Predictors of unmet need for family planning in Ethiopia 2019: a systematic review and meta analysis

Determinants of unmet need for contraceptive method among young married women in Ethiopia: Multilevel analysis of Ethiopia Demographic and Health Survey 2016

BACKGROUND

The notion of unmet need for family planning indicates the gap between women's contraceptive practice and their reproductive intention. Although universal access to sexual and reproductive health services including contraceptive methods is a bedrock for sustainable development goals, the unmet need for contraception is high among young women in low-income countries including Ethiopia. The unmet need for contraception is associated with unintended pregnancy which most of the time end in unsafe abortion. Hence, this study aimed to assess the determinants of unmet need for family planning among young married women in Ethiopia using nationally representative data.

METHOD

This study utilized secondary data collected in the 2016 Ethiopia Demographic and Health Survey (EDHS). A two-stage cluster sampling method was used. The analysis included a total of 2444 sexually active married young women (15-24 years). Multilevel logistic regression analysis was conducted to identify individual and community level factors associated with unmet need for contraceptives and the results were presented as adjusted odds ratio (AOR) at 95% confidence interval (CI), declaring statistical significance at a p-value <0.05 in all analyses.

RESULTS

In this study, the prevalence of unmet need for contraceptive method among married young women was 18.4% [95% CI: (16.9, 20.0)]. Female head of the household [AOR: 1.62, CI (1.25, 2.11)], primary level of education [AOR: 1.53, CI: (1.16, 2.03)], family size ≥5 [AOR: 1.53, 95%CI: (1.22, 1.93)], undecided to have child [AOR: 2.86, 95%CI: (1.58, 5.20)] and infecund [AOR: 1.54, 95%CI: (1.08, 2.20)] were factors positively associated with unmet need for family planning. Whereas the odds of unmet need for contraceptive method was lower among women-initiated sex between 15-17 years and >17 years [AOR:0.72, 95%CI (0.53, 0.98)] and [AOR: 0.58, 95%CI: (0.40, 0.85)] respectively and community with high proportion of poverty [AOR: 0.68, 95%CI: (0.46, 0.99)].

CONCLUSION

The prevalence of unmet need for contraceptive methods among young married women was relatively high. Being female household head, age at first sexual intercourse, educational status of the woman, family size, desire for more children, and community poverty were significantly associated with unmet need for family planning. Hence, interventions targeting these special populations at the individual and community level would play a paramount role in meeting the unmet need for contraception among young married women in Ethiopia.

What are the associated factors of low husbands/partners independent decision-maker in women's contraceptive use decision-making process in Ethiopia? Multilevel analysis

BACKGROUND

Many married women of reproductive age with husbands or partners are less cooperative in using contraceptives, often resulting in unintended pregnancies or secret contraceptive use. This private use of contraceptives causes women to suffer from side effects without proper support, and many women in Ethiopia die due to unintended pregnancies. However, the involvement of husbands or partners in the contraceptive decision-making process in Ethiopia is often neglected. There is also a lack of evidence regarding the determinants of husbands' or partners' decision-making power on contraceptive use in Ethiopia.

OBJECTIVE

This study aimed to assess the determinants of low involvement of husbands/partners in women's contraceptive use decision-making processes in Ethiopia.

METHODS

This study was based on Ethiopian Demographic and Health Survey data, collected from January 18 to June 27, 2016. Weighted samples of 3,669 reproductive-age women were included. Husbands'/partners' independent decision-making was measured by whether the husband/partner decided independently or alone about contraceptive use, categorized as "Yes" or "No". A multilevel logistic regression model was fitted, and ICC (Intra-class Correlation Coefficient), MOR (Median Odds Ratio), PCV (Proportion Change in Variance), and deviance were used to assess model fitness and comparison. Variables with a p-value of ≤ 0.2 in the bivariate analysis were considered candidates for multivariable multilevel analysis. An adjusted odds ratio with a 95% confidence interval was used to determine both the direction and strength of the association, and a p-value of < 0.05 was used to declare statistical significance.

