Magnitude and associated factors of unmet need for family planning among rural women in Ethiopia: a multilevel cross-sectional analysis

Unmet need for family planning and associated factors among currently married women in Nepal: A further analysis of Nepal Demographic and Health Survey-2022

INTRODUCTION

Family planning (FP) is crucial for improving maternal and newborn health outcomes, promoting gender equality, and reducing poverty. Unmet FP needs persist globally, especially in South Asia and Sub-Saharan Africa leading to unintended pregnancies, unsafe abortions, and maternal fatalities. This study aims to identify the determinants of unmet needs for FP from a nationally representative survey.

METHODS

We analyzed the data of 11,180 currently married women from nationally representative Nepal Health Demographic Survey 2022. We conducted weighted analysis in R statistical software to account complex survey design and non-response rate. We conducted univariate and multivariable binary and multinomial logistic regression to assess association of unmet need for FP with independent variables including place of residence, province, ecological belt, ethnicity, religion, current age, participant's and husband's education, occupation, wealth quintile, parity, desire for child, and media exposure.

RESULTS

The total unmet FP need was 20.8% (95%CI: 19.7, 21.9) accounting 13.4% (95%CI: 12.5, 14.4) for unmet need for limiting and 7.4% (95%CI: 6.8, 8.0) for unmet for spacing. Lower odds of total unmet need for FP were present in 20-34 years and 35-49 years compared to <20 years, women belonging to Madhesi ethnic group (AOR: 0.78; 95%CI: 0.64, 0.95) compared to Brahmin/Chhetri, women from richest (AOR: 0.69; 95%CI: 0.56, 0.84), richer (AOR: 0.82; 95%CI: 0.68, 0.97) and middle wealth quintile (AOR: 0.82; 95%CI:0.70, 0.98) groups compared poorest wealth quintile group and women belonging to rural area (AOR: 0.89; 95%CI: 0.80, 0.99) compared to urban area. Higher odds of unmet need for FP were present among women with basic (AOR: 1.34; 95%CI: 1.17, 1.54), and secondary level (AOR: 1.32; 95%CI: 1.12, 1.56) education compared to women without education, among women from Madhesh (AOR: 1.56; 95%CI: 1.22, 1.98), Gandaki (AOR: 2.11; 95%CI: 1.66, 2.68), Lumbini (AOR: 1.97; 95%CI: 1.61, 2.42) and Sudurpashchim province (AOR: 1.64; 95%CI: 1.27, 2.10) compared to Koshi province and among women whose husband education was basic level (AOR:1.37; 95%CI: 1.15, 1.63), or secondary level (AOR: 1.32; 95%CI: 1.09, 1.60) education.

CONCLUSION

Nepal faces relatively high unmet FP needs across various socio-demographic strata. Addressing these needs requires targeted interventions focusing on age, ethnicity, religion, education, and socio-economic factors to ensure universal access to FP services.

Magnitude of unmet need for family planning and associated factors among women in the extended postpartum period in Dabat district, Northwest Ethiopia. evidence from Dabat demographic health surveys

BACKGROUND

Due to additional roles and emotional changes that occur during postpartum period, women use contraceptives differs from other times in their life. However, there is limited information about the unmet need for family planning (FP) among women in the extended postpartum period in the study area. Therefore, this study aimed to assess magnitude of unmet need for family planning and associated factors among women in the extended postpartum period in Dabat district, Northwest Ethiopia.

METHODS

A secondary data analysis was performed using the Dabat Demographic and Health Survey 2021. A total sample of 634 women during the extended postpartum period was included in this study. Stata version 14 statistical software was used for data analysis. Descriptive statistics were described using frequencies, percentages, mean, and standard deviation. Multicollinearity was tested using the variance inflation factor (VIF) and we computed Hosmer and Lemeshow goodness of fit. Both bivariable and multivariable logistic regression analyses were carried out to determine the association between independent variables and outcome variable. Statistical significance was declared at a p-value ≤ 0.05 with a corresponding 95% confidence interval.

