Prevalence and determinants of modern contraceptive utilization among rural lactating mothers: Findings from the primary health care project in two northwest Ethiopian districts

  • BMC Women's Health, Volume 20, No. 1, Year 2020

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Study Justification:
– The study aimed to assess the prevalence and determinants of modern contraceptive utilization among rural lactating mothers in two districts in northwest Ethiopia.
– The study is important because contraceptive utilization is crucial for preventing unwanted pregnancies, and in Ethiopia, a significant number of rural women have shorter birth intervals and experience mistimed or unwanted pregnancies.
Highlights:
– The overall prevalence of modern contraceptive utilization among rural lactating mothers in the study area was 45.8%.
– The most commonly used contraceptive method was Depo-Provera (39.8%), followed by implants (4.8%).
– Mothers whose children were fully immunized were 5.58 times more likely to utilize modern contraceptives compared to mothers whose children were partially or not vaccinated.
– Mothers who received antenatal and postnatal care were 1.74 and 2.02 times more likely to utilize modern contraceptives, respectively, compared to those who did not receive such care.
Recommendations:
– Child immunization services should be utilized as a platform for reaching lactating mothers with information and access to modern contraceptives.
– Antenatal and postnatal care visits should be improved and intensified to provide effective advice on modern contraceptive utilization.
– Health system approaches should focus on improving antenatal and postnatal care, as well as child immunization services, to reduce unwanted pregnancies in low-resource settings.
Key Role Players:
– Health professionals and providers: They play a crucial role in delivering antenatal and postnatal care, as well as providing advice on modern contraceptive utilization.
– Community health workers: They can be trained to educate and raise awareness among lactating mothers about the importance of modern contraceptive utilization.
– Policy makers: They can develop and implement policies that prioritize and support the improvement of antenatal and postnatal care, as well as child immunization services.
Cost Items for Planning Recommendations:
– Training programs for health professionals and community health workers on providing effective advice on modern contraceptive utilization.
– Development and implementation of educational materials and campaigns to raise awareness among lactating mothers.
– Improvement of infrastructure and resources in health facilities to support antenatal and postnatal care services.
– Monitoring and evaluation systems to assess the impact of the recommendations and make necessary adjustments.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is a community-based cross-sectional study, which provides valuable information about the prevalence and determinants of modern contraceptive utilization among rural lactating mothers in northwest Ethiopia. The study collected data from 603 lactating mothers through face-to-face interviews using a structured questionnaire. Bivariate and multivariate logistic regression analyses were conducted to identify independent predictors of modern contraceptive utilization. The study findings indicate that the overall prevalence of modern contraceptive utilization was 45.8%, with Depo-Provera being the most commonly used method. The odds of contraceptive utilization were higher among mothers of fully immunized children and those who received antenatal and postnatal care. The study concludes that child immunization services and antenatal/postnatal care visits are key determinants of modern contraceptive utilization. To improve the strength of the evidence, future studies could consider using a longitudinal design to establish causality and explore other potential determinants of contraceptive utilization, such as socio-economic factors and cultural beliefs. Additionally, increasing the sample size and including a more diverse population could enhance the generalizability of the findings.

Background: Contraceptive utilization is a guarantee to avert unwanted pregnancies. In Ethiopia however, more than half of the rural women have shorter birth intervals. Consequently, 17 and 8% of the births have been either mistimed (wanted at later date) or unwanted, respectively. Therefore, this study investigated modern contraceptive utilization and its predictors among rural lactating women. Methods: A community based-cross-sectional study was conducted from May 01 to June 29, 2019, in Dabat and Gondar zuria districts, northwest Ethiopia. Data from 603 lactating mother were collected through face to face interviews using a structured questionnaire. Bivariate and multivariate logistic regression analyses were fitted to identify the independent predictors of modern contraceptive utilization. Results: The overall prevalence of modern contraceptive (MC) utilization rate was 45.8% [95% CI: 38.01, 53.59]. The contraceptive method mix was dominated by Depo-Provera (39.8%) followed by implants (4.8%). The odds of utilization of contraceptive were 5.58 times higher among mothers of children with fully immunized [AOR = 5.58, 95% CI: 3.45, 9.01] compared to mothers whose children were vaccinated partially or not at all. Mothers who received antenatal [AOR = 1.74, 95% CI: 1.13, 4.43] and postnatal care [AOR = 2.02, 95%CI: 1.24, 2.91) were 1.74 and 2.02 folds more likely to utilize modern contraceptives than mothers who did not receive such care, respectively. Conclusion: The prevalence of modern contraceptive utilization in this study area was lower than the planed national target. In the region, child immunization service is one of the promising platforms for reaching lactating mothers with modern contraceptive utilization. Our findings suggest that antenatal and postnatal care visits are the other key determinants of modern contraceptive utilization. Thus, in low-resource settings like ours, the health system approaches to improved antenatal and, postnatal care and child immunization services should be intensified with more effective advice on modern contraceptive utilization to reduce unwanted pregnancies.