RESULTS

Husbands'/partners' independent decision-making in women's contraceptive use was found to be 5.41% [4.72-6.19%]. Significant factors associated with this included: Husbands/partners aged 31-59 years (Adjusted Odds Ratio (AOR) = 1.3; Confidence Interval (CI) 2.3-5.4) and over 59 years (AOR = 2.3; CI 1.2-4.3), Educational level of husbands/partners: primary education (AOR = 3.2; CI 2.9-4.3), secondary education (AOR = 3.9; CI 2.7-4.4), and higher education (AOR = 4.3; CI 2.8-5.0), Media exposure (AOR = 4.5; CI 2.2-5.4), History of pregnancy termination (AOR = 3.3; CI 2.6-4.1), Perception that distance to health facilities is not a significant problem (AOR = 3.0; CI 1.7-4.7) and Urban residency (AOR = 3.5; CI 1.6-4.2).

CONCLUSIONS

In Ethiopia, the involvement of husbands/partners in the contraceptive use decision-making process is low. To increase their decision-making power, attention should be given to factors such as age, educational level, media exposure, history of pregnancy termination, distance to health facilities, and urban residency.

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.

Male involvement in family planning and its association with knowledge and spouse discussion in Ethiopia: a systematic review and meta-analysis

OBJECTIVE

This study aimed to estimate the pooled prevalence of male involvement in family planning (FP) and its association with knowledge and spouse discussion in Ethiopia.

DESIGN

Systematic review and meta-analysis using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines.

DATA SOURCES

The study was conducted by the articles searched from different databases: (PubMed, Cochrane Library, PsycINFO, HINARI and Google Scholar).

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

This research encompassed investigations carried out within married couples in Ethiopia, specifically focusing on studies where male involvement in FP was the primary outcome. The inclusion criteria comprised studies with an observational study design, encompassing both published and unpublished works, conducted in the English language, with no restrictions on data collection and publication year.

DATA EXTRACTION AND SYNTHESIS

Following a systematic search of the articles, two independent authors assessed the quality of the studies, and data extraction was conducted using Microsoft Excel. The data analysis was performed by using STATA V.17. The overall level of male involvement in FP in Ethiopia was calculated using DerSimonian and Liard's random-effect model, with a significance level set at a p<0.05. Heterogeneity was examined using the I2 test, and Egger's test was employed to assess publication bias.

RESULTS

The pooled prevalence of male involvement in FP in Ethiopia was 59.71% (95% CI (47.68% to 71.73%)). Good knowledge regarding FP (AOR 6.63, 95% CI (2.58 to 17.03)) and spouse discussion on FP (AOR 4.36, 95% CI (2.50 to 7.59)) were significantly associated with male involvement in FP.

CONCLUSIONS

The prevalence of male involvement in FP in Ethiopia was low as compared with other literature conducted outside Ethiopia. Both good knowledge and spouse discussion regarding FP were significantly associated with male involvement in FP. So, the government and healthcare providers should focus on interventions that could increase their knowledge through different media. In addition, encouraging couples to have a discussion regarding FP could be a recalled intervention for healthcare providers.

Emergency contraceptive knowledge and associated factors among abortion experienced reproductive age women in Ethiopia: a multilevel analysis using EDHS 2016 data

BACKGROUND

Emergency contraceptives (EC) are used to avoid unintended pregnancy, hence avoiding its incidence and its effects. In Ethiopia, emergency contraception is commonly accessible, especially in the big cities. However, there is virtually little understanding of or awareness of EC and Ethiopia has a high abortion rate. Therefore this study was aimed to assess the magnitude and associated factors for emergency contraceptive knowledge in Ethiopia.

METHODS

The study was based on secondary data analysis of the Ethiopian Demographic and Health Survey 2016 data. A total weighted sample of 1236 reproductive age women was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of emergency contraceptive knowledge. Statistical significance was determined using Adjusted Odds Ratio (AOR) with 95% confidence interval.

RESULTS

Overall magnitude of emergency contraceptive knowledge was observed to be 17.19% (95% CI: 15.18, 19.40) with intra-class correlation (ICC) 57% and median odds ratio (MOR) 6.4 in the null model. Women's age 25-34 (AOR = 2.6; 95% CI: 1.2, 5.5), and 35-49 (AOR = 1.5; 95% CI: 1.06, 3.3), secondary and above educational level (AOR = 3.41; 95% CI: 2.19, 4.88), media exposure (AOR = 2.97; 95% CI: 1.56, 5.64), Being in metropolitan region (AOR = 2.68; 95% CI: 1.46, 4.74), and women being in urban area (AOR = 3.19; 95% CI: 1.20, 5.23) were associated with emergency contraceptive knowledge.

