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Background: Ethiopia’s population policy specifically aims to reduce TFR from 7.7 to 4.0 and to increasecontraceptive use from 4.0% to 44.0% between 1990 and 2015. In 2011, the use of contraceptive methodsincreased seven-fold from 4.0% to 27%; and the TFR declined by 38% to 4.8. The use of modern contraceptives is,however, much higher in the capital Addis Ababa (56%) and other urban areas but very low in rural areas (23%) farbelow the national average (27%). In 2011, one in four Ethiopian women had an unmet need for contraception.The main aim of this study was to assess the pattern and examine the socioeconomic and demographic correlatesof unintended childbirth among women 15-49 years in Ethiopia. Methods: Data from the 2011 nationally representative Ethiopia Demographic and Health Survey are used. Itcovered 16,515 women of which 7,759 had at least one birth and thus included for this study. Multivariate logisticregression is used to see the net effects of each explanatory variable over the outcome variable.Results: The study found that nearly one in three (32%) births was unintended; and about two-thirds of these weremistimed. The regression model shows that the burden of unintended births in Ethiopia falls more heavily onyoung, unmarried, higher wealth, high parity, and ethnic majority women and those with less than secondary educationand with large household size. These variables showed statistical significance with the outcome variable.Conclusion: The study found a relatively high prevalence of unintended childbirth in Ethiopia and this implies high levelsof unmet need for child spacing and limiting. There is much need for better targeted family planning programs andstrategies to strengthen and improve access to contraceptive services, to raise educational levels, and related informationand communication particularly for those affected groups including young, unmarried, multipara, and those with less thansecondary level of education. Further quantitative and qualitative research on the consequences of unintended pregnancyand childbirth related to prenatal and perinatal outcomes are vital to document process of change in the problemovertime.
The data for this paper were drawn from the 2011 nationally representative Ethiopia Demographic and Health Survey (EDHS). This is a secondary analysis of data. Authorization was obtained from the ICF International to download data from the Demographic and Health surveys (DHS) on-line archive and analyze and present findings. The survey was implemented by the Ethiopian Central Statistical Agency (CSA) with the technical assistance of ICF International through the MEASURE DHS project. The survey enquires about household members’ and individual characteristics using Household Questionnaire, Woman’s Questionnaire and Man’s Questionnaire. Individual women of reproductive age (15-49 years) were interviewed face to face on their background characteristics as well as on fertility and family planning behaviour, child mortality, adult and maternal mortality, nutritional status of women and children, the utilization of maternal and child health services, knowledge of HIV/AIDS and prevalence of HIV/AIDS and anaemia [11]. The sample was weighted to make the survey base more accurately representative of the population from which the sample was taken. Thus the descriptive analyses for this paper were based on weighted figures. However, since the multivariate analyses preserve the one respondent-one-response relationship, data were not weighted. The present analysis is restricted to last born children in the five years preceding the survey. EDHS tries to assess the level of unwanted fertility among women age 15-49 through a series of survey questions asked about each of the children born to them in the preceding five years (including current pregnancy). Women were asked about their last birth whether they wanted it then, wanted later, or did not want to have any more children at all. The term “wanted” permits identifying those mistimed pregnancies or births that occurred sooner than desired. In this study, if the birth or pregnancy was wanted then, it was considered to be intended; if it was wanted but at a later time, it was considered to be mistimed, and if it was not wanted at the time of conception, it was considered to be unwanted [11]. The dependent variable of interest in this study is therefore measured as a two-outcome variable and coded as intended birth, if the last childbirth occurred at a time when the woman wanted it, and unintended birth, if the pregnancy or last childbirth occurred at a time when the woman would have wanted it later or did not want it at all. Hence, unintended birth is estimated as the proportion of births resulting from unintended pregnancies. Both bivariate and multivariate analyses were done to determine the presence of statistically significant associations and strength of associations between explanatory variables and the dependent variable. For this study, p-value of 0.05 was considered as significant level. The multivariate models (adjusted odds ratio) included variables that were significantly associated with the dependent variable (p-value < 0.05) in the bivariate analyses or crude odds ratios. The Hosmer and Lemeshow goodness of fit test showed P-value of 0.89 and Nagelkerke R Square value was 0.63 for the final model which shows that our data fairly fits with the logistic regression model. Multi-collinearities were also checked among selected variables including age versus parity, educational status versus working status, and educational status versus wealth index. The Variance Inflation Factor (VIF) and adjusted R2 values for each of the pairs ranged from 1.01- 1.31 and 0.001-0.011 respectively. Commonly, a VIF of 10 and above or a Tolerance (1-R2) of close to zero would be a concern for multi-collinearity. A wide range of predictor variables were considered in this study including woman's educational level (no education, primary, and secondary or higher education), working status (whether the woman was working at the time of data collection for remuneration), age (years), marital status (never in union/married, currently married, formerly married), parity (children ever born), wealth index (poor, middle, rich), religion (Orthodox Christian, Muslim, Catholic, Protestant, and Traditional), ethnicity (Tigraway, Oromo, Amhara, Guragie, Somalie, Afar, etc.), history of abortion, woman’s decision-making autonomy, and exposure to media. Exposure to media was categorized as adequate if the woman reads newspaper/magazine or listens radio or watches television at least once a week; inadequate if the woman reads newspaper/magazine, listens radio or watches television less than once a week. In the 2011 EDHS questions were asked on women’s participation in specific household decisions including on spending respondent’s earnings, household purchases, visits to family and respondent’s healthcare. The decision-making autonomy of women at household level was also considered among the independent variables including decision on own healthcare, large household purchases and visits to relatives. However, we couldn’t include them in the final model due to large missing or invalid values of up to 15% of the sample size. Other variables treated related to antenatal care, fertility and contraception include history of abortion, current contraceptive use, and knowledge of any contraceptive method. Type of place of residence was used as a control variable.
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