26% and 3.14% for the feeling categories very unhappy, sort of unhappy, mixed happy/unhappy, sort of happy and very happy respectively. Similarly, this same for women did not know or decide whether to have a child was 1/4 (24.07%), 34.17%, 25.75%, 11.02% and 4.99 % respectively. Likewise, among women who reported husband has other wifes 1/4 (26.28%),35.51%, 20.16%, 12.85% and 5.20 % were very unhappy, a sort of unhappy, in mixed happy and unhappy feeling, a sort of happy and very happy. Among those women who reported a larger family size of 6 to 14, the proportion of very unhappy and sort of un happy was 38.79% and 30.75% while mixed happy/unhappy, sort of happy and very happy accounted 15.15%, 12.74% and 2.56% respectively This same figure was 1/4 (28.87%), 32.07%, 17.37%, 15.63 % and 6.05 % among those perceived that their husband were very happy their most rent pregnancy respectively ( Table 2 ). Concerning contraceptive ever use among those who responded that they have ever used contraceptive in their life time 33.16%, 35.45%, 16.40%, 11.40% and 3.59% felt very unhappy, sort of unhappy, mixed happy/unhappy, sort of happy and very happy respectively. Similarly, among those who reported that the are currently using contraceptive on year postpartum; this respective figure for the feeling categories was 30.53%, 39.97%, 17.80%, 8.83% and 2.87% ( Table 2 ). The proportion of one postpartum women emotional fertility intention among those who reported that they have experienced at least one form of physical and/or sexual violence at enrollment was 4 in 10 (39.72%), 35.41%,11.63%, 11.06% and 2.18% for the feeling categories very unhappy, sort of unhappy, mixed happy/unhappy, sort of happy and very happy respectively. Similarly, among those who reported that they have experienced at least one form of physical and/or sexual violence at six week postpartum 4 in 10 (38.67%), 32.23%,13.96%, 11.16% and 3.97% felt very unhappy, sort of unhappy, mixed happy/unhappy, sort of happy and very happy respectively ( Table 2 ). Last but not least, among those who desired place of delivery was home or not decided at baseline, 3 in 10 (28.91%), 37.11%,14.66%, 13.74% and 5.58% felt very unhappy, sort of unhappy, mixed happy/unhappy, sort of happy and very happy respectively while this same figure for those whose baseline preferred birth attendant was traditional birth attendant (TBA), 3 in 10 (29.28%), 31.81%,15.81%, 17.96% and 5.14% felt very unhappy, sort of unhappy, mixed happy/unhappy, sort of happy and very happy respectively ( Table 2 ). Correlates of One Year Postpartum Emotional Fertility Intention among a Cohort of pregnant women followed for 2 years and its correlates in Ethiopia: using Community based longitudinal data from Performance Monitoring for Action 2019 to 21 This study has investigated and reported the one year postpartum hierarchal variation of women emotional fertility intentional feeling and factors contributing among a cohort of pregnant women who were followed for 2 years. This outcome variable was measured with 5 items ordinal scale and later categorized in to three ordinal categories (very unhappy/Sort of unhappy, mixed happy and unhappy and very happy/sort of happy) using generalized ordered model which gave us two cumulative logit for (for the very unhappy/Sort of unhappy vs. mixed happy and unhappy categories and the happier category; and for the very unhappy/Sort of unhappy and mixed happy and unhappy categories vs. the happier category). The re categorization was need for the seek of cell sample adequacy ( Table 3). The two variables namely, women baseline fertility desire and higher birth order have disproportional association across the cumulative logit of being in the upper/high rank categories of one year postpartum women emotional fertility intention, leading asymmetrical cumulative logit. The association was presented separately for the two of these independent variables since it’s the same for all other variables which met the parallel lines assumption ( Table 3). Since these two Independent variables were found to violate the proportional odds assumption, hence, generalized ordered logistics regression run. The generalized logit model is also called cumulative logit as it determines the cumulative probability of being in different combination of the higher level categories of the outcome variable is this case, one postpartum women fertility intention feeling result was reported (Table 3). The two variables namely, fertility desire and parity have no similar association across the cumulative logit of being in the two higher upper ranking categories of one year postpartum women emotional fertility intention, leading asymmetrical cumulative log it. Hence, the asymmetrical effect of fertility desire in the higher emotional fertility intention categories is as follows: 37% 0.63 (AOR:(0.41, 0.97)) and 58% (AOR 0.42 (0.22, 0.83)) lower odds among those who had one to two child and for women who had 3 to 14 children respectively as compared with those no child for the unhappy category while birth order dose not significantly affected one year postpartum mixed emotional feeling category. Similarly, women who reported they do not wanted no more child at one year postpartum had 49% 0.51 (0.29, 0.89) reduced odds to be in the very unhappy level of fertility emotional intention category while no effect (AOR: 0.26 (0.22, 1.40) for the level of mixed fertility emotional intention category ( Table 3). The likelihood of one year postpartum women to be in the higher level women fertility intention feeling categories was found to be 34% (AOR: 0.66 (0.44, 0.97)) lower among women who reported that they ever used contraceptive compared with non-ever users. Similarly, women who reported that they have started using contraceptive one year postpartum had proportional cumulative logit (AOR: 0.43 (0.29, 0.63)) of being in the higher level of women emotional fertility intention one postpartum compared with those pregnant who were enrolled and followed for two years but did not commence contraceptive use by then ( Table 3). Discussion Only results for two independent variables presented in both higher categories of women emotional fertility intention categories since these two independent variables are the only variables that violated the assumptions of ordinal logistic regression. For the rest of the variables include in the model, the assumption is fulfilled, and the estimates are the same across the cumulative logits of the higher level categories of women emotional fertility intention. In countries like Ethiopia where male dominance in household decision making in general and on fertility and reproduction decisions in particular and culturally accepted and social constructed investigating the factors affecting the level of women emotional feeling when they learned their index pregnancy and identifying the factors contributing for this variation has paramount importance to build and sustain a health and healthy family. In midst of the SDG period, measuring pregnant women index pregnancy emotion as measure of their reproductive health right and decision making on their reproductive life/health is hoped to generate and provide an actionable evidence for the ministry and relevant actors to improve women decision making on their desired fertility in particular and reproductive health right in general which in turn contributes for SDG 5.6.1. Due to the dearth of empirical evidence which exactly fit our research title the authors are forced to use look additional alternative evidence for discussion including findings from fertility intention studies. In addition to the conventional discussion write up methods the authors also use an indirect method of discussion such us comparing the finding with accomplishment goals stated national and international relevant policy and program endorsed documents and targets such the success and challenge of the Ethiopian health extension program, the national Health sector transformation plans along with international documents. The finding that one third (31.0%) of one year postpartum women emotional felt very unhappy,34.0% felt sort of un happy (24.12%) when asked how would you feel If they got pregnant now sat one year postpartum after being followed for 2 years so the reenrollment. On contrary 17.12%, 13.38% and 4.63% reported that they felt sort of happy, very happy and mixed happy/unhappy. The higher level happiness might be related with the success of health extension program (HEP) in country, Health Sector Transformational Plans I_II (HSTP 2) (16, 17) and the endorsement and implementation of the new reproductive health strategy running 2021 to 25 in which preconception care and related fertility related targets are include (17). The lower level women emotional fertility intention might be related women experiencing low quality antenatal care (ANC) and did not seek the recommended four or more ANC visits during their most recent pregnancy and childbirth (26); a recent study based entitled “Effective coverage of antenatal care services in Ethiopia: a population-based cross-sectional study. BMC Pregnancy Childbirth. 