CONCLUSION

Emergency contraceptive knowledge in this study was low. Women age, educational level, media exposure, residency, and region were significantly associated with emergency contraceptive knowledge. Therefore, to enhance understanding and use of ECs in the current Ethiopian setting, it is imperative to ensure exposure to EC information, particularly in rural regions.

Unmet need for modern contraception by HIV status: findings from community-based studies implemented before and after earlier ART initiation program in rural Tanzania

BACKGROUND

Tanzania Health policy insists on the need to provide all women access to contraception despite HIV status. We used data from two HIV epidemiologic serological surveys carried out at different periods of ART provision in rural Tanzania to assess the level of unmet need for modern contraception by HIV status and associated factors.

METHODS

We performed secondary data analysis of two surveys conducted at the Magu Health and Demographic Surveillance System site, in Mwanza, Tanzania. Information on unmet need for modern contraception was derived from fertility desire and contraception use. Unmet need, HIV status, and socioeconomic and demographic variables were analysed. The percentage of women with unmet needs for modern contraception by HIV status is presented for the 2012 and 2017 surveys. Bivariate and multivariate analyses using logistic regression were used to investigate associated factors showing adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs).

RESULTS

Data from 3352 and 3196 women aged 15-49 years collected in the 2012 and 2017 surveys, respectively, were analysed. The percentages of women with unmet needs for modern contraception in the 2012 and 2017 surveys were 30.9% (95% CI 29.4-32.6) and 31.6% (95% CI 30.0-33.3), respectively. The unmet need for modern contraception was 26% lower in HIV-uninfected women in 2012 (aOR = 0.74; 95% CI 0.569-0.973); p = 0.031). Risk factors for unmet need for modern contraception in 2012 were HIV uninfected (adjusted OR = 0.74; 95% CI 0.569-0.973); p = 0.031), married marital status (adjusted OR = 0.768; 95% CI 0.743-0.794); p < 0.0001), higher education (adjusted OR = 0.768; 95% CI 0.743-0.794); p < 0.0001), and taking alcohol (adjusted OR = 0.768; 95% CI 0.743-0.794); p < 0.0001). Only two factors were associated with unmet need for modern contraception in 2017: married marital status (adjusted OR = 0.46; 95% CI 0.305-0.722); p = 0.001) and women who earned for their families (aOR = 0.66; 95% CI 0.494-0.887); p = 0.006).

DISCUSSION

Nearly one-third of women had an unmet need for modern contraception, which was lower in HIV-uninfected women than in WLHIV-infected women. The study has identified women whose demand for contraception has not been met: WLHIV, post marital women, women with low education and women who were reported to earn money for their families. Family planning interventions should be tailored to these groups of women.

Prevalence and predictors of post-abortion modern contraceptive utilization among reproductive age women in Ethiopia

The development of a post-abortion family plan is an integral part of comprehensive abortion care. In spite of this, it received insufficient attention as a means of breaking the cycle of repeated abortions, unintended pregnancies, and maternal deaths resulting from abortion. Therefore, this study examined post abortion modern contraceptive utilization among Ethiopian women as well as associated factors. The study was based on secondary data analysis of the Ethiopian Demographic and Health Survey 2016 data. A total weighted sample of 1236 reproductive age women was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of post abortion contraceptive use. Statistical significance was determined using Adjusted Odds Ratio (AOR) with 95% confidence interval. Overall prevalence of post abortion contraceptive use was observed to be 25.6% (95% CI: 23.24, 28.12). Women's age 15-24 (AOR = 2.34; 95% CI: 1.11, 4.93), and 25-34 (AOR = 1.94; 95% CI: 1.27, 2.98), married women (AOR = 2.6; 95% CI: 1.43, 4.96), women who had 1-4 (AOR = 4.13; 95% CI: 1.79, 9.57) and ≥ 5 number of children (AOR = 8.80; 95% CI: 3.30, 13.49), Being in metropolitan region (AOR = 9.14; 95% CI: 1.79, 12.48), women being in urban area (AOR = 1.85; 95% CI: 1.32, 2.24), and community media exposure (AOR = 1.75; 95% CI: 1.11, 3.56) were associated with post abortion modern contraceptive use. Post abortion modern contraceptive use in this study was low. Women age, current marital status, number of living children, residency, community media exposure, and region were significantly associated with post abortion modern contraceptive utilization. Therefore, it is better to provide ongoing health information about post-abortion family planning and its benefits, especially for people who live in rural and small peripheral regions, and public health policymakers should take both individual and community level factors into account when designing family planning programmes.

