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

PLoS ONE, Volume 17, No. 8 August, Year 2022

Ukuhunyushwa

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. Using dataset of 2005, 2011, and 2016 Ethiopian Demographic Health Surveys (EDHS), this study looked at trends and predictors of change in the unmet demand for family planning among Ethiopian women of reproductive age. Those surveys were conducted using cross sectional study design and through the application of a two-stage cluster sampling method. In the first stage, 540 Enumeration Areas (EAs) in EDHS 2005, 624 EAs for EDHS 2011, and 645 EAs in EDHS 2016 were randomly selected proportional to their EA size and in the second stage, on average 27 to 32 households from each containing EA were selected. For this study, a pooled weighted sample of 26,230 (7,761 in EDHS 2005, 9,136 in EDHS 2011 and 9,333 in EDHS 2016) reproductive-age women were utilized. The detailed information about sampling procedures of the survey is presented at each EDHS report [19, 20]. The outcome variable is an unmet need for FP, which is composed of an unmet need for spacing and limiting. Unmet need refers to the proportion of women who desired to either delay the current or next pregnancy or limit future pregnancies but not using any method of the modern contraception [21]. The outcome variable was categorized as “unmet need” if women had unmet need either for spacing or for limiting purpose were coded as 1, while those using FP methods for spacing or limiting or with no unmet need were “met need” coded as 0. The independent variables included in this study were: respondent’s age, respondent’s educational status, religion, husband’s education status, marital status, place of residence, women working status, husband working status, wealth status, media exposure, termination of pregnancy, knowledge about family planning, visited health facility last 12 months, visited by field workers in the last 12 months, perceived distance to health facility, age at first marriage, birth order, sex of household head, region and desired number of children. Knowledge about family planning. According to EDHS, having good knowledge to FP is defined as, Percentage of all respondents, currently married respondents, and sexually active unmarried respondents aged 15–49 who have heard of any contraceptive method, according to specific method. Important variables were extracted from the Individual Record (IR) dataset. Sample of each DHS were weighted using the “svyset” STATA command and it was applied for each descriptive analyses. The weight variable (v005), primary sampling unit (v021), and strata (v023) are the variables required to develop the “svyset” command. Trend and decomposition analysis of the unmet need for family planning was done. The trend analysis has been done by separating based on period as (2005–20011), (2011–2016) and the overall trend (2005–2016). 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 across the two surveys. For our study, Logit based decomposition analysis was employed. 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 components. For our study, the 2016 EDHS data was appended to the 2005 EDHS data using the “append” Stata command, and the Logit based multivariable decomposition analysis (using mvdcmp STATA command) was used to identify factors that contributed to the change in unmet need for family planning over the last 11 years. The change in unmet need for family planning can be explained by the compositional difference between surveys (i.e. differences in characteristics) and/or the difference in effects of explanatory variables (i.e. differences in the coefficients) between the surveys. Hence, the observed decrease in unmet need over time is additively decomposed into a compositional difference of respondents of each survey (endowments) component and a coefficient (or effects of characteristics) component. For logistic regression, the Logit or log-odd of unmet need for family planning is taken as: [22] X indicates independent variables (unmet need for FP in this study) β denotes that, the regression coefficient of each selected contributing variables The E component refers to the part of the differential owing to differences in endowments or characteristics. The C component refers to that part of the differential attributable to differences in coefficients or effects. Authors have requested DHS Program through an online request by written letter of objective and significance of the study. Permission for data access was granted to download and use the data from http://www.dhsprogram.com. The EDHS programs permitted data access, and data were used for only the current study.

I-AI Digest

Study Justification:

This study aimed to investigate the trends and predictors of change in the unmet need for family planning among reproductive-age women in Ethiopia. Family planning is crucial for controlling population growth and improving maternal and child health. Understanding the factors contributing to the unmet need for family planning can help policymakers and healthcare providers develop targeted interventions to address this issue.

Highlights:

– The percentage of Ethiopian women with an unmet need for family planning decreased from 39.6% in 2005 to 23.6% in 2016.
– Education level, birth order, and desired number of children were identified as key factors that changed over the 11-year period and contributed to the change in unmet need for family planning.
– The study utilized data from the Ethiopian Demographic and Health Surveys conducted in 2005, 2011, and 2016, providing a comprehensive analysis of trends over time.

Recommendations for Lay Reader:

– Access to family planning services has improved in Ethiopia, but there is still a significant unmet need.
– Education plays a crucial role in reducing the unmet need for family planning. Efforts should be made to ensure that women have access to education.
– Addressing birth order and desired number of children can also help reduce the unmet need for family planning.
– Policymakers should prioritize investments in family planning programs and ensure that they are accessible to all women.