2024;24(1):330” indicated that the overall effective ANC coverage was low, primarily due to a considerable drop in the proportion of women who completed four or more ANC visits. To this end, the implication of the finding that one in 4 (18.01% (16.00%, 20.20%)) post-partum women reported that they felt happy if they became pregnant indicate one that we have a long way to go to make women decided on their fertility desire and its emotional as well availing preconception care which is relatively new for our country (3, 6, 27). Furthermore, the expansion of the urban Health extension professional and addition of level IV Health extension workers in rural set up should be used as a stepping stone to improve the quality care (28) at community level thereby enabling women to get informed counseling about their reproductive health needs and rights including planning and spacing their pregnancies and those who did that might planned their desired family size and felt happy when learned to their index pregnancy since the pregnancy is likely intended. Moreover, the government’s effort to improve quality of maternal and child health care and respectful maternity care (29) along with the continuum of care is likely to encourage women to plan their pregnancies and subsequently to be happy when learned their index pregnancy and the variation in community support for pregnant women to utilize the three domains of the maternal and new born continuum of care packages also contributes for this observed variation in the women emotional fertility feeling (30) a recent study Pregnant Women Perceived Community Acceptance on Continuum of maternal and newborn care its Correlates in Ethiopia: Community based 2 year Cohort follow up Study The variation in the degree of women emotional fertility intentional feeling might be related with the socially constructed and culturally accepted male dominance in matters that affect women including women reproductive autonomy and their fertility control among others in low and middle income countries including Ethiopia. A recent nationally representative study from Ethiopia on partner-perpetrated pregnancy coercion inhibits women’s reproductive autonomy reported that approximately 20% of Ethiopian women reported past-year pregnancy coercion (11.4% less severe; 8.6% more severe), ranging from 16% in Benishangul-Gumuz to 35% in Dire Dawa (2). Addressing this gap in women emotional fertility intention would help to track the success of SDG gaol 5.6.1 (27) and the reproductive health targets articulated in the current national reproductive health plan running from 2021 to 24 (3). Poor patient-provider communication and inadequate support of women’s autonomy contributed most to poor person-centered maternity care as well contribute for this variation in the level of women emotional fertility intention as its well-articulated on a study from Ethiopian entitled: Understanding variation in person-centered maternity care: Results from a household survey of postpartum women in 6 regions of Ethiopia (1). The finding women intended to have another child had lowered but disproportionate association with the higher level categories of one year postpartum women emotional fertility intentional feeling might be related the families’ aspiration to achieve the desired family size and can be seen as exercising her reproductive right and reproductive autonomy (31). Moreover, the finding that being in the higher level categories of women emotional fertility intentional feeling was lower among those with higher birth order might be related with women prior pregnancy experience (32) and is likely related with male decision making on the number of children as stated decided to limit their family size but became pregnant because of their husband and/or partner influence as he need more children (33, 34) (7). This is in line with finding on women fertility desire (35, 36). The finding women reported that they have started using contraceptive by one year postpartum was found to lower the symmetrical cumulative logit of women emotional fertility intention might indicate the link between contraceptive access (37, 38) and pregnancy and child bearing (37).It might also be related contraception and fertility transition (39) as well as women fertility desire and contraceptive behavior might also be possible explanation (40). The aforementioned justification might be applied for the observed proportional likelihood lowering effect of contraceptive ever among women in the level of one year postpartum women fertility emotional feeling (37, 38). The finding showed that the type of contraceptive use decision maker affects the hierarchal women fertility intention, accordingly when the health care provider decided on women contraceptive use similar cumulative logit of across the categories of women emotional fertility intention was observed had an implication of the poor quality counseling (41, 42) and we need a long way to go to empower women on the their contraceptive use (43, 44) and also might be likely related poor patient-provider communication and inadequate support of women’s autonomy contributed most to poor person-centered maternity care (1). Conclusion Nearly 2/3, 64.87% (62.20%, 67.45%) one year post-partum women have reported very unhappy or a sort of unhappy if they became pregnant while 17.12% (15.15%, 19.29%) and 18.01% (16.00%, 20.20%) felt mixed feeling and for very happy/sort of happy if they became pregnant one year postpartum respectively calling up on intended and spaced pregnancies by ensuring women reproductive and economic empowerment to control women over their fertility. Activities and efforts that promote intended, spaced pregnancies and diversifying and access to contraceptive methods are likely to improve one year postpartum women emotional fertility intention; and activities that enable women to decide their contraceptive use along with patient centered counseling as well. The study result implied that awareness creation on preconception ans availing the service is also hoped to address the varying level of one year postpartum emotional fertility intention. Abbreviations ARRR: Adjusted Relative Risk CS: Cross Sectional EA: Enumeration Areas HH: households GOLR: Generalized Ordered Logistics Regression PMA: Performance for Monitoring for Action Ethiopia SDP: Service Delivery Point SNNPR: Southern Nations, nationalities and Peoples Region. Declarations Ethics approval and consent to participate: This study involved a secondary analysis of deidentified data from the PMA Ethiopia. The PMA Ethiopia survey was conducted strictly under the ethical rules and regulations of world health organization and IIRB of Ethiopian Health and Nutrition Research Institute (EHNRI). Informed consent was obtained from respondents during the data collection process of PMA Ethiopia on the baseline data collection on Oct 2021. Minors less than 15 years as per the law were not included in this study. Informed verbal consent was take from study participants. PMA surrey has been also conducted after obtained ethical approval from Bloomberg School of Public Health at Johns Hopkins University in Baltimore, USA. Consent for publication: N/A not applicable Availability of data and materials : The datasets generated during the study are publicly available from the PMA website. https://www.pmadata.org/data/request-access-datasets. Competing interests : the authors declare that they have no competing interest. Funding: The authors did not obtained any funding. Authors contribution SA conceptualized the study, obtained the data, conducted the Data curationand the formal analysis; and draft the manuscript and wrote the final the manuscript, interpreted the results and critically revised the manuscript. FT contributed to the conception of the idea, write the draft manuscript and interpretation of the results along with critically reviewing the final manuscript. FT and SA also participated in the field wok supervision, implementation and project facilitation. HGM and TT Participated in the field work and critically and intellectually review the final manuscript. KM .critically review the manuscript including language check. BA and TY contribute in intellectually reviewing the manuscript. TA, AA and TD involved in the project data management, guide the analysis and critically review the final manuscript. TA also assisted in the data curation. TD also assisted in the data interpretation and in the modeling process. MY and NT contributed for the conception coordinate and facilitating the project implementation and contributed intellectually in critically reviewing the manuscript. NT also participated in the data interpretation and the modeling process. AS and SS contributed for the conception of the idea, provide guidance in the manuscript write up, oversee the project implementation and, data interpretation and critically and intellectually reviewing the final manuscript. All authors reviewed and approved the final version of the manuscript. Acknowledgement : The authors would like to pass their acknowledgement for PMA Ethiopia Project for providing the data set through the data lab. We appreciate the huge commitment of PMA Ethiopian data collection team, notably Enumerators and Supervisors and most importantly study participants for their kindest cooperation. Finally, Staff Ethiopian Red Cross training center and Kereyu resort_Adama deserve huge recognition for their hospitality in facilitating PMA filed staff trainings. References Elizabeth K.Stierman P, Linnea A. Zimmerman P, Solomon Shiferaw P, Assefa Seme M, Saifuddin Ahmed P, Andreea A. Creanga M. Understanding variation in person-centered maternity care: Results from a household survey of postpartum women in 6 regions of Ethiopia. AJOG Global Reports February 2023. Shannon N Wood, Jessica L Dozier, Celia Karp, Selamawit Desta, Michele R Decker, Solomon Shiferaw, et al. Pregnancy coercion, correlates, and associated modern contraceptive use within a nationally representative sample of Ethiopian women, Sexual and Reproductive Health Matters, 30:1, 2139891, DOI: 10.1080/26410397.2022.2139891. 