Early discontinuation of long-acting reversible contraceptives at four government hospitals, Addis Ababa, Ethiopia

OBJECTIVE

Given high unmet need for contraception in Ethiopia, this study aimed to determine prevalence and factors associated with early discontinuation of long-acting reversible contraceptives (LARC).

METHODS

This institution-based cross-sectional study was conducted with 389 participants using exit interviews with clients presenting for removal of LARC at the family planning clinic of four government hospitals in Addis Ababa. SPSS version 26 was used for analysis. Descriptive statistics, bivariate, and multivariate logistic regression were computed.

RESULT

Among the 389 clients, 236 (60.7%) discontinued early. In multivariate regression, lack of pre-insertion counseling on side effects (AOR = 3.5, p = 0. 000; 95% C.I = 1.8-6.8), presence of side effects (AOR = 1.9, p = 0. 017; 95% C.I = 1. 1- 3.4), history of abortion (AOR = 3.5, p = 0. 001; 95% C.I = 1. 6- 7.4); and no prior contraception use (AOR = 2.9, p = 0. 000; 95% C.I = 1. 6- 5.3) were positively associated with early discontinuation. Whereas insertion outside of Saint Paul's Hospital Millennium Medical College (AOR = 0.4, p = 0. 000; 95% C.I = 0. 2- 0.6), and influence on choice of contraceptives by others (AOR = 0.2, p = 0. 000; 95% C.I = 0. 2- 0.4) were negatively associated with early discontinuation.

CONCLUSION

Early discontinuation of LARC was high among study participants. Counseling about possible side effects and giving women the opportunity to decide their own choice of contraception might help in reducing early discontinuation.

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.

Multilevel analysis of intimate partner violence and associated factors among pregnant women in East Africa: Evidence from recent (2012-2018) demographic and health surveys

BACKGROUND

Globally, intimate partner violence (IPV) during pregnancy is the most common and major public health problem. It has a negative effect on the lives of both mother and fetus. Despite its prominence, many countries in East Africa have paid little attention to this issue. This study assessed the prevalence and associated factors of intimate partner violence among pregnant women in East African countries.

METHODS

The study adopted a secondary method data analysis that utilized recent Demographic and Health Surveys of 10 countries in East Africa between 2012 and 2018. A total of 23,521 women who gave birth in the 5 years preceding the survey were included. A multilevel mixed-effect logistic regression model was fitted to identify factors associated with IPV. Variables with a p-value < 0.05 were declared as significant factors associated with IPV.

RESULTS

The overall prevalence of IPV in East Africa was 37.14 (95% CI 36.53, 37.76). Women with age 25-34 (AOR = 1.20;95%CI; 1.06, 1.36), 35-39 (AOR = 1.40;95%CI; 1.24, 1.58), and 40-49 (AOR = 1.66;95%CI; 1.43, 1.95), women with no education (AOR = 1.27;95%CI; 1.16, 1.39), women with no occupation (AOR = 1.36; 95%CI; 1.27, 1.47), women from households with the poorest (AOR = 1.51; 95%CI: 1.33, 1.71), poorer (AOR = 1.40;95% CI:1.24, 1.58), middle (AOR = 1.32;95%CI:1.17, 1.48), and richer (AOR = 1.26;95%CI: 1.13, 1.40), husband drinks alcohol (AOR = 2.54; 95%CI 2.39, 2.71), ≥ 5 number of living children (AOR = 1.28; 95%CI: 1.31, 2.57) and rural areas (AOR = 1.14; 95%CI: 1.03, 1.25) were significantly associated with IPV.

