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

  • PloS one, Volume 16, No. 12, Year 2021

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Study Justification:
The study titled “Unmet need for family planning and associated factors among currently married women of reproductive age in Bishoftu town, Eastern Ethiopia” aimed to address the issue of unmet need for family planning in a setting of increased industrialization and internal migrations in Ethiopia. This is important because unmet family planning needs contribute to low contraceptive prevalence rates in developing countries, including Ethiopia. By identifying the factors associated with unmet need for family planning, the study provides valuable insights for policymakers and program planners to improve access to and utilization of family planning services.
Highlights:
1. The prevalence of unmet need for family planning among currently married women in Bishoftu town was found to be 26%, which is higher than the United Nations sphere standard and slightly lower than the regional average.
2. Factors significantly associated with unmet need for family planning included maternal age, educational status, occupational status, healthcare provider visits, and desired number of children.
3. The study highlights the importance of strengthening health education and behavior change communication related to family planning services, as well as improving access to these services.
Recommendations:
1. Strengthen health education and behavior change communication related to family planning services to increase awareness and knowledge among currently married women.
2. Improve access to family planning services by increasing the availability and distribution of contraceptives in Bishoftu town.
3. Enhance the training and capacity of healthcare providers to provide comprehensive family planning services, including counseling and contraceptive methods.
4. Develop targeted interventions to address the specific needs and preferences of different subgroups of currently married women, such as those with lower educational attainment or in specific occupational categories.
Key Role Players:
1. Ministry of Health: Responsible for policy development, coordination, and oversight of family planning programs.
2. Regional Health Bureau: Provides guidance and support to local health offices in implementing family planning programs.
3. Bishoftu Town Health Office: Implements family planning programs at the local level and coordinates with healthcare facilities.
4. Healthcare Providers: Deliver family planning services, including counseling and provision of contraceptives.
5. Community Health Workers: Play a crucial role in raising awareness, providing information, and promoting family planning services at the community level.
Cost Items for Planning Recommendations:
1. Training and Capacity Building: Budget for training healthcare providers on family planning counseling and contraceptive methods.
2. Contraceptive Supplies: Allocate funds for the procurement and distribution of contraceptives to meet the increased demand.
3. Health Education and Behavior Change Communication: Allocate resources for developing and implementing targeted health education campaigns and materials.
4. Infrastructure and Equipment: Budget for the improvement and expansion of healthcare facilities to accommodate the increased demand for family planning services.
5. Monitoring and Evaluation: Allocate funds for monitoring and evaluating the implementation and impact of the recommended interventions.
Please note that the cost items provided are general categories and not actual cost estimates. The actual budget will depend on the specific context and needs of Bishoftu town.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a community-based cross-sectional study with a relatively large sample size. The study used multivariate logistic regression to identify factors associated with the outcome variable and reported a 95% confidence interval for the associations. However, the abstract does not provide information about the representativeness of the sample or the response rate, which could affect the generalizability of the findings. To improve the strength of the evidence, future studies could consider using a more representative sample and reporting the response rate.

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 1st January to 28th 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.