RESULTS

The overall unmet need for FP during the extended postpartum women was 42.43% (95% CI: 38.62, 46.33), of which 33.44% was unmet need for spacing. Place of residence (AOR = 2.63, 95%CI: 1.61, 4.33), place of delivery (AOR = 2.09, 95%CI: 1.35, 3.24), and availability of radio and or TV (AOR = 1.58, 95% CI: 1.22, 2.13) were significantly associated with unmet need for family planning.

CONCLUSION

The magnitude of unmet need for family planning among women during the extended postpartum period in the study area was high when compared to the national average and the United Nations sphere standard of unmet need for family planning. Place of residence, place of delivery, and availability of radio and or TV were significantly associated with unmet need for family planning. Hence, the concerned bodies are recommended to promote intuitional delivery and give spatial attention to those who are residing in rural areas and to those who have had no media exposure in order to reduce the unmet need for family planning among postpartum women.

Contributing factors for urban-rural inequalities in unmet need for family planning among reproductive-aged women in Ethiopia: a Blinder-Oaxaca decomposition analysis

BACKGROUND

Unmet need for family planning (FP) is a global public health concern, particularly in low- and middle-income countries. In Ethiopia, although several studies have assessed unmet needs for FP, there have only been few empirical investigations into regional inequalities and their contributory factors. This study assessed urban-rural inequalities in unmet FP needs among reproductive-aged women in Ethiopia and particularly examined the contribution of material, cultural-behavioral, and psychosocial factors therein.

METHODS

A cross sectional study was conducted among 8811 reproductive-aged women derived from the nationally representative 2019 Ethiopian Performance Monitoring for Action (PMA) data. The outcome variable was unmet need for FP. The exposure variable was place of residence (urban or rural). Contributing factors were categorized into material, psychosocial and cultural-behavioral factors. Blinder-Oaxaca decomposition analysis was used to assess urban-rural inequalities in unmet need for FP as well as to disentangle the contributory factors in percentage points.

RESULT

In our study, 13.8% of reproductive-aged women in Ethiopia reported unmet FP needs. Urban-rural inequalities therein accounted for 6.8% points. Disparities in FP needs between urban and rural areas were mostly explained by psychosocial factors (81.0%) followed by material (21.0%), and cultural-behavioral (3.2%) factors. While women who were living with a partner (39.1%, p < 0.01) and multiparas (51%, p < 0.01) contributed to increasing inequalities, attending family planning counseling services with a healthcare provider (-1.7%, p = 0.03) reduced the gap in unmet need for FP between urban and rural areas. Women from the poorest and poor category contributed 14.1% (p = 0.02) and 11.1% (p = 0.04), respectively. Being from a Muslim religion also contributed to the disparity by 7.3% (p < 0.01).

CONCLUSION

This study showed that among reproductive-aged women in Ethiopia, inequalities in unmet FP needs show distinct urban-rural patterning. Most inequalities could be attributed to psychosocial factors, mainly parity and marital status, followed by material and cultural-behavioral factors. Policymakers should target these modifiable psychosocial factors to reduce urban-rural inequalities in unmet need for FP in Ethiopia.

Unmet need for family planning and associated factors among currently married women in Hawella Tulla subcity, Hawassa, southern Ethiopia: community-based study

BACKGROUND

The unmet need for family planning remains a major public health concern in developing countries, especially in sub-Saharan Africa. Similarly, in Ethiopia, the unmet need for family planning is considerably high. However information regarding associated factors of unmet need of family planning is limited, the study area in particular. Thus, this study was aimed at assessing unmet family planning and associated factors among currently married women in Hawella Tulla Subcity.