2022. FMoH. RH Strategic Plan - Ethiopia 2021-2025. 2021. Rono et al. A policy analysis of policies and strategic plans on Maternal, Newborn and Child Health in Ethiopia. International Journal for Equity in Health (2022) 21:73 https://doiorg/101186/s12939-022-01656-x. 2022. Kerber KJ, de Graft-Johnson JE, Bhutta ZA, Okong P, Starrs A, Lawn JE. Continuum of care for maternal, newborn, and child health: from slogan to service delivery. The Lancet. 2007;370(9595):1358-69. Wegene MA, Gejo NG, Bedecha DY, Kerbo AA, Hagisso SN, Damtew SA. Utilization of preconception care and associated factors in Hosanna Town, Southern Ethiopia. PLoS One. 2022;17(1):e0261895. Dereje G. Femininity, masculinity and family planning decision-making among married men and women in rural Ethiopia: A qualitative study. Journal of African Studies and Development. 2018;10(9):124-33. Dereje G, Zewdie Birhanu, Michelle Kaufman, Bezawit Temesgen. Gender Norms and Family Planning Decision-Making Among Married Men and Women, Rural Ethiopia: A Qualitative Study. Science Journal of Public Health. 2015;3(2). Laurie F. DeRose, F. Nii-Amoo Dodoo and, Vrushali Patil. Fertility Desires and Perceptions of Power in Reproductive Conflict in Ghana Gender and Society, Vol 16, No 1 (Feb, 2002), pp 53-73. 2002. Babalola S, Oyenubi O, Speizer IS, Cobb L, Akiode A, Odeku M. Factors affecting the achievement of fertility intentions in urban Nigeria: analysis of longitudinal data. BMC Public Health. 2017;17(1):942. Yeboah I, Okyere J, Duah HO, Conduah AK, Essiaw MN. Analysis of Couples’ Discordance on Fertility Desire in Ghana. Genealogy. 2023;7(3). Diro and Afework. Agreement and concordance between married couples regarding family planning utilization and fertility intention in Dukem, Ethiopia. BMC Public Health 2013, 13:903 http://wwwbiomedcentralcom/1471-2458/13/903. 2013. Hashemzadeh M, Shariati M, Mohammad Nazari A, Keramat A. Childbearing intention and its associated factors: A systematic review. Nurs Open. 2021;8(5):2354-68. Kesetebirhan AJFDRoE, Ministry of Health. National guideline for family planning services in Ethiopia. 2011:20-3. Workie NW, Ramana GN. The health extension program in Ethiopia. 2013. Assefa Y, Gelaw YA, Hill PS, Taye BW, Van Damme W. Community health extension program of Ethiopia, 2003-2018: successes and challenges toward universal coverage for primary healthcare services. Global Health. 2019;15(1):24. FMoH. Health Sector Transformation Plan II (HSTP-II). 2021. Bielli C, Berhanu G, Isaias A, Orasi A. Population growth and environment in Ethiopia: CSA; 2001. Central Statistical Agency Addis Ababa E, ICF TDP, Rockville M, USA,. Demographic and Health Survey 2016. 2017. Bongaarts J. Trends in fertility and fertility preferences in sub-Saharan Africa: the roles of education and family planning programs. Genus. 2020;76(1). Church AC, Ibitoye M, Chettri S, Casterline JB. Traditional supports and contemporary disrupters of high fertility desires in sub-Saharan Africa: a scoping review. Reprod Health. 2023;20(1):86. Cranney SJPos, health r. The association between belief in god and fertility desires in Slovenia and the Czech Republic. 2015;47(2):83-9. Zimmerman L, Desta S, Yihdego M, Rogers A, Amogne A, Karp C, et al. Protocol for PMA-Ethiopia: A new data source for cross-sectional and longitudinal data of reproductive, maternal, and newborn health. Gates Open Res. 2020;4:126. Williams R. Understanding and interpreting generalized ordered logit models. The Journal of Mathematical Sociology. 2016;40(1):7-20. Fullerton AS, Anderson KF. Ordered Regression Models: a Tutorial. Prev Sci. 2023;24(3):431-43. Abdissa Z, Alemu K, Lemma S, Berhanu D, Defar A, Getachew T, et al. Effective coverage of antenatal care services in Ethiopia: a population-based cross-sectional study. BMC Pregnancy Childbirth. 2024;24(1):330. UN. Transforming Our World: The 2030 Agenda for Sustainable Development. New York; 2015. Federal Democratic Republic of Ethiopia Ministry of Health. Ethiopian Health Care Quality Bulletin: Continuous Health Care Quality Improvement through Knowledge Management, Vol 1 May 2019. 2019. Habte A, Tamene A, Woldeyohannes D, Endale F, Bogale B, Gizachew A The prevalence of respectful maternity care during childbirth and its determinants in Ethiopia: A systematic review and meta-analysis. PLoS ONE 17(11): e0277889. https://doi.org/10.1371/journal. pone.0277889. 2022. Damtew Solomon Abrha, Fentaye Fitsum Tariku, Kassa Bezawork Ayele, Sene Kelemua Menegesha. Pregnant Women Perceived Community Acceptance on Continuum of maternal and newborn care its Correlates in Ethiopia: Community based 2 year Cohort follow up Study. DOI: https://doiorg/1021203/rs3rs-4230469/v1 Pre print. Apr 2024. Karp C, Wood SN, Galadanci H, Sebina Kibira SP, Makumbi F, Omoluabi E, et al. 'I am the master key that opens and locks': Presentation and application of a conceptual framework for women's and girls' empowerment in reproductive health. Soc Sci Med. 2020;258:113086. JHPIEGO. monitoring birth preparedness and complication readiness tools and indicators for maternal and newborn health. 2004. Osamor PE, Grady C. Women's autonomy in health care decision-making in developing countries: a synthesis of the literature. Int J Womens Health. 2016;8:191-202. Erci B. Women's efficiency in decision making and their perception of their status in the family. Public health nursing (Boston, Mass). 2003;20(1):65-70. Ahinkorah BO, Seidu AA, Armah-Ansah EK, Budu E, Ameyaw EK, Agbaglo E, et al. Drivers of desire for more children among childbearing women in sub-Saharan Africa: implications for fertility control. BMC Pregnancy Childbirth. 2020;20(1):778. Ahinkorah BO, Seidu AA, Budu E, Agbaglo E, Adu C, Dickson KS, et al. Which factors predict fertility intentions of married men and women? Results from the 2012 Niger Demographic and Health Survey. PLoS One. 2021;16(6):e0252281. Shiferaw S, Spigt M, Seme A, Amogne A, Skrovseth S, Desta S, et al. Does proximity of women to facilities with better choice of contraceptives affect their contraceptive utilization in rural Ethiopia? PLoS One. 2017;12(11):e0187311. Bersamin M, Todd M, Remer L. Does distance matter? Access to family planning clinics and adolescent sexual behaviors. Matern Child Health J. 2011;15(5):652-9. Alazbih NM, Tewabe GN, Demissie TD. Contraception and fertility transition in AMHARA National Regional State of ETHIOPIA: an application of BONGAARTS’ model. Fertility Research and Practice. 2017;3(1). OlaOlorun F, Seme A, Otupiri E, Ogunjuyigbe P, Tsui A. Women's fertility desires and contraceptive behavior in three peri-urban communities in sub Saharan Africa. Reprod Health. 2016;13:12. Hrusa G, Spigt M, Dejene T, Shiferaw S. Quality of FamiLy Planning Counseling in Ethiopia: Trends and determinants of information received by female modern contraceptive users, evidence from national survey data, (2014- 2018). PLoS ONE 15(2): e0228714. https://doi.org/ 10.1371/journal.pone.0228714. 2020. Ejigu BA, Seme A, Zimmerman L, Shiferaw S. Trend and determinants of quality of family planning counseling in Ethiopia: Evidence from repeated PMA cross-sectional surveys,(2014–2019). Plos one. 2022;17(5):e0267944. Damtew SA, Fantaye FT. Women alone modern contraceptive use decision making and its correlates, evidence from PMA CS 2021 survey. BMC Women's Health. 2024;24(1). Fantaye FT, Damtew SA. Women decision making on use of modern family planning methods and associated factors, evidence from PMA Ethiopia. PLoS One. 2024;19(2):e0298516. Tables Tables 1 to 3 are available in the Supplementary Files section Additional Declarations The authors declare no competing interests. Supplementary Files Tables.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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legend.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4414137/v1/7dc4daad1be66a05a72c2d8e.png"},{"id":56487715,"identity":"001e86ef-2654-4496-b6ce-50dc36e8e360","added_by":"auto","created_at":"2024-05-14 21:07:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":678366,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4414137/v1/37287716-fb93-4ba3-9edb-10426153dcca.pdf"},{"id":56487550,"identity":"3106905a-3044-4624-87ce-f7e10b347428","added_by":"auto","created_at":"2024-05-14 20:59:34","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":58482,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-4414137/v1/ebd80b110083ffa06d5aecab.