The study was conducted in Bishoftu town. Bishoftu town is one among the town administrations of Oromia region located 47 KM far away from Addis Ababa in Eastern part of Ethiopia. It is located adjacent to Eastern industrial zone of Ethiopia. The town administration comprises of 14 kebeles of which nine were urban kebeles and the remaining three were semi-urban kebeles. In the town, there were two public hospitals, five health centers, two private hospitals, and ten private clinics providing services ranging from preventive and basic curative to advanced medical services to the catchment area population. According to Bishoftu town health office report of 2020, the town had a total population of 217,971 and of this female population accounted 51% (111,165) and women in the reproductive age group eligible to family planning services were 19% (41,328). The study was conducted from 1st January to 28th February, 2021. A community-based cross-sectional study was conducted among currently married women of reproductive age group. All currently married women in the reproductive age group (15–49) and lived in the town for at least 6 months were eligible to the study. Infecund women, women who were not legally married and who were critically ill during the survey period were excluded. Infecundity and marital status of women were identified based on self-report. The sample size was determined using Epi Info sample size calculator for cross-sectional surveys considering the assumptions and parameters: 95% confidence level, 4% margin of error, proportion of unmet need for family planning as 30.9% from the study conducted in Debre Birhan [27], 1.5 design effect, and 10% non-response rate. The calculated sample size yields 846. Where: Multi-stage stratified sampling strategy was used to select kebeles and study participants. In the first stage, five urban kebeles and three semi-urban kebeles were selected using simple random sampling strategy from nine urban and five semi-urban kebeles. In the second stage, a systematic random sampling strategy was used to select households in each kebeles. All households in the primarily selected Kebeles and women in the reproductive age group were listed. The sample size was proportionally allocated to each selected Kebeles based on the total number of currently married women in each Kebeles. All eligible women in every 25th household (K = 25) were interviewed after taking consent for participation. In the case when the selected households had no eligible women, the next household was considered and whenever there were more than one eligible women in the sampled household, one woman was selected randomly. Each selected household was visited three times on occasions where respondents were unavailable during the first visit and after the third visit households were recorded as no-response (Fig 1). The outcome variable was the unmet need for family planning. It was the sum of the unmet need for spacing and the unmet need for limiting. Other outcome variables included demand for family planning and demand satisfied for family planning. Demand for family planning was calculated as the sum of currently married women who were on family planning and the unmet need for family planning. Percentage of demand satisfied for family planning was calculated as currently using family planning divided by the demand for family planning. The explanatory variables were socio-demographic and economic factors, reproductive health factors, and service characteristics. Semi structured interviewer administered questionnaire was used to collect data. The questionnaire was developed based on relevant literature and adapted to the research context [21,23,27,28]. It comprised of three parts: background of respondents, reproductive characteristics, and service related factors. The questionnaire was primarily developed in English language and translated to local languages (Afan Oromo and Amharic). Five nurses and two supervisors with qualification of bachelor of science in public health were participated in the data collection process. A two-day training was given to data collectors and supervisors on the questionnaire, data collection process and research ethics. Pre-test was conducted in 5% of the sample size in an adjacent Kebele of the study area and corrections were made to the questionnaire as appropriate. Supervisors have closely monitored the data collection process and provided support at the field level. Each data records were checked for completeness and consistency, and duplicated cases were removed. Data were entered to Epi-Info version 7 and exported to SPSS version 25 for analysis. The data analysis was progressed in such a way that primarily descriptive statistics was used to describe and summarize the characteristics of respondents. Secondly, bivariate logistic regression was undertaken and those variables with P-value<0.25 were taken to multivariate logistic regression. The outcome variable of the study was the unmet need for family planning services. Variable Inflation Factor (VIF) was used to check the presence of multi collinearity and Hosmer-Lemeshow test of Goodness-of-fit was used to test how well the model explains the data. The strength of association was expressed in an odds ratio with 95% confidence interval and P-value <0.05 was used as cut-off point to declare significance in the final model. Research ethical clearance was obtained from Adama Hospital Medical College Institutional Research Ethics Review Board (Reference number: AHMC/MPHWek/8/12/2020). Support letter was taken from Oromia Regional Health Bureau and Bishoftu town health office. The research was conducted according to the Declaration of Helsinki. The research aims, benefits, and risks were explained to each research participant. Following this, a written informed consent was obtained from participants and for minors, informed written consent was taken from parents or guardians. No personal identifiers were recorded and codes were used on each questionnaire. Paper based data was kept in a locked cabinet and computer-based data were secured with a confidential password. Research data will only be used for the intended aim and not shared with the third people.

The study titled “Unmet need for family planning and associated factors among currently married women of reproductive age in Bishoftu town, Eastern Ethiopia” provides valuable insights into the unmet need for family planning services in the study area. Based on the findings, the following recommendations can be developed into innovations to improve access to maternal health:

1. Strengthen Health Education and Behavior Change Communication: Develop innovative health education programs that specifically target women and their families to raise awareness about family planning services and their benefits. This can include the use of interactive mobile applications, social media campaigns, and community-based theater performances to effectively communicate key messages.

2. Improve Access to Family Planning Services: Implement innovative strategies to enhance the availability and accessibility of family planning services in Bishoftu town. This can include the establishment of mobile clinics or telemedicine services to reach women in remote areas, the use of community health workers to provide door-to-door family planning counseling and services, and the integration of family planning services into existing maternal health programs.

3. Address Socio-Demographic and Economic Factors: Develop innovative interventions that address the socio-demographic and economic factors associated with unmet need for family planning. This can include the implementation of income-generating projects specifically targeted towards women, the provision of scholarships or vocational training programs to improve educational opportunities, and the establishment of women’s empowerment groups to promote decision-making autonomy.

4. Strengthen Health Care Provider Engagement: Implement innovative training programs for healthcare providers to enhance their knowledge and skills in family planning counseling and services. This can include the use of virtual reality simulations or online training modules to improve provider competency. Additionally, innovative approaches such as telemedicine consultations or mobile applications can be utilized to facilitate regular follow-up and support for women accessing family planning services.