METHODS

A community based cross-sectional study was employed on 436 currently married women. Both bivariable and multivariable logistic regression model were used and having P-value of < 0.05 was considered as independently associated factors. Strength of association of the variable was described using adjusted odd ratios with their 95% confidence interval.

RESULT

The overall unmet need for family planning among currently married women was found to be 18.1% (95% CI: 14.5%, 21.8%). Having age of below 18 years at first marriage AOR = 1.95 (95% CI: 1.14, 3.33), woman's not attained formal education AOR = 2.23 (95% CI: 1.02, 4.84), women whose partner had non-supportive for family planning use AOR = 2.32 (95% CI: 1.35, 3.99) and women without media access AOR = 2.13 (95% CI: 1.19, 3.81) were significantly associated with increasing unmet need for family planning.

CONCLUSIONS

Despite the presence of high family planning services coverage in the study area, the magnitude of unmet need for family planning is still reasonably high. Having age of below 18 years at first marriage, woman's not attained formal education, women whose partner had non-supportive for family planning use and inavailability of media access in the house were found to be associated with high unmet need for family planning. Therefore, efforts are needed to empower women through education, avoiding early marriage and encouraging couple-based family planning interventions. Increasing media access is also advisable intervention.

Unmet need for family planning and associated factors among adolescent girls and young women in Ethiopia: a multilevel analysis of Ethiopian Demographic and Health Survey

BACKGROUND

Unmet need for family planning among adolescent girls and young women (AGYW) is a common cause of the low contraceptive utilization in developing countries, including Ethiopia. To address problems associated with unmet for family planning among adolescent girls and young women nationally available evidences are essential. However, there is limited evidence regarding factors associated with the unmet need for family planning among adolescent girls and young women in Ethiopia. Hence, this study aims to assess the prevalence and associated factors of unmet need for family planning among adolescent girls and young women in Ethiopia.

METHODS

Our analysis was based on secondary data using the 2016 Ethiopian Demographic and Health Survey data. A total weighted sample of 1086 adolescent girls and young women was included in this study. A multi-level mixed-effect logistic regression analysis was fitted. Adjusted odds ratios with 95% confidence intervals were used to show the strength and direction of the association. Statistical significance was declared at a p-value less than 0.05.

RESULTS

The prevalence of unmet need for family planning was 28.3% (95% CI: 25.7, 31.0). Adolescent girls and young women age 15-19 years (aOR: 2.4, 95%CI: 1.3, 4.3), household wealth quantile; poor (aOR: 5.6, 95%CI: 2.8, 11.1) and middle (aOR: 2.9, 95%CI: 1.4, 6.0), had no media exposure (aOR: 2.1, 95%CI: 1.1, 4.1), and adolescent girls and young women from developing regions (aOR: 5.1, 95%CI: 1.1, 14.5) were significantly associated with unmet need for family planning.

CONCLUSIONS

Unmet need for family planning was high among adolescent girls and young women when compared to the national average and the United Nations sphere standard of unmet need for family planning. Age, wealth quantile, media exposure, and region were significantly associated with unmet need for family planning. Hence, there is the need to implement consistently effective family planning policies among AGYW living in developing regions of Ethiopia. Moreover, Public health policies and interventions that improve the existing strategies to improve media exposure of AGYW on family planning issues and increase the wealth status of households should be designed and implemented to reduce the unmet need for family planning in Ethiopia.

Individual and Community-level factors associated with early marriage in Zambia: a mixed effect analysis

BACKGROUND

Child marriage has long been a public health concern around the world, because it has the potential to deprive adolescent girls of their sexual reproductive health rights and limits their ability to reach their full potential in life. The prevalence of child marriage has been consistently higher in sub-Saharan Africa than elsewhere. However, fewer studies have explored the influence of both individual and community-level influences on early marriage in sub-Saharan Africa. This study, therefore, examined individual and community-level factors associated with child marriages in Zambia.

