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Mesfin Gebremedhin Jnr,1 Addisu Alemayehu,2 Manaye Yihune,1 Samuel Dessu,3 Tamirat Melis,4 Negash Nurahmed5 1Arba Minch University, College of Medicine & Health Sciences, Department of Public Health, Arba Minch, Ethiopia; 2Dilla University, College of Medicine & Health Sciences, Department of Public Health, Dilla, Ethiopia; 3Wolkite University, College of Medicine & Health Sciences, Department of Public Health, Wolkite, Ethiopia; 4Wachamo University, College of Medicine & Health Sciences, Department of Public Health, Hosanna, Ethiopia; 5Paster Ethiopian Public Health Institute, Addis Ababa, EthiopiaCorrespondence: Mesfin Gebremedhin Jnr Email mesfing762@gmail.comBackground: An intrauterine contraceptive device is suitable for women of all reproductive age groups for preventing unwanted pregnancies. Immediate postpartum family planning (PPFP) services need to be emphasized when the woman leaves the hospital. Despite the accepted demand for PPFP, many women do not access the services. Therefore, this study aimed to assess acceptability and factors associated with immediate postpartum intrauterine contraceptive device use among women who gave birth at government hospitals of Gamo Zone, Southern Ethiopia.Methods: A cross-sectional study was conducted from March 1 to 30, 2019 with 452 participants studied using systematic random sampling technique. Data was collected using a pretested interviewer-administered questionnaire from March 1 to 30, 2019. The data were coded, cleaned and entered into Epi-data manager version 4.2.2.1 and exported to SPSS version 23 for advanced analysis. Binary logistic regression was performed to identify associated factors of immediate PPIUCD acceptability.Results: This study revealed that about 161 (35.6%) in 95% CI (31.0, 39.6) of the study participants accepted immediate PPIUCD. Multiparty (AOR = 2.33, 95% CI, (1.29, 4.20)), completed antenatal follow up (AOR = 3.65, 95% CI, (2.22, 5.99)), counselling (AOR= 8.38, 95% CI, (4.85, 14.48)) and prior discussion (AOR=2.57, 95% CI, (1.51, 4.36)) were statistically significant.Conclusion and Recommendation: Even though 58% of the mothers were counselled about PPIUCD during the important cascade of pregnancy and 53% of the mothers completed antenatal service, efforts need to improve antenatal care services and integrate counselling services through the whole cascade of pregnancy.Keywords: acceptability, immediate postpartum intrauterine contraceptive device