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Objectives: Accessing family planning is a key investment in reducing the broader costs of health care and can reduce a significant proportion of maternal, infant, and childhood deaths. In Ethiopia, use of modern contraceptive methods is still low but it is steadily increasing. Identifying the contributing factors to the changes in contraceptive use among women helps to improve women’s contraceptive use and helps to plan strategies for family planning programs. Thus, the current study aimed to analyze the trends and predictors of changes in modern contraceptive use over time among married women in Ethiopia. Data source and study design: Secondary data analysis of the national representative data of 2000–2016 Ethiopian Demography and Health Survey was employed. Methods: This secondary data analysis was considered using 2000 through 2016 Ethiopian Demographic and Health Surveys. The study used data from the four DHSs conducted in Ethiopia (2000–2016). The data from all EDHS was collated so as to follow the trends throughout the period considered for the survey. Married women aged 15–49 years with sample sizes of 36,721 (9,203 in 2000, 8,438 in 2005, 9,478 in 2011, and 9,602 in 2016) were included. The analysis involved three levels, including trend analysis (to see changes from 2000 to 2005, 2005–2011, 2011–2016 and 2000–2016). Bivariate and multivariate analysis were also considered to identify predictors of modern contraceptive use. Data was extracted from the EDHS datasets for which authorization was obtained from the DHS Program/ICF International using a data extraction tool. SPSS 24 was employed for data management and analysis. Results: Among married women of reproductive age, modern contraceptive prevalence increased from 6.2% in 2000 to 35.2% in 2016. This 5-fold increment in modern contraceptive use was due to being in the age group of 25–29 years (AOR = 1.4; 95%CI (1.1, 1.7)), having two children (AOR = 1.3; 95%CI (1.1, 1.6)), the richest wealth category (AOR = 3.0; 95% CI (2.5, 3.5)), currently working (AOR = 1.3; 95%CI (1.2, 1.5)) and attending secondary and above education (AOR = 1.2; 95%CI (1.1, 1.6)) were found to be predictors. Conclusions: Over the past 15 years, an annual average of a 1.9% point increment has been observed in modern contraceptive use, but the country lags behind the SDGs’s 2030 target of achieving zero unmet needs for contraception. Program interventions, and continued education of women, are mandatory, as education is one of the major factors contributing to increasing contraceptive use.
We used secondary data analysis of the national representative data of 2000–2016 Ethiopian Demography and Health Survey (EDHS). In 2000–2016 EDHS, a two stage stratified cluster sampling technique has been employed. The nationally representative secondary analysis of survey study was conducted using 2000 through 2016 EDHS. Ethiopia is a Federal Democratic Republic structured into 9 regional states and two city administrations. It has a total area of 1,100, 000 km2. Regional states are divided into zones, and zones are subdivided into districts, and districts into kebeles, the lowest administrative units [46]. These DHS were conducted in all the geographic areas of the country. In terms of its population size, Ethiopia is the second most populous nation in Africa, with more than 112 million people (56,010, 000 females and 56, 069, 000 males) in 2019 [47]. Women of reproductive age represent 21% of the population in the country. According to the Mini Ethiopian Demographic and Health Survey (EMHDS) conducted in 2019, the under-five mortality rate has been reduced to 55 from 123 in 2005 and infant mortality has declined from 77 in 2005 to 43 in 2019. Similarly, the use of modern contraceptive methods has shown an increase from 14% in 2005 to 41% in 2019. Addis Ababa City Administration and Amhara Regional states have the highest proportion (50%) of women using modern contraceptive methods and the Somali region has the lowest (3%) [15]. In this study, our data was restricted to married and non-pregnant women of the reproductive age group. Based on these criteria, our sample sizes from the four EDHS were 9,203 women in 2000 (9,653 weighted cases), 8,438 in 2005 (8,914 weighted cases), 9,478 in 2011 (9,594 weighted cases), 9,602 in 2016 (10,014 weighted cases). The four DHS of Ethiopia surveyed a total of 15,367, 14,070, 16,515, and 15,683 women in 2000, 2005, 2011, and 2016, respectively. The selection of samples for these secondary survey analysis was conducted using a two-stage sampling procedure. The first stage involved the selection of enumeration areas from the rural and urban strata in the 9 regional states and the two city administrations. The selection of enumeration areas for these surveys was conducted using the list of enumeration areas as a sampling frame designated by the Central Statistics Agency of Ethiopia for the Household and Population Census. The second stage involved the selection of a fixed number of households from each enumeration area using a systematic sampling, and all women 15–49 years eligible for the surveys were selected for the woman’s questionnaire that collected information on family planning and other topics. Therefore, a total of 38,175 married women aged 15–49 years (9,653 from 2000, 8,914 from 2005, 9,594 from 2011, to 10,014 from the 2016 DHS of Ethiopia) were used for this study (Fig. 2). Sample size and Sampling procedure for the study on the trend and predictors of modern contraceptive use using the four EHDS, 2020. A response variable is the current use of modern