METHODS

Data came from the Zambia Demographic and Health Surveys (ZDHS) conducted in 2007, 2013-14 and 2018. A pooled weighted sample of 9990 women aged 20-29 years was used in the analysis. Stata software version 17 was used to perform statistical analysis, taking into account complex survey design. The association between individual- and community- level factors and early marital behavior was assessed using multilevel logistic regression models.

RESULTS

The prevalence of child marriage among women aged 20-29 was 44.4 percent (95% CI: 42.1, 46.7) in 2018, declining from 51.5 percent (95% CI: 48.9, 54.0) in 2007. Women with secondary or higher level of education [aOR = 0.36, 95% CI = 0.26-0.49] and [aOR = 0.07, 95% CI = 0.03-0.18] and those whose age at first birth was (15-19 year) or (20-29 years) were associated with less likelihood of experiencing child marriage. Communities with a high percentage of women who gave birth at a young age [aOR = 1.36, 95% CI = 1.15-1.62] were more likely to experience child marriage. Individual and community-level characteristics accounted for 35% of the overall variations in communities' likelihood of experiencing early marriage. Even after controlling for both individual and community-level influences, the intra-class correlation revealed that around 4.5 percent of the overall variations remained unexplained.

CONCLUSION

Prevalence of child marriage has reduced over the years but is still high in Zambia. Both individual and community- level factors influenced child marriage in Zambia. There is a need to strengthen strategies that keep girls in school to delay their exposure to early sexual debut and child marriage. Designing of reproductive health interventions in the country should consider integration of community factors such as economic insecurity and access to reproductive health information.

Prevalence and determinants of unmet need for contraception among women in low and high-priority segments for family planning demand generation in Nigeria

BACKGROUND

Studies have identified various determinants of unmet need for contraception. These determinants cut across individual, household, community, and health facility levels. Despite this evidence, there remains a lack of information regarding differentials in the prevalence and determinants of unmet need for contraception among women in the low-priority segments (such as women of advanced reproductive age and women living with disabilities) and high-priority segments (such as adolescents, young adults, and unmarried women) for family planning demand generation, hence this study.

METHODS

The study design is cross-sectional. The study analyzed merged data from the individual, and persons recode of the 2018 Nigeria Demographic and Health Survey (NDHS). The samples analyzed are 5,147 women in the high-priority segment and 7,536 women in the low-priority segment. The outcome variable in the study was unmet need for contraception. The explanatory variables were selected at the individual, household, community, and facility levels. Statistical analyzes were performed using Stata 14. Three multilevel mixed-effects regression models were fitted. Model 1 was the empty model, while Model 2 included the sets of individual, household, and community variables. Model 3 controlled for the facility-level variables.

RESULTS

Findings show a higher prevalence of unmet need for contraception among women in the family planning low-priority segment compared to women in the family planning high-priority segment. Religion and desired family size were the two individual characteristics that significantly predicted the unmet need for contraception among women in the two segments. Sexual autonomy was the only household characteristic that predicted unmet need for contraception in both segments. There were differences in the community characteristics that predicted unmet need for contraception among women in the two segments.

CONCLUSION

The prevalence of unmet need for contraception is not the same among women in low and high family planning priority segments. The determinants also differ among women in the two segments. Though, women in different family planning segments have the same contraceptive needs of avoiding pregnancy when not needed, however, getting the needs satisfied requires that existing programs be further examined to develop initiatives that will resonate with each segment of reproductive-age women.

Magnitude of unmet need for family planning and its predictors among reproductive age women in high fertility regions of Ethiopia: Evidence from Ethiopian Demographic and Health Survey

BACKGROUND

Unmet need for family planning refers to fertile women who want to limit or space their delivery but are not using contraceptive methods. Despite multiple studies were conducted to address family planning in Ethiopia, there is limited information on unmet need in high fertility regions. Knowing the magnitude and predictors of unmet need in the study area helps as an impute for interventions. Therefore, this study aims to assess the magnitude and predictors of unmet need for family planning among reproductive age women in high fertility regions of Ethiopia.