CONCLUSION

More than one-third of pregnant women experienced intimate partner violence in East Africa. Promoting the educational status of women, the economic capacity of women, and the healthy behavior of the husband by reducing alcohol consumption, with particular attention to rural women and violence during pregnancy, is vital to reduce the prevalence of IPV.

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.

Modern contraceptive utilisation and its associated factors among reproductive age women in high fertility regions of Ethiopia: a multilevel analysis of Ethiopia Demographic and Health Survey

OBJECTIVE

This study is aimed to assess the magnitude of modern contraceptives utilisation and associated factors among reproductive age women in high fertility regions of Ethiopia.

DESIGN

Cross-sectional study.

SETTING

High fertility regions of Ethiopian.

PARTICIPANTS

A total weighted sample of 3822 married reproductive age women.

METHODS

In this study, data were obtained from the recent Ethiopian Demographic and Health Surveys. A total weighted sample of 3822 women of reproductive age was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of modern contraceptive utilisation. Statistical significance was determined using adjusted OR (AOR) with 95% CI.

RESULTS

The overall modern contraceptive utilisation was 29.75% (95% CI 28.2% to 31.2%). Among the factors associated with utilisation were women's age 25-34 years (AOR 1.3; 95% CI 1.01 to 1.66) and ≥35 (AOR 1.71; 95% CI 1.37 to 2.70), husband's occupation (AOR 1.49; 95% CI 1.03 to 1.99), number of alive children: 1-4 (AOR 2.20; 95% CI 1.47 to 3.30), 5-8 (AOR 1.74; 95% CI 1.09 to 2.77), husband's desired number of children (AOR 0.77; 95% CI 0.61 to 0 .96), residency (AOR 2.37; 95% CI 1.20 to 4.67), community media exposure (AOR 1.77; 95% CI 1.01 to 3.08), region (AOR 0.13; 95% CI 0.03 to 0.52) and religion (AOR 0.49; 95% CI 0.36 to 0.66) were significantly associated with modern contraceptive utilisation.

CONCLUSION

Modern contraceptives utilisation in high fertility regions of Ethiopia was low. Women age, husband occupation, number of living children, husband's desired number of children, residency, community media exposure, region and religion were significantly associated with modern contraceptive utilisation. Therefore, to improve the utilisation of modern contraceptives, public health policy makers should consider creating awareness through mass media, male involvement in family planning, as well as family planning programmes, should be encouraged in rural areas.

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.

Determinant Factors of Post-Partum Contraception among Women during COVID-19 in West Java Province, Indonesia

BACKGROUND

One of the manifestations of family development is pregnancy planning, where this method is applied 0-42 days after childbirth. Post-partum contraception is an effort to avoid pregnancy by using contraceptive medicine from 42 days to 84 days after childbirth.

PURPOSE

This research aims to analyze the attitudes of fertile couples who use contraceptive devices after childbirth during the COVID-19 pandemic and the factors that influence it.

METHOD

This research uses a quantitative method approach. The sampling technique was random sampling with proportional sampling so that 280 respondents were obtained from 3 regencies/cities in West Java with high fertility rates and low post-partum contraceptive participation rates. Quantitative data analysis used univariate, bivariate, and multivariate methods.

RESULT

The results showed that the final model of the analysis of the most determining factors for post-partum contraception during a pandemic were family support, healthcare staff support, counselling with healthcare staff, attitudes, and age at first marriage.

CONCLUSION

Fertile couples with the highest amount of family support are more likely to use post-partum contraceptive devices during COVID-19. The results of this study can be used as material for consideration in making decisions about post-partum contraception, especially during the COVID-19 pandemic.

Poor adherence to iron-folic acid supplementation and associated factors among pregnant women who had at least four antenatal care in Ethiopia. A community-based cross-sectional study

Background

In developing countries, including Ethiopia, maternal mortality is a major public health concern. The Ethiopian Demographic Health Survey (EDHS) reported that the maternal mortality ratio (MMR) was 420 per 100,000 live births in 2016. Iron-folic acid supplementation (IFAS) is a key intervention to reduce these deaths. Therefore, this study aimed to assess the magnitude of poor adherence to IFAS and associated factors among pregnant women who had at least four antenatal care in Ethiopia.