A community-based cross-sectional study was carried out from May 01 to June 29, 2019 in Dabat and Gondar Zuria districts, northwest Ethiopia. Two of the total 23 districts in North Gondar zone of the Amhara region, Dabat and Gondar zuria districts, consist of 30 and 38 kebeles (the smallest administrative units in Ethiopia), respectively. Located in different ecological zones (high, middle, and low land), the districts had 145,509(Dabat) and 231,324(Gondar zuria) inhabitants who’s largely depended on subsistence farming. Of the total inhabitants, 5973 in Dabat and 8180 in Gondar zuria district were lactating mothers, respectively. Lactating mothers who lived in Dabat and Gondar zuria districts for at least 6 months were included. The study aimed to assess the prevalence and determinants of modern contraceptive utilization among rural lactating mothers in Dabat and Gondar zuria districts, northwest Ethiopia. Of the total kebeles, eight in Dabat and 10 in Gondar zuria were selected using the lottery method. The systematic sampling technique was used to select study participants. For households with multiple lactating mothers who fulfilled the inclusion criteria, the lottery method was used to choose one. Sample size was calculated using Epi-info version 3.7 by considering the assumptions: 48.4% prevalence of modern contraceptive utilization in Gondar town [23, 25], 95% level of confidence and 5% margin of error. A design effect of 1.5 and 10% non-response rate were also anticipated to obtain the final sample size of 631. A structured questionnaire was adapted from the Ethiopian Demography and Health Survey (EDHS) to collect the data [8, 13]. The questionnaire was composed of socio-demographic characteristics and primary health care utilization (immunization, family planning, health education, hygiene and sanitation, maternal health service and physical access to health services) [13, 25]. The questionnaire was first prepared in English and translated to Amharic (the native language of the study area). Back translation to English was made to compare the consistency and amendments accordingly. Fifteen data collectors and three field supervisors were recruited for data collection. Two days training was given on the objective of the study, confidentiality of information and the techniques of an interview to data collectors and supervisors. To ascertain the outcome variable, modern utilization of contraceptive, women were asked if they were currently using a method of contraception and what method they were using. The outcome was coded 1 if they were using a modern method (pill, Intra uterine contraceptive device (IUCD), injections, condom, male or female sterilization, implant, or diaphragm/foam/jelly) and 0 if they were using a traditional method or were not currently using a method. Epi-data version 3.1 was used for data entry and data were exported to SPSS version 21 for analysis. Descriptive statistics were computed. Binary Logistic regression model was used to identify the relationship between dependent and independent variables. Those significant independent variables in bivariate analysis (p-value< 0.2) were entered into the multivariable analysis. In the binary logistic regression model, backward- stepwise multivariate analysis was used to elicit associated factors of modern utilization of contraceptive. In the final model, a significant association was declared at a p-value less than 0.05 and finally, the results were presented in texts and tables with adjusted odds ratio (AOR) and the corresponding 95% confidence interval.

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The study titled “Prevalence and determinants of modern contraceptive utilization among rural lactating mothers: Findings from the primary health care project in two northwest Ethiopian districts” aimed to assess the prevalence and determinants of modern contraceptive utilization among rural lactating mothers in Dabat and Gondar zuria districts, northwest Ethiopia. The study was conducted from May 01 to June 29, 2019.

Here are the key findings of the study:

1. The overall prevalence of modern contraceptive utilization rate among rural lactating mothers was 45.8%.

2. The most commonly used contraceptive method was Depo-Provera (39.8%), followed by implants (4.8%).

3. Mothers whose children were fully immunized were 5.58 times more likely to utilize modern contraceptives compared to mothers whose children were partially or not vaccinated at all.

4. Mothers who received antenatal care were 1.74 times more likely to utilize modern contraceptives, and those who received postnatal care were 2.02 times more likely to utilize modern contraceptives compared to mothers who did not receive such care.

Based on these findings, the study suggests that improving child immunization services can be a promising platform for reaching lactating mothers with modern contraceptive utilization. Additionally, it highlights the importance of antenatal and postnatal care visits in increasing modern contraceptive utilization among rural lactating mothers.

It is important to note that the study was conducted in a specific region and may not be generalizable to other settings. Further research and interventions are needed to address the barriers and improve access to maternal health services, including modern contraceptive utilization, in low-resource settings like northwest Ethiopia.
AI Innovations Description
The study titled “Prevalence and determinants of modern contraceptive utilization among rural lactating mothers: Findings from the primary health care project in two northwest Ethiopian districts” aimed to assess the prevalence and determinants of modern contraceptive utilization among rural lactating mothers in Dabat and Gondar zuria districts, northwest Ethiopia.

