Unmet need for family planning and associated factors among married women attending anti-retroviral treatment clinics in Dire Dawa City, Eastern Ethiopia

Background Unmet need for family planning is a measure of the gap between women’s contraceptive behavior and their fertility desires. It should be measured among different population groups to effectively implement public health interventions. Thus, this study aimed to determine the magnitude of unmet need for family planning and associated factors among HIV- positive women in Dire Dawa city Anti-retroviral treatment (ART) clinics, Eastern Ethiopia. Methods We carried out a facility-based cross-sectional study (March-June 2020) among 409 married women aged 15–49 on ART, using systematic random sampling. A face-to-face interview was done using a structured questionnaire. Bivariable and multivariable logistic regression was done to identify factors associated with unmet need for family planning. Results Overall, 33% [95% confidence interval (CI): 28.9–37.9] of the respondents had unmet need for family planning. Woman’s residing in a rural area (adjusted odds ratio (AOR): 2.41 [95% CI: 1.24–4.67]), woman’s not attained formal education (AOR: 4.14 [95% CI: 1.73–9.93]) and attaining primary education (AOR: 2.97 [95% CI: 1.54–5.74]), poor knowledge (AOR: 2.87 [95% CI: 1.52–5.40]), and unfavorable attitude towards family planning (AOR: 2.21 [95% CI: 1.12–4.34]), clients not satisfied with family planning service (AOR: 6.34 [95% CI: 3.31–12.15]), the woman not having decision making power on family planning (AOR:3.97 [95% CI: 2.14–7.38]) and not getting family planning counseling in ART clinics (AOR: 2.87 [95% CI: 1.54–5.35]) were positively associated with having unmet need for family planning. Conclusion This study indicates there a high unmet need for family planning among married HIV-positive women. Factors like a place of residence, educational status of women, knowledge and attitude towards family planning, client satisfaction with FP service, women decision-making power, and FP counseling service in ART. Therefore, we recommend that the concerned bodies should collaborate with ART clinics to design interventions that enhance access to family planning programs to combat the high unmet need for family planning among HIV-positive women.