Methods

Secondary data analysis was used using 2016 Ethiopian Demographic and Health Survey (EDHS). We analyzed the data using Stata version 14. To identify factors associated with poor adherence to IFAS, a multilevel mixed-effect logistic regression model was fitted. Variables with a p < 0.05 in the multilevel mixed-effect logistic regression model were declared as significant factors associated with poor adherence to IFAS.

Result

The magnitude of poor adherence to IFAS was 82.87% (95% CI: 80.96-84.65). Women education; primary [adjusted odds ratio (AOR) = 0.48; 95% CI: 0.31-0.75] and secondary (AOR = 0.52; 95% CI: 0.29-0.96), husband education; primary (AOR = 0.56; 95% CI: 0.36-0.86) and secondary (AOR = 0.51; 95% CI: 0.29-0.95), and community media exposure (AOR = 0.47; 95% CI: 0.27-0.79) were significantly associated with poor adherence to IFAS.

Conclusion

In the current study, more than eight out of ten pregnant women who had at least four antenatal care had poor adherence to IFAS. Thus, promoting maternal and husband education and establishing community media with a priority on iron-folic acid supplementation and health-related programs are essential strategies to reduce poor adherence to IFAS.

Knowledge, attitudes, and practices of health providers regarding access to and use of contraceptive methods among adolescents and youth in urban Guinea

Introduction

The objective of this study was to analyze providers' knowledge, attitudes, and practices regarding access to and use of contraception by urban adolescents and youth.

Methods

This is a cross-sectional study of 1,707 health care providers in 173 selected private and public health facilities in the capital city of Conakry and the seven administrative regions of Guinea. Factors associated with health care providers' attitudes and practices were then analyzed using logistic regression.

Results

Among the 1,707 health providers, 71% had a good level of Knowledge about modern contraceptive use among adolescents and youth. In addition, 62% had positive attitudes, and 41% had good prescribing practices toward using modern contraceptive methods by adolescents and youth. Being a midwife (aOR: 1.39, 95%CI: 1.02-1.89), Being aged 25-34 years (aOR: 1.7, 95%CI: 1.2-2.3), 35-44 years (aOR: 2.1, 95%CI: 1.4-3.0), and 45 years, and older (aOR: 2.4, 95%CI: 1.3-4.2), an increase of years in professional experience (aOR:1.05; 95%CI: 1.02-1.08) were factors significantly associated with provider positive attitudes. However, being a medical doctor (aOR: 2.37, 95%CI: 1.04-4.42), an increase of years in professional experience (aOR: 1.07; 95%CI: 1.04-1.10) and a positive attitude (aOR: 3.16. 95%CI: 2.48-4.01) were factors associated with good practice in delivering modern contraceptive methods to adolescents and youth.

Conclusion

Positive attitudes and good practices toward the use of contraceptive services by adolescents and youth were found among providers. However, many health care providers still have unfavorable attitudes and practices toward delivering FP services to urban adolescents and youth. Therefore, future intervention programs should focus on training health care providers in youth- and adolescent-friendly reproductive health services and promoting contraception among adolescents.

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.

Trends and predictors of change of unmet need for family planning among reproductive age women in Ethiopia, based on Ethiopian demographic and health surveys from 2005–2016: Multivariable decomposition analysis

Background

By spacing births and preventing unintended pregnancies, family planning is a crucial technique strategy for controlling the fast expansion of the human population. It also improves maternal and child health. women who are thought to be sexually active but who do not use modern contraception methods, who either do not want to have any more children (Limiting) or who want to delay having children for at least two years are considered to have an unmet need for family planning (Spacing).

Objective

This study carried out to determine which socio-demographic factors are the key contributors to the discrepancies in the unmet need for family planning among women of reproductive age between surveys years 2005 and 2016.

Methods

The data for this study arrived from the Ethiopia Demographic Health Surveys in 2005, 2011, and 2016 to investigate trends and Predictors of change of unmet need for family planning among reproductive age women in Ethiopia. Pooled weighted sample of 26,230 (7761 in 2005, 9136 in 2011 and 9,333 in 2016 Ethiopian demographic health surveys) reproductive-age women were used for this study. For the overall trend (2005–2016) multivariable decomposition analysis for non-linear response outcome was calibrated to identify the factors that contributed to the change of unmet need for family planning. The Logit based multivariable decomposition analysis utilizes the output from the logistic regression model to assign the observed change in unmet need for family planning over time into two components. Stata version 16.0 was used to analyze the data.