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eOne Year Postpartum Emotional Fertility Intentions among a Cohort of Pregnant Women followed for 2 Years and its Correlates in Ethiopia: Community based longitudinal data from Performance Monitoring for Action; Generalized Ordered Logistics Regression Modeling\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Background ","content":"\u003cp\u003eEmotional health and couples communication are key\u0026nbsp;(1)\u0026nbsp;during pregnancy and child birth with simultaneous minimization of \u0026nbsp;reproductive coercion\u0026nbsp;(2). It should be maintained in the postpartum period to maintain inter pregnancy period healthy and make the next pregnancy planned and successful in particular and women reproductive health and child health in general\u0026nbsp;(3, 4). The postpartum period is key in the newborn development milestone and maintain maternal health and an serves as an entry point to provide the inter pregnancy maternal and newborn heath continuum\u0026nbsp;(5)\u0026nbsp; as well as preconception care in the inerter pregnancy period\u0026nbsp;(6).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn low and middle income countries fertility desired is determined by the husband (7).and male\u0026nbsp;dominance in decision making as far sexual and reproductive health concerned\u0026nbsp;(7-10)\u0026nbsp;which negatively affects women intentions to conceive. Further evidence also showed that discordance in fertility desire among couples \u0026nbsp;(11). Women intentions to conceive is an integral part of reproductive health (RH) right and can be consider as decision making over their fertility. However, in low and middle income countries including Ethiopia where males dominance is culturally accepted and socially constructed, males take the lead in every decision making process for the family; ranging from household \u0026nbsp;level decision including to determine \u0026nbsp;the family size; women and new born reproductive (RH) rights and RH health service use. In such a scenario women may not have their say heard and voice respected.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs a result women are likely to hold negative and unpleasant feeling and emotion when every they thought if they became pregnant of or learned they become \u0026nbsp;pregnant \u0026nbsp;(9). \u0026nbsp;The unproportional huge burden of raising children experienced most women in developing countries coupled with family leading burden including domestic chores women tend to hold negative emotion for every additional child they are going to bear. Unless evidence is generated action take such unpleasant filling exacerbates the fertility rate and population dynamics being in midst of rapid population growth\u0026nbsp;(7, 12, 13).\u003c/p\u003e\n\u003cp\u003eMale dominance in fertility control force women to give birth of many children contributing its share for the Ethiopian population to be one of the top growing population in Africa. \u0026nbsp; The ministry of health and the government of Ethiopian have been showing commitments to make the population growth in line with the country´s economic growth and development through provision of contraceptive commodities free of charge and advocating spaced and intended pregnancies\u0026nbsp;(14-16). \u0026nbsp;Unfortunately, over \u0026nbsp;the last decade \u0026nbsp;or so it has not been feasible to achieve the desired level of change in fertility level as was planned and intended in the national health sector transformation plan (HSTP) and reproductive health (RH) strategies \u0026nbsp;(3, 17, 18)\u0026nbsp;(19). Lack of women emotional fertility intentions in general and in the postpartum period towards fertility and child bearing is likely to contribute for such sustained higher fertility rate and subsequent health and economic effects\u0026nbsp;(20, 21).\u003c/p\u003e\n\u003cp\u003eTo this end, one year postpartum women fertility intention, how would they feel if they became pregnant in the inter pregnancy interval, one postpartum less explored and there is a dearth of evidence. Such an emotion or feeling in might be related with religion and culture acceptability of large families (22). Hence, determining the degree of one year postpartum women emotional fertility feeling and identifying its correlates contributing for such hierarchical variation will provide actionable evidence to mitigate the fertility surge by promoting continuum of care and preconception care in the postpartum period.\u003c/p\u003e"},{"header":"Methods and Data Sources","content":"\u003cp\u003eStudy Design and Population and Sample Size\u003c/p\u003e\n\u003cp\u003eNationally Representative 2 year cohort data collected from pregnant women in four rounds was used. After the complete census was conducted in the selected enumeration areas all pregnant women with gestational age of 1 to 9 months who were either \u003cstrong\u003eusual residents\u003c/strong\u003e in the selected EAs or who came to the EA to deliver \u0026nbsp;were enrolled and followed one year post from the selected randomly 35 households per EA were interviewed for the female questionnaire. A total of \u003cstrong\u003e1,703\u003c/strong\u003e pregnant women of child bearing age were included in this analysis. This analysis was restricted to women who were married or live together and completed all the three follow up interviews with complete response for the one year post-partum pregnancy reaction question (How would you feel if you became pregnant now). The overall sample size and cell sample size adequacy was checked and found adequate to generating unbiased estimates for the one year postpartum women emotional fertility intention variable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData collection and Field Work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA merged cohort one data consisting baseline data, six week, six month and one year data from cohort one PMA survey conducted from 2019 to 2021 was used for this study\u0026nbsp;(23). \u0026nbsp;A two stage stratified cluster sampling method was used to select enumeration areas.\u0026nbsp;The first field work of the pane baseline survey was screening pregnant women and women who were less than 6 weeks post-partum. \u0026nbsp;A two stage stratified cluster sampling method was used to select enumeration areas. Complete census was conducted in the selected enumeration areas followed\u0026nbsp;by selection of 35 households per enumeration area using simple random sampling.\u0026nbsp;Data were collected at baseline and three follow up points, 6 week, 6 month and one year postpartum.\u003c/p\u003e\n\u003cp\u003eIt was executed by Addis Ababa University’s School of Public Health in collaborative efforts with the Ethiopian Public Health Association with assistance from the Federal Ministry of Health, Central Statistical Agency, Bill \u0026amp; Melinda Gates Institute for Population and Reproductive Health (Johns Hopkins Bloomberg School of Public Health), and the source of funding is from Bill \u0026amp; Melinda Gates Foundation. The main sample units or enumeration areas (EAs) were chosen using the frame to Ethiopia Population and Housing Census (PHC), which was performed in 2019 by the Ethiopia Central Statistical Agency.\u0026nbsp;\u0026nbsp;A total of 162 EAs were chosen in the first stage, with Independent selection in each sample stratum and a probability proportional to EA size. All pregnant women \u0026nbsp; between\u0026nbsp;the ages of 15 and 49 who were either long-term residents of the chosen households \u0026nbsp;or who come to deliver there they were screened using enrollment criteria and those found eligible were consented to participate in the baseline line interview. The protocol Of PMA Ethiopia contains all the details on sample design and selection methods. More detail in the details on sampling design and selection procedures and field work implementation was described well elsewhere~.\u0026nbsp;The protocol Of PMA Ethiopia contains all the details on sample design and selection methods. More detail in the details on sampling design and selection procedures and field work implementation was described well elsewhere \u0026nbsp;(23). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVariables:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOutcome variable\u003c/p\u003e\n\u003cp\u003eOne year postpartum Women Emotional fertility intention/desire is the main outcome variable. It was measured by a single likert scale question with 5 scales as shown below in table (\u003cstrong\u003eTable 1\u003c/strong\u003e). Women were asked if you get pregnant now how you would feel with the five response options show in the table below. For seek of getting a meaning out this specific scale of measurement the scale was reverse that the very happy category gets the larger value on the scale and the very unhappy labeled as the smallest value in the scale since women were asked in the reverse order and the question is asked in a positive way.