The study was conducted from May 01 to June 29, 2019, in Dabat and Gondar zuria districts, which are located in different ecological zones and largely depend on subsistence farming. A total of 603 lactating mothers were included in the study, and data was collected through face-to-face interviews using a structured questionnaire.

The overall prevalence of modern contraceptive utilization rate was found to be 45.8%. The most commonly used contraceptive method was Depo-Provera (39.8%), followed by implants (4.8%). The study identified several factors associated with modern contraceptive utilization. Mothers of children who were fully immunized were 5.58 times more likely to utilize contraceptives compared to mothers whose children were partially or not vaccinated. Additionally, mothers who received antenatal and postnatal care were 1.74 and 2.02 times more likely to utilize modern contraceptives, respectively.

The study concluded that the prevalence of modern contraceptive utilization in the study area was lower than the planned national target. It suggested that child immunization services could be a promising platform for reaching lactating mothers with modern contraceptive utilization. The study also emphasized the importance of antenatal and postnatal care visits as key determinants of modern contraceptive utilization. It recommended that health system approaches to improve antenatal and postnatal care, as well as child immunization services, should be intensified with more effective advice on modern contraceptive utilization to reduce unwanted pregnancies.

In summary, the study provides valuable insights into the prevalence and determinants of modern contraceptive utilization among rural lactating mothers in northwest Ethiopia. The findings highlight the need for targeted interventions to improve access to maternal health services and increase the utilization of modern contraceptives in low-resource settings.
AI Innovations Methodology
Based on the provided description, here are some potential recommendations to improve access to maternal health:

1. Strengthening Child Immunization Services: Since child immunization services were found to be a promising platform for reaching lactating mothers with modern contraceptive utilization, it is recommended to strengthen and expand these services. This can be done by improving the availability and accessibility of immunization services, increasing community awareness and education about the benefits of immunization, and ensuring that healthcare providers are trained to provide effective advice on modern contraceptive utilization during immunization visits.

2. Enhancing Antenatal and Postnatal Care: The study found that mothers who received antenatal and postnatal care were more likely to utilize modern contraceptives. Therefore, it is important to enhance the quality and coverage of antenatal and postnatal care services. This can be achieved by improving the training and skills of healthcare providers, ensuring the availability of necessary equipment and supplies, and promoting the importance of antenatal and postnatal care through community outreach and education programs.

3. Increasing Awareness and Education: To reduce unwanted pregnancies, it is crucial to increase awareness and education about modern contraceptive methods among rural lactating mothers. This can be done through community-based health education programs, involving community health workers and local leaders to disseminate information about the benefits and availability of modern contraceptives. Additionally, targeted campaigns and media messages can be used to raise awareness and address misconceptions about contraception.

Methodology to simulate the impact of these recommendations on improving access to maternal health:

To simulate the impact of the recommendations on improving access to maternal health, the following methodology can be adopted:

1. Data Collection: Collect baseline data on the current utilization of modern contraceptives, availability and accessibility of child immunization services, and utilization of antenatal and postnatal care in the study area. This can be done through surveys, interviews, and data from health facilities.

2. Modeling: Develop a mathematical model that represents the relationship between the recommendations (strengthening child immunization services, enhancing antenatal and postnatal care, increasing awareness and education) and the outcome variable (improved access to maternal health). The model should consider factors such as population size, healthcare infrastructure, socio-economic factors, and cultural beliefs.

3. Parameter Estimation: Estimate the parameters of the model based on the collected data. This may involve statistical analysis, regression modeling, and expert opinions.

4. Simulation: Use the estimated parameters to simulate the impact of the recommendations on improving access to maternal health. This can be done by running the model with different scenarios, such as varying levels of implementation of the recommendations or different target populations.

5. Evaluation: Evaluate the results of the simulations to assess the potential impact of the recommendations on improving access to maternal health. This can be done by comparing the simulated outcomes with the baseline data and identifying any significant improvements.

6. Sensitivity Analysis: Conduct sensitivity analysis to assess the robustness of the results. This involves varying the input parameters within a certain range to see how sensitive the outcomes are to changes in the parameters.

7. Policy Recommendations: Based on the simulation results, provide policy recommendations on the most effective strategies to improve access to maternal health. These recommendations should consider the feasibility, cost-effectiveness, and sustainability of the proposed interventions.

By following this methodology, policymakers and healthcare providers can gain insights into the potential impact of the recommendations and make informed decisions to improve access to maternal health.


Statistics:
Citations: 2
Identifiers:
DOI: 10.1186/s12905-020-00933-7
Research Areas:
Community Interventions, Environmental, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants
Study Countries:
Ethiopia
Study Design:
Case-Control Study, Cross Sectional Study, Grounded Theory
Study Approach:
Quantitative
Participants Gender:
Male & Female
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