Result

The percentage of Ethiopian women of reproductive age who still lack access (unmet need) for family planning declined from 39.6% in 2005 to 23.6 percent in 2016. The decomposition analysis revealed that the change of unmet need for family planning was due to change in characteristics and coefficients. The difference in coefficients accounted for around nine out of 10 variations in unmet family planning need. Education level, birth order, and desired number of children were all factors that changed over the course of the last 11 years in relation to the unmet need for family planning.

Conclusion

Between 2005 and 2016, there were remarkable changes in unmet need for family planning. Women with birth orders of five and up, women with secondary education, and women who wanted fewer children overall were the main causes of the change in unmet need for family planning.

Unmet need for contraception and associated factors among women with cardiovascular disease having follow-up at Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia: a cross-sectional study

Background

Unmet need for contraception refers to the proportion of women who want to postpone or stop childbearing but are not using a contraceptive method. Addressing unmet need is especially important for women with medical conditions such as cardiovascular disease (CVD). Preventing unintended pregnancy is crucial to improve pregnancy outcomes and minimize complications of CVD during pregnancy. However, unmet need for contraceptives continues to undermine the potential benefits of contraceptive use. This research aimed to determine the rate of unmet need for contraceptives and associated factors among women with cardiovascular disease having follow-up at Saint Paul’s Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia.

Methods

A facility-based cross-sectional study was conducted from February 1 to May 31/2020. A total of 284 reproductive age women with cardiovascular disease having follow-up at the cardiac clinic of SPHMMC were enrolled consecutively until the desired sample size was reached. Data was collected through an exit interview using a structured and pretested questionnaire. Descriptive, bivariate, and multivariable methods were used to analyze the level of unmet need and its associated factors.

Results

The overall unmet need for contraception was 36.0% (95% CI: 30.4–41.5). The majority of the respondents lack counseling on contraception use. The most common reasons for non-use of a contraceptive method were fear of drug side effects and drug interaction. Unmet need for contraception was found to be more likely among those who have not been counseled on contraceptive utilization (AOR 6.7, CI 1.8–24.7) and those who lack partner support on contraception use (AOR = 6.2, CI: 1.91–19.8). Unmet need was also found to be more likely among women who have never used contraception before (AOR = 3.2, CI 1.12–8.92).

Conclusion

Unmet need for contraception was high in this high-risk population group. The cardiac follow-up clinic should implement client-centered counseling by a multidisciplinary team to address the needs of women and prevent consequences of unintended pregnancy. Furthermore, there is a need to initiate interventions that encourage communication between couples and increase male partner involvement through a renewed focus on couples counseling.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40834-022-00173-0.

Unmet need for family planning among rural married women in Ethiopia: What is the role of the health extension program in reducing unmet need?

BACKGROUND

Ethiopia is striving to reduce unmet need for family planning (FP) and implementation of the health extension program (HEP) is one of the major actions that the country took to address health issues of rural communities including FP. However, there is limited published evidence demonstrating the role of HEP in reducing the unmet need of married rural women for FP. The aim of this study is to estimate the role of HEP in reducing unmet need for FP in rural Ethiopia.

METHODS

This paper is based on data extracted from a national rural HEP assessment that covered all regions of Ethiopia. We identified 4991 eligible married women both from agrarian and pastoralist settings. The role of HEP was measured by the exposure of eligible women to FP services through the implementation of HEP packages. We used descriptive statistics to summarize different variables and used logistic regression to model the unmet need for FP.

RESULTS

The overall prevalence of unmet need for FP among married rural Ethiopian women was 22.41%, contraceptive prevalence rate (CPR) was 44.60%, and the total demand for FP was 60.86%. Women exposed to HEP had a lower level of unmet need (4.82%), a higher demand for FP (37.78%) and a higher CPR (24.93%) compared to women unexposed to HEP. Having exposure to FP services (adjusted odds ratio (AOR) = 0.46, 95% confidence interval (CI) 0.37-0.59), having level IV Health Extension Workers (HEWs) in the catchment health post (AOR = 0.80, 95% CI 0.67-0.95) and older age are significantly associated with lower levels of unmet need for FP. Having more children (AOR = 2.11, 95% CI 1.67-2.65) and better awareness of the husband about the availability of FP services (AOR = 1.22, 95% CI 1.01-1.48) were associated with a higher likelihood of an unmet need for FP.