\u003c/p\u003e\n\u003cp\u003eIndependent Variables \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIndependent variables were classified into individual-level variables and enumeration area-level Variables. Individual-level independent variables further categorized into socio demographic/economic characteristics variables, parity and other RH characteristics, knowledge on contraceptive related characteristics, husband related characteristics. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGroup or enumeration area (EA) level variables included two integral variables namely, region and place of residence and “Region” was grouped into four categories 3= Amhara, 4=Oromia, 7= SNNPRs and 10= Addis Ababa city administration. \u0026nbsp;Place of residence follows the default urban/rural classification.\u003c/p\u003e\n\u003cp\u003eAnalysis and Measurement \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA merged cohort one data consisting baseline data, six week, six month and one year data from cohort one PMA survey conducted from 2019 to 2021 was used for this study. The data was merged using \u0026nbsp;a unique participant ID given at enrollment/baseline and recorded in each visit. Repeatedly asked questions in every follow up survey were renamed by giving a prefix 6W, 6M and OY for questions asked in all the six week, six month and the one year postpartum interviews during the data preparation stage before merging.\u003c/p\u003e\n\u003cp\u003eFrequencies and percentages were computed to characterize the study population. Chi-square test statistics was computed to check cell sample size adequacy and the sample size was found to be adequate to provide unbiased estimates. Exploratory data analysis was run for data cleaning thereby checking item nonresponse rate for every variable and don’t know response which were later excluded from the analysis. Following this variable were recoded to create biological plausible categories along with checking distribution of the recoded variables using mean and proportion. Composite variable was created; namely, women perceived risk about contraceptive methods, and \u0026nbsp; knowledge on contraceptive methods. \u0026nbsp;Integral, facility related factors/group level variables such distance from the nearest health facility, type of the nearest facility, method type provide by the nearest health facility and method stock out in the nearest health facility.\u003c/p\u003e\n\u003cp\u003eGeneralized Ordinal logistics regression, (partial proportional odds model) was used to identify important correlates of one year postpartum women emotional fertility intention, what did they felt if they became pregnant one post-partum following the index birth. At bivariate analysis a p value cut of 0.25 was used to select candidate variable for multilevel multivariable logistics regression analysis. Results were presented in the form of percentage, and odds ratio with 95% CI. Significance was declared at a significance level of 0.05. \u0026nbsp;Results were reported based on weighted count and One year follow up weight was applied.Unlike the conservative ordered logistics regression the GOLR is relaxes the assumption of proportional odds for some variables\u0026nbsp;(24). Since practically the parallel line assumption is most of the time violated using the generalized ordered model entertains this practical phenomenon. It can be \u0026nbsp;less restrictive than proportional odds models and \u0026nbsp;more parsimonious than methods that ignore the ordering of categories altogether\u0026nbsp;(24).\u0026nbsp;Hence, generalized Ordinal logistic regression was utilized to determine the correlates of the women emotional pregnancy intention\u0026nbsp;(24, 25).\u003c/p\u003e\n\u003cp\u003eData Quality Management and Control\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData completeness for variables and items for creating composite variables was checked by exploratory data analysis following which any item nonresponse was excluded from the analysis. Frequency run to exclude responses with do not know (DNK) and no response (NR). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePMA Ethiopia used of standard and pretested tool, intensive training with mock interviews for resident enumerators was provided, close supervisor during filed work, timely progress report and correction, 10% random check were some of the modalities used to maintain the quality of the collected data, the detail is reported somewhere else\u0026nbsp;(23). \u0026nbsp;\u003c/p\u003e"},{"header":"Result ","content":"\u003cp\u003e\u003cstrong\u003eMagnitude of One Year Postpartum Emotional Fertility Intention among a cohort of pregnant women followed for 2 years and its correlates in Ethiopia: using Community based longitudinal data from Performance Monitoring for Action 2019 to 2021\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study reported the proportion of one year postpartum emotional fertility intention when women were asked how they would feel if they became pregnant one postpartum among pregnant women who were enrolled and followed for 2 years.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNearly one third 31.0% (28.4%, 33.66%) and 34.0% (31.36%, 36.52%) \u0026nbsp;of the women followed for 2 years reported that \u0026nbsp;they felt very or sort unhappy by \u0026nbsp;one year post-partum when asked what do they feel if they became pregnant respectively. Similarly 17.12% (15.15%, 19.29%) for mixed feeling while 13.38% (11.63%,15.34%) felt \u0026nbsp;sort of happy and one in 20 women 4.63% (3.60%,5.94%) reported that they felt very happy when asked what would they feel if they become pregnant one year postpartum.\u003c/p\u003e\n\u003cp\u003eThe proportion of enrolled pregnant women followed for two women who felt a sort of or very of happy \u0026nbsp; when asked if the they become pregnant by one year postpartum was 18.01% (16.00%, 20.20%. Nearly two third 64.87% (62.20%, 67.45%) reported that they very/a sort of unhappy by one year post-partum when asked what do they feel if they became pregnant. Nearly one in 6, 17.12% (15.15%, 19.29%) women reported mixed feeling one postpartum (Fig 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDistribution of One Year Postpartum Emotional Fertility Intention among a cohort of pregnant women followed for 2 years and its correlates in Ethiopia: using Community based longitudinal data from Performance Monitoring for Action 201 to 21\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study reported the proportion of one year emotional fertility intention when women were asked how they would feel if they became pregnant one postpartum among pregnant women who were followed for 2 years.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAmong women in the age category 45 to 49 years 39.75%, 34.79%, 15.80%, 6.98% and 2.68% reported that they felt very unhappy, sort of un happy , mixed happy and unhappy, sort of happy an very happy \u0026nbsp; respectively when asked how do you feel if got pregnant know. Similarly, of women in the secondary or above category the proportion of those felt very unhappy, sort of un happy , mixed happy and unhappy, sort of happy an very happy was 27.84%, 29.68%,24.42%, 17.73% and 6.33% respectively .\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis same figure for women belonging in the households with lowest wealth quintile was \u0026nbsp;25.62%, 37.39%, 14.43%, 17.14% and 5.42% for the respective feeling categories. For residents of Tigray region 62.87%.,12.25%, 8.18%, 13.74% \u0026nbsp;and 2.95% of women were very unhappy, sort of un happy, mixed happy and unhappy, sort of happy an very happy respectively. Likewise, for urban residents this similar figure for the respective feeling categories was 27.92%, 29.61%, 24.26%, 14.34% and 4.83% For Muslim religion followers this respective figure stood 31.60%, 29.11%, 17.63%, 15.25% and 6.42% respectively. Likewise among those women who reported that they married more than once 1/3 (32.14%), 33.05%, 17.32%, 12.31% and 4.91% reported that they felt very unhappy, a sort of unhappy, mixed un/ happy, a sort of happy, very happy respectively by one year postpartum (\u003cstrong\u003eTable 2\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe proportion of one postpartum women emotional fertility intention among those with higher birth order was 1/3 (37.22%),33.94%,13.44%, 12.26% and 3.14% for the feeling categories very unhappy, sort of unhappy, mixed happy/unhappy, sort of happy and very happy respectively. Similarly, this same for women did not know or decide whether to have a child was 1/4 (24.07%), 34.17%, 25.75%, 11.02% and 4.99 % respectively. Likewise, among women who reported husband has other wifes \u0026nbsp;1/4 (26.28%),35.51%, 20.16%, 12.85% and 5.20 % were very unhappy, a sort of unhappy, in mixed happy and unhappy feeling, a sort of happy