Does Voluntary Family Planning Contribute to Food Security? Evidence from Ethiopia

**Background:** Food security remains a critical challenge in Ethiopia, with 71.6% of households in the studied zones reported as food insecure. Family planning (FP) is hypothesized to contribute to food security by enabling women to space and limit pregnancies, thereby improving maternal health, increasing labor force participation, and reducing household food needs. However, there is limited evidence on the direct association between FP utilization and food security. This study aimed to assess the relationship between voluntary FP use and household food security in three drought-prone zones of Ethiopia.

**Methods:** A cross-sectional mixed-methods study was conducted in 2020 across the South Omo and Wolaita zones of SNNPR and the Bale zone of Oromia region. A total of 737 women (both FP users and non-users) were selected using systematic random sampling from health post registries (HMIS and ANC registries). Sample distribution was proportional to population size: 387 (52.5%) from Wolaita, 138 (18.7%) from South Omo, and 212 (28.8%) from Bale. Data were collected electronically using ODK/KOBO with a structured questionnaire adapted from USAID, FAO, and WFP tools. Food security was measured using the Household Food Insecurity Access Scale (HFIAS) with a 30-day recall period and the Food Consumption Score (FCS) with a 7-day recall. Hierarchical logistic regression was performed, with variables having p<0.25 in bivariate analyses included in multivariable models. Model III included both individual-level and community-level factors.

**Key Results:** The mean age of participants was 28.9 years (SD ±6.6); 96.9% resided in rural areas, 95.4% were married, and 55.2% were illiterate. Health extension workers were the primary source of FP information for 96.3% of women. Among participants, 81.4% had ever used FP services and 78.2% were current users. Among current users, 63.3% used implants and 30.1% used injectables. The mean duration of FP use was 21.2 months. Only 44.8% of households were food secure; 22% were mildly, 18% moderately, and 15% severely food insecure. Food security was higher among FP users (46.2%) than non-users (9.6%). The mean FCS was 37.5, categorized as 'acceptable' overall, though Wolaita scored 'borderline' (24). Hierarchical logistic regression (Model III) identified the following independent predictors of food security: Women aged 20–29 years had 82% lower odds (AOR 0.18, 95% CI 0.04–0.83) and women aged 30–49 had 92% lower odds (AOR 0.08, 95% CI 0.02–0.35) of food security compared to those aged 15–19. FP use for ≤21 months was associated with 64% lower odds of food security (AOR 0.64, 95% CI 0.42–0.99) compared to use >21 months. Households with 'good' positive adaptive behaviors were 3.6 times more likely to be food secure (AOR 3.60, 95% CI 2.07–6.26) compared to those with poor adaptive behaviors. Women influenced by significant others to use FP had 49% lower odds of food security (AOR 0.51, 95% CI 0.33–0.80).

**Clinical Implications:** The findings demonstrate that longer duration of voluntary FP use is significantly associated with improved household food security, supporting the integration of FP services into food security and nutrition programs. The strong reliance on health extension workers (96.3% of women cited them as their trusted source) suggests that community-based health programs are effective delivery platforms. The inverse association between age and food security likely reflects larger family sizes among older women, reinforcing the need for FP to enable birth spacing and family size limitation. The finding that women influenced by others in FP decision-making had worse food security outcomes highlights the importance of women's empowerment and autonomous decision-making. Culturally sensitive strategies, community dialogues, and multi-sectoral approaches are needed to address misconceptions, expand FP awareness, and strengthen household adaptive capacity to shocks and climate variability.