5. Enhance Monitoring and Evaluation: Develop innovative monitoring and evaluation systems to track the progress of interventions aimed at improving access to maternal health. This can include the use of mobile data collection tools or electronic health records to ensure real-time data collection and analysis. Additionally, innovative data visualization techniques can be utilized to effectively communicate key findings and inform decision-making processes.

By implementing these innovative approaches, it is possible to address the unmet need for family planning and improve access to maternal health services in Bishoftu town, Eastern Ethiopia.
AI Innovations Description
The study titled “Unmet need for family planning and associated factors among currently married women of reproductive age in Bishoftu town, Eastern Ethiopia” provides valuable insights into the unmet need for family planning services in the study area. Based on the findings, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Strengthen Health Education and Behavior Change Communication: Implement targeted health education programs to raise awareness about family planning services and their benefits. This can include community outreach programs, workshops, and campaigns to educate women and their families about the importance of family planning in maternal health.

2. Improve Access to Family Planning Services: Enhance the availability and accessibility of family planning services in Bishoftu town. This can be achieved by increasing the number of health facilities that provide family planning services, especially in rural and semi-urban areas. Additionally, efforts should be made to ensure a consistent supply of contraceptives and improve the distribution system to reach women in need.

3. Address Socio-Demographic and Economic Factors: Develop interventions that target socio-demographic and economic factors associated with unmet need for family planning. This can include initiatives to improve educational opportunities for women, promote income-generating activities, and empower women to make informed decisions about their reproductive health.

4. Strengthen Health Care Provider Engagement: Train and educate healthcare providers on family planning counseling and services. Encourage regular visits by healthcare providers to women in the community, especially those who have not accessed family planning services in the past year. This can help address misconceptions, provide accurate information, and increase the uptake of family planning methods.

5. Enhance Monitoring and Evaluation: Establish a robust monitoring and evaluation system to track the progress of interventions aimed at improving access to maternal health. Regular data collection and analysis can help identify gaps, measure the impact of interventions, and inform future strategies.

By implementing these recommendations, it is possible to develop innovative approaches that address the unmet need for family planning and improve access to maternal health services in Bishoftu town, Eastern Ethiopia.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be used:

1. Strengthen Health Education and Behavior Change Communication:
– Develop targeted health education programs and behavior change communication strategies.
– Implement community outreach programs, workshops, and campaigns to raise awareness about family planning services and their benefits.
– Conduct pre- and post-intervention surveys to assess changes in knowledge, attitudes, and practices related to family planning.
– Measure the increase in the utilization of family planning services through facility records and surveys.

2. Improve Access to Family Planning Services:
– Increase the number of health facilities providing family planning services, especially in rural and semi-urban areas.
– Conduct facility assessments to identify gaps in service provision and address them through infrastructure development and resource allocation.
– Monitor the availability of contraceptives and ensure a consistent supply through regular stock monitoring and distribution system improvements.
– Track the increase in the utilization of family planning services through facility records and surveys.

3. Address Socio-Demographic and Economic Factors:
– Implement interventions targeting socio-demographic and economic factors associated with unmet need for family planning.
– Provide educational opportunities for women through scholarships, vocational training, and adult literacy programs.
– Promote income-generating activities and entrepreneurship among women to improve their economic status.
– Conduct surveys and interviews to assess changes in socio-demographic and economic indicators among women in the study area.

4. Strengthen Health Care Provider Engagement:
– Develop training programs for healthcare providers on family planning counseling and services.
– Conduct pre- and post-training assessments to evaluate changes in knowledge, skills, and attitudes of healthcare providers.
– Monitor the number of healthcare provider visits to women in the community, especially those who have not accessed family planning services in the past year.
– Assess changes in healthcare provider-client interactions and client satisfaction through surveys and interviews.

5. Enhance Monitoring and Evaluation:
– Establish a monitoring and evaluation system to track the progress of interventions.
– Collect data on key indicators such as contraceptive prevalence rate, unmet need for family planning, and demand satisfied for family planning.
– Analyze data regularly to identify trends, gaps, and areas for improvement.
– Conduct periodic surveys to assess the impact of interventions on access to maternal health services.

By implementing this methodology, it will be possible to simulate the impact of the main recommendations on improving access to maternal health in Bishoftu town, Eastern Ethiopia. The data collected through surveys, interviews, and facility records will provide valuable insights into the effectiveness of the interventions and guide future strategies for improving access to maternal health services.

Statistics:
Citations: 3
Authors: 4
Identifiers:
DOI: 10.1371/journal.pone.0260972
Research Areas:
Community Interventions, 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:
Female
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