and very happy. \u0026nbsp;Among those women who reported a larger family size of 6 to 14, the proportion of very unhappy and sort of un happy was 38.79% and 30.75% while mixed happy/unhappy, sort of happy and very happy accounted 15.15%, 12.74% and 2.56% respectively This same figure was 1/4 (28.87%), 32.07%, 17.37%, 15.63 % and 6.05 % among those perceived that their husband were very happy their most rent pregnancy respectively (\u003cstrong\u003eTable 2\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConcerning contraceptive ever use \u0026nbsp;among those who responded that they have ever used contraceptive in their life time 33.16%, 35.45%, 16.40%, 11.40% and 3.59% felt very unhappy, sort of unhappy, mixed happy/unhappy, sort of happy and very happy respectively. Similarly, among \u0026nbsp;those who reported that the are currently using contraceptive on year postpartum; this respective figure \u0026nbsp;for the feeling categories was 30.53%, 39.97%, \u0026nbsp;17.80%, 8.83% and 2.87% (\u003cstrong\u003eTable 2\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eThe proportion of one postpartum women emotional fertility intention among those who reported that they have experienced at least one form of physical and/or sexual violence at enrollment was \u0026nbsp; 4 in 10 \u0026nbsp;(39.72%), 35.41%,11.63%, 11.06% and 2.18% for the feeling categories very unhappy, sort of unhappy, mixed happy/unhappy, sort of happy and very happy respectively. Similarly, among those who reported that they have experienced at least one form of physical and/or sexual violence at six week postpartum 4 in 10 \u0026nbsp;(38.67%), 32.23%,13.96%, 11.16% and 3.97% felt very unhappy, sort of unhappy, mixed happy/unhappy, sort of happy and very happy respectively (\u003cstrong\u003eTable 2\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLast but not least, among those who desired place of delivery was home or not decided at baseline, 3 in 10 \u0026nbsp;(28.91%), 37.11%,14.66%, 13.74% and 5.58% felt very unhappy, sort of unhappy, mixed happy/unhappy, sort of happy and very happy respectively while this same figure for those whose baseline preferred birth attendant was traditional \u0026nbsp;birth attendant (TBA), 3 in 10 \u0026nbsp;(29.28%), 31.81%,15.81%, 17.96% and 5.14% felt very unhappy, sort of unhappy, mixed happy/unhappy, sort of happy and very happy respectively \u0026nbsp;(\u003cstrong\u003eTable 2\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelates\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eof One Year Postpartum Emotional Fertility Intention among a Cohort of pregnant women followed for 2 years and its correlates in Ethiopia: using Community based longitudinal data from Performance Monitoring for Action 2019 to 21\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has investigated and reported the one year postpartum hierarchal variation of women emotional fertility intentional feeling and factors contributing among a cohort of pregnant women who were followed for 2 years. This outcome variable was measured with 5 items ordinal scale and later categorized in to three ordinal categories (very unhappy/Sort of unhappy, mixed happy and unhappy and very happy/sort of happy) using generalized ordered model which gave us two cumulative logit for (for the very unhappy/Sort of unhappy vs. mixed happy and unhappy categories and the happier category; and for the very unhappy/Sort of unhappy and mixed happy and unhappy categories vs. the happier category). The re categorization was need for the seek of cell sample adequacy (\u003cstrong\u003eTable 3).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe two variables namely, women baseline fertility desire \u0026nbsp;and higher birth order have \u0026nbsp;disproportional association across the cumulative logit of being in the upper/high rank categories of one year postpartum women emotional fertility intention, leading asymmetrical cumulative logit. The association was presented separately for the two of these independent variables since it\u0026rsquo;s the same for all other variables which met the parallel lines assumption (\u003cstrong\u003eTable 3).\u003c/strong\u003e Since these two Independent variables were found to violate the proportional odds assumption, hence, generalized ordered logistics regression run.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe generalized logit model is also called cumulative logit as \u0026nbsp;it determines the cumulative probability of being in different combination of the higher level categories of the outcome variable is this case, one postpartum women fertility intention feeling result was reported \u003cstrong\u003e(Table 3).\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe two variables namely, fertility desire and parity \u0026nbsp; have \u0026nbsp;no similar association \u0026nbsp;across the cumulative logit of being in the two higher upper ranking \u0026nbsp;categories of one year postpartum women emotional fertility intention, leading asymmetrical cumulative log it. Hence, the asymmetrical effect of fertility desire in the higher emotional fertility intention categories is as follows: 37% 0.63 (AOR:(0.41, 0.97)) and 58% (AOR 0.42 (0.22, 0.83)) lower odds among those who had one to two child and for women who had 3 to 14 children respectively as compared with those no child for the unhappy category while birth order dose not significantly affected one year postpartum mixed emotional feeling category. Similarly, women who reported they do not wanted no more child at one year postpartum had 49% 0.51 (0.29, 0.89) reduced odds to be in the very unhappy level of fertility \u0026nbsp; emotional intention category \u0026nbsp;while no effect (AOR: 0.26 (0.22, 1.40) for the level of mixed fertility emotional intention category (\u003cstrong\u003eTable 3).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe likelihood of one year postpartum women to be in the higher level women fertility intention feeling categories was found to be 34% (AOR: 0.66 (0.44, 0.97)) lower among women who reported that they ever used contraceptive compared with non-ever users. Similarly, \u0026nbsp;women who reported that they have started using contraceptive one year postpartum had proportional cumulative logit (AOR: 0.43 (0.29, 0.63)) of being in the higher level of women emotional fertility intention one postpartum compared with those pregnant who were enrolled and followed for two years but did not commence contraceptive use by then (\u003cstrong\u003eTable 3).\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOnly results for two independent variables presented in both higher categories of women emotional fertility intention categories since these two independent variables are the only variables that violated the assumptions of ordinal logistic regression. For the rest of the variables include in the model, the assumption is fulfilled, and the estimates are the same across the cumulative logits of the higher level categories of women emotional fertility intention.\u003c/p\u003e\n\u003cp\u003eIn countries like Ethiopia where male dominance in household decision making in general and on fertility and reproduction decisions in particular and culturally accepted and social constructed investigating the factors affecting the level of women emotional feeling when they learned their index pregnancy and identifying the factors contributing for this variation has paramount importance to build and sustain a health and healthy family. In midst of the SDG period, measuring pregnant women index pregnancy emotion as measure of their reproductive health right and decision making on their reproductive life/health is hoped to generate and provide an actionable evidence for the ministry and relevant actors\u0026nbsp;to improve women decision making on their desired fertility in particular and reproductive health right in general which in turn contributes for SDG 5.6.1.\u003c/p\u003e\n\u003cp\u003eDue to the dearth of empirical evidence which exactly fit our research title the authors are forced to use look additional alternative evidence for discussion including findings from fertility intention studies. In addition to the conventional discussion write up methods the authors also use an indirect method of discussion such us comparing the finding with accomplishment goals stated national and international relevant policy and program endorsed documents and targets such the success and challenge of the Ethiopian health extension program, the national Health sector transformation plans along with international documents.\u003c/p\u003e\n\u003cp\u003eThe finding that one third (31.0%) of one year postpartum women emotional felt \u0026nbsp;very unhappy,34.0% felt sort of un happy (24.12%) when asked how would you feel If they got pregnant now sat one year postpartum after being followed for 2 years so the reenrollment.