contraceptive methods. Modern contraceptive methods in this study included female sterilization, injectable, implants, pills, Intrauterine devices (IUD), and condoms. In the four EDHS, the current use of modern contraceptives was labeled with four responses (no method, folkloric, traditional, and modern methods). However, the response variable in this study was recorded as a dichotomous variable, Yes or No, where “Yes” was for those who currently used modern contraceptive methods and “No” for those who were not using modern contraceptive methods. Demographic Health Survey (DHS) employees a standard tool and hence questions used across different periods are similar. Explanatory variables used in the current analysis were checked for any possible variations before using them in our study. Merging of similar variables from the four surveys into one was then conducted using Integrated Public Use Microdata Series (IPUMS). Explanatory variables having in common variables from different data sets which were collected at different times from the same population were selected and merged. Explanatory variables include sociodemographic factors: the age of the women, parity, place of residence, religion, wealth index, educational attainment, occupational status. And, women empowerment: participation in decision-making on family planning use and health care; fertility norms and preferences: number of children desired, age at first marriage or cohabitation; exposure to family planning messages and the media: being visited by a health worker, knowledge about contraceptives, attitude towards contraceptive methods, and access to the media, such as radio, television, and newspapers. Contraceptive prevalence is the proportion of women who are currently using, or whose sexual partner is currently using, at least one method of contraception, regardless of the method being used. Modern Contraceptive Methods: In this study include female sterilization, the intrauterine contraceptive device (IUD), implants, injectable, pill, male condoms, female condoms, emergency contraception, standard day’s method, and lactational amenorrhea method (LAM) [15]. Traditional methods of family planning include rhythm, withdrawal and other folk methods [15]. This study used secondary data from the previous four consecutive EDHS for the years 2000, 2005, 2011, and 2016 that were conducted by the Central Statistical Agency in collaboration with the Ministry of Health and other partners providing technical and financial support [7,[48], [49], [50]]. In this study, our data are restricted to married and non-pregnant women aged 15–49. Based on these criteria data was extracted from the EDHS datasets in the DHS Program following authorization by the DHS program. Extraction of the required variables for this study was guided by a data extraction tool composed of questions selected from the woman’s questionnaire, focusing on the factors affecting the use of modern contraceptive methods among married women of reproductive ages. The data was cleaned and analyzed using SPSS software version 24. The analysis of data for this study involved three levels, including trend analysis, bivariate, and multivariate analysis. The trend in modern contraceptive use was analyzed using descriptive analyses, stratified by residence, educational status, wealth quantile, and age of the respondents and other selected characteristics. The trend was examined separately for the periods 2000–2005, 2005–2011, 2011–2016, and 2000–2016. The second type of analysis was bivariate analysis that was used for testing the presence of significant association between the response and independent variables. For this study, the dependent variable (current use of modern contraceptives) was coded into dichotomous response categories (Yes or No) and a binary logistic regression was run to identify the factors that have a significant association with modern contraceptive use in the unadjusted model. To identify the predictors of modern contraceptive use, a multivariate analysis was conducted and the final logit model was built with AOR using a backward stepwise method where the variables that had a p-value of <0.05 using the likelihood test were maintained in the model while other variables were removed. Multicollinearity with variance inflation factor was less than ten was checked before multivariable logistic regression analysis was done. To account for the variations due to study design, stratification and sampling procedures, all the figures used in this study were computed from weighted samples. Weighted data were analyzed with a complex survey sampling analysis technique. Significance tests and associations were based on these assumptions, and AOR with 95%CI was used to measure the Signiant associations between the response and the explanatory variables in this study. The four EDHS were conducted with ethical approval obtained from the former Ethiopian Health and Nutrition Research Institute (EHNRI) Review Board, the National Research Ethics Committee at the Ministry of Science and Technology, ICF International’s Institutional Review Board, and the Center for Disease Control and Prevention (CDC). Details of the ethical clearance and approval processes followed during these four EHDS can also be found in the published reports of these surveys [7,[48], [49], [50]]. The authors have submitted a proposal to the DHS Program/ICF International and permission was granted to download and use the data for this study. The DHS Program authorized data access and data was used solely for the purpose of the recent study.
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