METHODS

A secondary data analysis was performed using the Ethiopian Demographic and Health Survey 2016. A total sample weight of 4312 currently married reproductive age women were included in this study. A multilevel mixed-effect binary logistic regression model was fitted. Finally, the odds ratios along with the 95% confidence interval were generated to determine the individual and community level factors of unmet need for family planning. A p-value less than 0.05 was declared as statistical significance.

RESULTS

The overall unmet need for family planning among currently married reproductive-age women in high fertility regions of Ethiopia was 29.78% (95% CI: 28.26, 31.3). Women with no formal education (AOR: 1.65, 95% CI: 1.17, 2.15), women in the poor wealth quantile (AOR: 1.67, 95% CI: 1.34, 2.09), women with no media exposure (AOR: 1.32, 95% CI: 1.09, 1.58), multiparous women (AOR: 1.57, 95% CI: 1.15, 2.16), sex of household head (AOR: 1.39, 95% CI: 1.11, 1.77) and rural residency (AOR: 2.45, 95% CI: 1.12, 3.59) were predictors of unmet need for family planning.

CONCLUSION

The magnitude of unmet need for family planning among currently married reproductive-age women in high fertility regions of Ethiopia was high when compared to the national average and the United Nations sphere standard of unmet need for family planning. Education, wealth index, mass media, parity, sex of household head, and residence were independent predictors of unmet need for family planning among reproductive-age women in high fertility regions of Ethiopia. Any interventional strategies that reduce the unmet need for family planning should consider these factors to overcome the problems in the regions.

Unmet need for family planning among married women in Zambia: lessons from the 2018 Demographic and Health Survey

BACKGROUND

Unmet need for family planning among married women is still a public health concern in sub-Saharan Africa. In Zambia, one in every five married women had an unmet need for family planning in 2018. Unmet need for family planning has the potential to increase the number of unintended pregnancies and unsafe abortions. These factors can increase the proportion of women of child bearing age, who are at high risk of birth complications. This study was therefore conducted to understand the determinants of unmet need for family planning among married women in Zambia based on recent cross-sectional data.

METHODS

The study analysed data extracted from the Zambia Demographic and Health Survey, which was a representative cross-sectional survey conducted in 2018. The analysis was done on a sample of 7598 currently married women aged 15-49 years. Multivariate logistic regression was used to examine determinants of unmet need for family planning in Zambia. The analyses was weighted to account for complex sample design.

RESULTS

Prevalence of unmet need for family planning is still high in Zambia at 20%. Women in the age groups 25-34 and 35-49 were less likely to have total unmet need for family planning (AOR = 0.61; 95% CI 0.47, 0.78) and (AOR = 0.63; 95% CI 0.45, 0.86) respectively, compared with those aged 15-24 years. Age of a woman, parity, household wealth and exposure to media-based family planning messages were found to be significantly associated with unmet need for family planning among married women.

CONCLUSION

There were significant differences in unmet need for family planning based on a woman's age, number of children ever born, wealth level, and exposure to media-based family planning messaging. Improving access to family planning messages and addressing underlying structural factors that improve the wealth status, particularly among young women, may help to reduce unmet need for family planning in Zambia.

Prevalence of Contraceptive Non-use Due to Husbands/Partners Influence Among Married Women in Ethiopia: A Multilevel Analysis Using Demographic and Health Survey 2016 Data

Background

In Ethiopia women with their husbands/partners are the decision-makers for contraceptives non-use suffered either due to the consequence of unintended pregnancy or due to the indirect impact of the secret use of contraceptives from their husbands/partners. Despite this challenge, there is a dearth of evidence about the magnitude of husbands/partners' decision-makers on contraceptives n non-used in Ethiopia.