\u0026nbsp;On contrary 17.12%, 13.38% and 4.63% reported that they felt sort of happy, very happy and mixed happy/unhappy. The higher level happiness\u0026nbsp;might be related with the success of health extension program (HEP) in country, Health Sector Transformational Plans I_II (HSTP 2) \u0026nbsp;(16, 17)\u0026nbsp;and the endorsement and implementation of the \u0026nbsp;new reproductive \u0026nbsp;health strategy running 2021 to 25 in which preconception care and related fertility related targets are include\u0026nbsp;(17). The lower level women emotional fertility intention might be related women experiencing low quality antenatal care (ANC) and did not seek the recommended four or more ANC visits during their most recent pregnancy and childbirth\u0026nbsp;(26); a recent study based entitled “Effective coverage of antenatal care services in Ethiopia: a population-based cross-sectional study. BMC Pregnancy Childbirth. 2024;24(1):330” indicated that the overall effective ANC coverage was low, primarily due to a considerable drop in the proportion of women who completed four or more ANC visits.\u003c/p\u003e\n\u003cp\u003eTo this end, the implication of the finding that one in 4 (18.01% (16.00%, 20.20%)) post-partum women reported that they felt happy if they became pregnant indicate one that we have a long way to go to make women decided on their fertility desire and its emotional as well availing preconception care which is relatively new for our country\u0026nbsp;(3, 6, 27). Furthermore, the expansion of the urban Health extension professional and addition of level IV Health extension workers in rural set up should be used as a stepping stone to improve \u0026nbsp;the quality care\u0026nbsp;(28)\u0026nbsp;at community level thereby enabling women to get informed counseling about their reproductive health needs and rights including planning and spacing their pregnancies and those who did that might planned their desired family size and felt happy when learned to their index pregnancy since the pregnancy is likely intended. Moreover, the government’s effort to improve quality of maternal and child health care and respectful maternity care\u0026nbsp;(29)\u0026nbsp;along with the continuum of care is likely to encourage women to plan their pregnancies and subsequently to be happy when learned their index pregnancy and the variation in community support for pregnant women to utilize the three domains of the maternal and new born continuum of care packages also contributes for this observed variation \u0026nbsp;in the women emotional fertility feeling \u0026nbsp;(30)\u0026nbsp;a recent study\u0026nbsp;Pregnant Women Perceived Community Acceptance on Continuum of maternal and newborn care its Correlates in Ethiopia: Community based 2 year Cohort follow up Study\u003c/p\u003e\n\u003cp\u003eThe variation in the degree of women emotional fertility intentional feeling might be related with \u0026nbsp; the socially constructed and culturally accepted male dominance in matters that affect women including women reproductive autonomy and their fertility control among others in low and middle income countries including Ethiopia. A recent \u0026nbsp;nationally representative study from Ethiopia on partner-perpetrated pregnancy coercion inhibits women’s reproductive autonomy reported that approximately 20% of Ethiopian women reported past-year pregnancy coercion (11.4% less severe; 8.6% more severe), ranging from 16% in Benishangul-Gumuz to 35% in Dire Dawa\u0026nbsp;(2). Addressing this gap in women emotional fertility intention would help to track the success of SDG gaol 5.6.1\u0026nbsp;(27)\u0026nbsp;and the reproductive health targets articulated in the current national reproductive \u0026nbsp;health plan running from 2021 to 24\u0026nbsp;(3). Poor patient-provider communication and inadequate support of women’s autonomy contributed most to poor person-centered maternity care as well contribute for this variation in the level of women emotional fertility intention as its well-articulated on a study from Ethiopian entitled: Understanding variation in person-centered maternity care: Results from a household survey of postpartum women in 6 regions of Ethiopia\u0026nbsp;(1).\u003c/p\u003e\n\u003cp\u003eThe finding women intended to have another child had lowered but disproportionate association with the higher level categories of one year postpartum women emotional fertility intentional feeling \u0026nbsp;might be related \u0026nbsp;the families’ aspiration to achieve the desired family size and can be seen as exercising her reproductive right and reproductive autonomy\u0026nbsp;(31). Moreover, the finding that being in the higher level categories of women emotional fertility intentional feeling \u0026nbsp;was lower among those with higher birth order might be related with women prior pregnancy experience\u0026nbsp;(32)\u0026nbsp;and is \u0026nbsp;likely related with male decision making on the number of children as stated decided to limit their family size but became pregnant because of their husband and/or partner influence as he need more children\u0026nbsp;(33, 34)\u0026nbsp;(7). This is in line with finding on women fertility desire\u0026nbsp;(35, 36).\u003c/p\u003e\n\u003cp\u003eThe finding women reported that they have started using\u0026nbsp;contraceptive by one year postpartum was found to lower the symmetrical cumulative logit of women emotional fertility intention might indicate the link between contraceptive access\u0026nbsp;(37, 38)\u0026nbsp;and pregnancy and child bearing\u0026nbsp;(37).It might also be related contraception and fertility transition\u0026nbsp;(39)\u0026nbsp;as well as women fertility desire and contraceptive behavior might also be possible explanation \u0026nbsp;(40). The aforementioned justification might be applied for the observed proportional likelihood lowering effect of contraceptive ever among women in the level of one year postpartum women fertility emotional feeling\u0026nbsp;(37, 38).\u003c/p\u003e\n\u003cp\u003eThe finding showed that the type of contraceptive use decision maker affects the hierarchal women fertility intention, accordingly when the health care provider decided on women contraceptive use similar cumulative logit of\u0026nbsp;across the categories of women emotional fertility intention was observed had an implication of the poor quality counseling\u0026nbsp;(41, 42)\u0026nbsp;and we need a long way to go to empower women on the their contraceptive use\u0026nbsp;(43, 44)\u0026nbsp;and \u0026nbsp;also might be likely related poor patient-provider communication and inadequate support of women’s autonomy contributed most to poor person-centered maternity care\u0026nbsp;(1).\u003c/p\u003e\n\u003ch1\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u0026nbsp;\u003c/h1\u003e\n\u003cp\u003eNearly 2/3, 64.87% (62.20%, 67.45%) one year post-partum women have reported very unhappy or a sort of unhappy if they became pregnant while 17.12% (15.15%, 19.29%) and 18.01% (16.00%, 20.20%) felt mixed feeling and for very happy/sort of happy if they became pregnant one year postpartum respectively calling up on intended and spaced pregnancies by ensuring women reproductive and economic empowerment to control women over their fertility. Activities and efforts that promote intended, spaced pregnancies and diversifying and access to contraceptive methods are likely to improve one year postpartum women emotional fertility intention; and activities that enable women to decide their contraceptive use along with patient centered counseling as well. The study result implied that awareness creation on preconception ans availing the service is also hoped to address the varying level of one year postpartum emotional fertility intention.\u003c/p\u003e"},{"header":"Abbreviations\t","content":"\u003cp\u003eARRR: Adjusted Relative Risk\u003c/p\u003e\n\u003cp\u003eCS: Cross Sectional\u003c/p\u003e\n\u003cp\u003eEA: Enumeration Areas\u003c/p\u003e\n\u003cp\u003eHH: households\u003c/p\u003e\n\u003cp\u003eGOLR: Generalized Ordered Logistics Regression\u003c/p\u003e\n\u003cp\u003ePMA: Performance for Monitoring for Action Ethiopia\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSDP: Service Delivery Point\u003c/p\u003e\n\u003cp\u003eSNNPR: Southern Nations, nationalities and Peoples Region.\u003c/p\u003e"},{"header":"Declarations ","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study involved a secondary analysis of deidentified data from the PMA Ethiopia. The PMA Ethiopia survey was conducted strictly under the ethical rules and regulations of world health organization and IIRB of Ethiopian Health and Nutrition Research Institute (EHNRI). Informed consent was obtained from respondents during the data collection process of PMA Ethiopia on the baseline data collection on Oct 2021. Minors less than 15 years as per the law were not included in this study. Informed verbal consent was take from study participants. PMA surrey has been also conducted after obtained ethical approval from Bloomberg School of Public Health at Johns Hopkins University in Baltimore, USA.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003cstrong\u003eConsent for publication: N/A not applicable\u003c/strong\u003e\u003cbr\u003e\u003cstrong\u003e\u0026nbsp;Availability of data and materials\u003c/strong\u003e: The datasets generated during the study are publicly available from the PMA website. https://www.pmadata.org/data/request-access-datasets.