CONCLUSION

The unmet need for family planning is high in rural Ethiopia in general and among women who do not have exposure to HEP packages in particular. Assigning a better-qualified health worker at the health post, reaching out to pastoralist women, maximizing opportunities to counsel rural women about FP during any contact with HEWs, and increasing positive attitudes of husbands towards FP use are likely to have positive impacts in reducing the unmet need for FP of rural women.

Trends of unmet need for family planning among currently married reproductive age women in Ethiopia: A multivariate decomposition analysis

INTRODUCTION

Despite decreasing the percentage of women with unmet needs, Ethiopian women still have a higher unmet need for family planning due to different factors. Therefore, addressing the unmet need for FP provides an opportunity for policymakers in all sectors to respond to the expressed fertility preferences of their population. This study aimed to analyze trends and determinants of changes in unmet needs over time among married women of reproductive age in Ethiopia.

METHODS

The study used data from three consecutive Demographic and Health Surveys conducted in Ethiopia (2005, 2011, and 2016). These nationally representative household surveys cover all Ethiopia region and city administrations with population health and other relevant indicators). The study included a total weighted sample of 8642 in 2005, 10204 in 2011, and 9824 in 2016 in the final analysis. Factors contributing to the change in unmet need rate were examined using logit-based multivariate decomposition analysis.

RESULTS

Among married women, unmet needs declined from 33.8% (95% confidence interval (CI):32.8,34.8) in 2005 to 21.0%(95%CI:20.2,21.9) in 2016. In decomposition analysis, the difference in coefficients was responsible for 90% of the overall change in the unmet need rate. In particular, being at the age of 25-49 years, rural place of residence, agrarian regions, and having more than four children were significant predictors of the increase in unmet need rate.

CONCLUSIONS

Unmet needs among women have shown a remarkable decline over the last decade in Ethiopia. Policy and program interventions better targeting younger, agrarian regions and rural dwellers would help to maintain a declining trend in unmet needs.

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.

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

OBJECTIVE

This study was aimed to assess the magnitude and associated factors of unmet need for family planning among rural women in Ethiopia.

DESIGN

Cross-sectional study.

SETTING

Ethiopia.

PARTICIPANTS

Reproductive age group women.

PRIMARY OUTCOME

Unmet need for family planning.

METHODS

This study drew data from Ethiopian Demographic and Health Survey, which was conducted from 18 January to 27 June 2016. A total of 8327 rural reproductive-aged (15-49 years) women were included. A two-level multivariable logistic regression model was carried out to identify individual and community-level factors associated with unmet need for family planning. Adjusted OR (AOR) with a 95% CI was used to assess the strength of association between independent and dependent variables.

RESULTS

The overall unmet need for family planning among rural women was 24.08% (95% CI 23.17 to 25.01), of which 14.79% was for spacing and 9.29% for limiting. Number of children (AOR=1.15; 95% CI 1.07 to 1.24) and working status of women (AOR=1.18; 95% CI 1.02 to 1.37) were significantly associated with a higher odds of unmet need for family planning. However, women with primary education (AOR=0.87; 95% CI 0.74 to 0.94), women married at age 18 or later (AOR=0.82; 95% CI 0.70 to 0.96), women from households with high wealth index (AOR=0.77; 95% CI 0.64 to 0.94), women who deem distance to a health facility as not a big problem (AOR=0.85; 95% CI 0.73 to 0.99), women from communities with a high percentage of educated women (AOR=0.73; 95% CI 0.59 to 0.89) and women who live in communities with high media exposure (AOR=0.81, 95% CI 0.68 to 0.98) were significantly associated with a lower odds of unmet needs for family planning.

CONCLUSION

Unmet need for family planning among reproductive-aged women in rural Ethiopia was high. Number of children, working status of women, women's education, age at first marriage, household wealth, distance to a health facility, community women's education and community media exposure were significantly associated with unmet needs for family planning. Therefore, to reduce unmet need for family planning, public health policymakers should consider both individual and community-level factors when designing FP programmes and emphasis should be given to high-risk populations.