Objective

This study was aimed to assess the magnitude of husbands'/partners decisions on contraceptive non-use and associated factors among married and non-contraceptive user reproductive-age women in Ethiopia.

Methods

The study was conducted based on Ethiopian demographic and health survey 2016 data which was a cross-sectional survey from 18 January 2016 to 27 June 2016. A total weighted sample size of 5,458 married and non-contraceptive user reproductive-age women were taken. A multilevel logistic regression model was used because of the data nature hierarchical, and variables with p ≤ 2 in the bivariable multilevel analysis were taken to multivariable multilevel analysis. Adjusted odds ratio with 95% CI was used to declare both the direction and strength of association and variables with p < 0.05 were considered statistically significant with the outcome variable.

Results

Husband decision-making power on contraceptive non-use was 10.44% [9.65–11.28%]. Husband's educational level higher (adjusted odds ratio (AOR = 2.6; CI 1.4–4.7), being Muslim, protestant, and others in religion (AOR = 2.4; CI 1.7–3.5), (AOR = 2.1; CI 1.4–3.1), (AOR = 4.5; CI 2.3–8.5), respectively, media exposure (AOR = 1.4; CI 1.0–1.8), husband wants more children (AOR = 3.7; CI 2.8–4.8), husband desire did not know (AOR = 1.4; CI 1.1–1.9), information about family planning (AOR = 0.6; CI 0.4–0.8), visited by field worker (AOR = 0.7; CI 0.5–0.9), visited health facility (AOR = 0.6; CI 0.4–0.7), and community husband education high (AOR = 1.6; CI 1.1–2.4) were statistically significant with husband decision making power on contraceptive non-use.

Conclusion

In Ethiopia 1 out of 10 married and non-pregnant women is influenced by their husband/partner's decision-making power of non-use contraceptives. Husband's educational level high, religion (Muslim, protestant, and others), media exposure, husband's desire for children (husband wants more and does not know), and community husband education were variables positively associated with the outcome variable; whereas having information about family planning, visited by field worker, and visited health facility were negatively associated husband decision making power for non-use contraceptive in Ethiopia.

Unmet need for family planning and associated factors among currently married women of reproductive age in Bishoftu town, Eastern Ethiopia

Background

Unmet family planning is one of the common causes for low contraceptive prevalence rates in developing countries, including Ethiopia. Rapid urbanization had profound effect on population health, however, little is known about the unmet need of family planning in settings where there was increased industrializations and internal migrations in Ethiopia. This study aims to determine the unmet need for family planning services among currently married women and identify factors associated with it in Bishoftu town, Eastern Ethiopia.

Methods

Community-based cross-sectional study was conducted from 1^st January to 28^th February, 2021 among 847 randomly sampled currently married women of the reproductive age group. Data were collected using semi structured interviewer administered questionnaire. Multivariate logistic regression was used to identify factors associated with the outcome variable and a 95% confidence interval was used to declare the presence of statistical significance associations.

Results

Eight hundred twenty-eight women were participated in the study. The prevalence of unmet need for family planning among currently married women was 26% [95% CI: 23,29]. Maternal age [AOR, 3.00, 95% CI:1.51–5.95], educational status [AOR, 2.49, 95% CI:1.22–5.07], occupational status of self-employee [AOR, 1.98, 95% CI:1.15–3.39] and housewife [AOR, 1.78, 95% CI:1.02–3.12], being visited by health care provider in the last 12 months [AOR, 1.81, 95% CI: 1.26–2.60] and desired number of children less than two [AOR, 1.53, 95% CI:1.01–2.30] were significantly associated with unmet need for family planning.

Conclusions

Unmet need for family planning was higher in the study area compared with the United Nations sphere standard of unmet need for family planning and the national average, and slightly lower than the regional average. Socio-demographic, economic, and health institution factors were determinants of the unmet need for family planning in the study area. Therefore, health education and behaviour change communication related to family planning services should be strengthened and access to family planning services should be improved.