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: the authors declare that they have no competing interest.\u003cbr\u003e\u003cstrong\u003eFunding: \u003c/strong\u003eThe authors did not obtained any funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contribution\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSA conceptualized the study, obtained the data, conducted the Data curationand the formal analysis; and draft the manuscript and wrote the final the manuscript, interpreted the results and critically revised the manuscript.\u003c/p\u003e\n\u003cp\u003eFT contributed to the conception of the idea, write the draft manuscript and interpretation of the results along with critically reviewing the final manuscript.\u003c/p\u003e\n\u003cp\u003eFT and SA also participated in the field wok supervision, implementation and project facilitation.\u003c/p\u003e\n\u003cp\u003eHGM and TT Participated in the field work and critically and intellectually review the final manuscript.\u003c/p\u003e\n\u003cp\u003eKM .critically review the manuscript including language check.\u003c/p\u003e\n\u003cp\u003eBA and TY contribute in intellectually reviewing the manuscript.\u003c/p\u003e\n\u003cp\u003eTA, AA and TD involved in the project data management, guide the analysis and critically review the final manuscript. TA also assisted in the data curation. TD also assisted in the data interpretation and in the modeling process.\u003c/p\u003e\n\u003cp\u003eMY and NT contributed for the conception coordinate and facilitating the project implementation and contributed intellectually in critically reviewing the manuscript. NT also participated in the data interpretation and the modeling process.\u003c/p\u003e\n\u003cp\u003eAS and SS contributed for the conception of the idea, provide guidance in the manuscript write up, oversee the project implementation and, data interpretation and critically and intellectually reviewing the final manuscript.\u003c/p\u003e\n\u003cp\u003eAll authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eThe authors would like to pass their acknowledgement for PMA Ethiopia Project for providing the data set through the data lab. We appreciate the huge commitment of PMA Ethiopian data collection team, notably Enumerators and Supervisors and most importantly study participants for their kindest cooperation. Finally, Staff Ethiopian Red Cross training center and Kereyu resort_Adama deserve huge recognition for their hospitality in facilitating PMA filed staff trainings.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eElizabeth K.Stierman P, Linnea A. Zimmerman P, Solomon Shiferaw P, Assefa Seme M, Saifuddin Ahmed P, Andreea A. Creanga M. Understanding variation in person-centered maternity care: Results from a household survey of postpartum women in 6 regions of Ethiopia. AJOG Global Reports February 2023.\u003c/li\u003e\n \u003cli\u003eShannon N Wood, Jessica L Dozier, Celia Karp, Selamawit Desta, Michele R Decker, Solomon Shiferaw, et al. 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DOI: https://doiorg/1021203/rs3rs-4230469/v1 Pre print. Apr 2024.\u003c/li\u003e\n \u003cli\u003eKarp C, Wood SN, Galadanci H, Sebina Kibira SP, Makumbi F, Omoluabi E, et al. \u0026apos;I am the master key that opens and locks\u0026apos;: Presentation and application of a conceptual framework for women\u0026apos;s and girls\u0026apos; empowerment in reproductive health. Soc Sci Med. 2020;258:113086.\u003c/li\u003e\n \u003cli\u003eJHPIEGO. monitoring birth preparedness and complication readiness tools and indicators for maternal and newborn health. 2004.\u003c/li\u003e\n \u003cli\u003eOsamor PE, Grady C. Women\u0026apos;s autonomy in health care decision-making in developing countries: a synthesis of the literature. Int J Womens Health. 2016;8:191-202.\u003c/li\u003e\n \u003cli\u003eErci B. Women\u0026apos;s efficiency in decision making and their perception of their status in the family. 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PLoS One. 2024;19(2):e0298516.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 3 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Women Health, Cohort Study, One year postpartum Fertility Intention, PMA Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-4414137/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4414137/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eEmotional health and couples communication are key during pregnancy and childbirth with simultaneous minimization of reproductive coercion which should be maintained in the postpartum period to maintain inter pregnancy period healthy and make the next pregnancy planned and successful. The postpartum period is key in the newborn development milestone and maintain maternal health. Women intentions to conceive are an integral part of Reproductive Health (RH) right and can be consider as decision making on their fertility control. However, in low and middle income countries including Ethiopia where male dominance is culturally constructed and socially acceptable, males take the lead in every decision making process for the family ranging from house level decision including to determine number of children that the family and new born RH rights and RH health service use. In such a scenario women may say not have heard likely hence, this study aimed at determining the level of women emotional fertility readiness and its correlates so as to avail actionable evidence for the ministry and partners working Reproductive and women health so as to be used as an action point to empower women on their reproductive health right to control their fertility.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Nationally representative 2-year cohort data collected from pregnant women in four rounds were used. Frequency was computed to describe the study participant’s characteristics. Generalized ordered logistics regression was employed to identify correlates of the hierarchical variation in one year postpartum women fertility intention if they became pregnant. Results were presented in the form percentages and odds ratio with 95% Confidence Intervals. Candidate variables were selected using p-value of0.25. Statistical significance was declared at p-value of 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e One in 20, (4.63% (3.60%, 5.94%)) postpartum women have reported that they felt very happy. Nearly two third 64.87% (62.20%, 67.45%) of one year postpartum women have reported that they very or a sort of unhappy by one year post-partum when asked what do they feel if they became pregnant. Nearly one in 6, (17.12% (15.15%, 19.29%)) women reported mixed feeling in the same period. Women who reported they have ever used contraceptive and those who reported that they have started contraceptive use one year postpartum had a proportional cumulative logit of 0.66 (0.44, 0.97) and 0.43 (0.29, 0.63) respectively across the higher level categories of one year postpartum women emotional fertility intention compared with their counter parts. \u0026nbsp;The likelihood of one year postpartum emotional fertility intention among women with higher birth order and those who do not wanted additional child was found lower and asymmetrically across the higher level categories.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eNearly 2/3 of one year post-partum women have reported very unhappy or a sort of unhappy if they became pregnant while one in 6 and one in five felt mixed feeling if they became pregnant one year postpartum respectively calls up on intended and spaced pregnancies by ensuring women reproductive decision making to control over their fertility. Activities and efforts that promote intended and spaced pregnancies; and diversifying access to contraceptive methods are likely to improve the level of one year postpartum women emotional fertility intention. Activities that enable women to decide their contraceptive use along with patient centered contraceptive use counseling as well. The implication the findings is that awareness creation on preconception and availing the service is also hoped to address the varying level of one year postpartum emotional fertility intention.\u003c/p\u003e","manuscriptTitle":"One Year Postpartum Emotional Fertility Intentions among a Cohort of Pregnant Women followed for 2 Years and its Correlates in Ethiopia: Community based longitudinal data from Performance Monitoring for Action; Generalized Ordered Logistics Regression Modeling","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-14 20:59:30","doi":"10.21203/rs.3.rs-4414137/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"147c062c-7e66-422a-ae37-fe38c3a45084","owner":[],"postedDate":"May 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-05-14T20:59:30+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-14 20:59:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4414137","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4414137","identity":"rs-4414137","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}