Recommendations for Policy Maker:

– Increase investments in education to empower women and improve their access to family planning information and services.
– Develop targeted interventions for women with higher birth orders and those who desire fewer children to address their specific needs for family planning.
– Strengthen the healthcare system to ensure that family planning services are available and accessible to all women, especially in rural areas.
– Collaborate with international organizations and donors to secure funding for family planning programs and initiatives.

Key Role Players:

– Ministry of Health: Responsible for developing and implementing policies and programs related to family planning.
– Non-governmental organizations (NGOs): Provide support and resources for family planning initiatives on the ground.
– Healthcare providers: Deliver family planning services and counseling to women.
– Educators: Play a crucial role in providing comprehensive reproductive health education to young people.
– Community leaders: Can help raise awareness and promote the importance of family planning within their communities.

Cost Items for Planning Recommendations:

– Education programs: Budget for initiatives aimed at improving access to education for women and girls.
– Healthcare infrastructure: Allocate funds for the development and improvement of healthcare facilities to provide family planning services.
– Training and capacity building: Invest in training healthcare providers and educators to deliver quality family planning services and education.
– Outreach and awareness campaigns: Set aside funds for community-based programs to raise awareness about family planning and its benefits.
– Contraceptive commodities: Budget for the procurement and distribution of contraceptives to meet the demand for family planning services.

Amandla Obufakazi

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is rated 8 because it provides a detailed description of the study design, data source, and methodology. It also presents the key findings and conclusions. However, it could be improved by providing more information on the statistical analysis techniques used and the limitations of the study.

Abstract

Using dataset of 2005, 2011, and 2016 Ethiopian Demographic Health Surveys (EDHS), this study looked at trends and predictors of change in the unmet demand for family planning among Ethiopian women of reproductive age. Those surveys were conducted using cross sectional study design and through the application of a two-stage cluster sampling method. In the first stage, 540 Enumeration Areas (EAs) in EDHS 2005, 624 EAs for EDHS 2011, and 645 EAs in EDHS 2016 were randomly selected proportional to their EA size and in the second stage, on average 27 to 32 households from each containing EA were selected. For this study, a pooled weighted sample of 26,230 (7,761 in EDHS 2005, 9,136 in EDHS 2011 and 9,333 in EDHS 2016) reproductive-age women were utilized. The detailed information about sampling procedures of the survey is presented at each EDHS report [19, 20]. The outcome variable is an unmet need for FP, which is composed of an unmet need for spacing and limiting. Unmet need refers to the proportion of women who desired to either delay the current or next pregnancy or limit future pregnancies but not using any method of the modern contraception [21]. The outcome variable was categorized as “unmet need” if women had unmet need either for spacing or for limiting purpose were coded as 1, while those using FP methods for spacing or limiting or with no unmet need were “met need” coded as 0. The independent variables included in this study were: respondent’s age, respondent’s educational status, religion, husband’s education status, marital status, place of residence, women working status, husband working status, wealth status, media exposure, termination of pregnancy, knowledge about family planning, visited health facility last 12 months, visited by field workers in the last 12 months, perceived distance to health facility, age at first marriage, birth order, sex of household head, region and desired number of children. Knowledge about family planning. According to EDHS, having good knowledge to FP is defined as, Percentage of all respondents, currently married respondents, and sexually active unmarried respondents aged 15–49 who have heard of any contraceptive method, according to specific method. Important variables were extracted from the Individual Record (IR) dataset. Sample of each DHS were weighted using the “svyset” STATA command and it was applied for each descriptive analyses. The weight variable (v005), primary sampling unit (v021), and strata (v023) are the variables required to develop the “svyset” command. Trend and decomposition analysis of the unmet need for family planning was done. The trend analysis has been done by separating based on period as (2005–20011), (2011–2016) and the overall trend (2005–2016). 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 across the two surveys. For our study, Logit based decomposition analysis was employed. 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 components. For our study, the 2016 EDHS data was appended to the 2005 EDHS data using the “append” Stata command, and the Logit based multivariable decomposition analysis (using mvdcmp STATA command) was used to identify factors that contributed to the change in unmet need for family planning over the last 11 years. The change in unmet need for family planning can be explained by the compositional difference between surveys (i.e. differences in characteristics) and/or the difference in effects of explanatory variables (i.e. differences in the coefficients) between the surveys. Hence, the observed decrease in unmet need over time is additively decomposed into a compositional difference of respondents of each survey (endowments) component and a coefficient (or effects of characteristics) component. For logistic regression, the Logit or log-odd of unmet need for family planning is taken as: [22] X indicates independent variables (unmet need for FP in this study) β denotes that, the regression coefficient of each selected contributing variables The E component refers to the part of the differential owing to differences in endowments or characteristics. The C component refers to that part of the differential attributable to differences in coefficients or effects. Authors have requested DHS Program through an online request by written letter of objective and significance of the study. Permission for data access was granted to download and use the data from http://www.dhsprogram.com. The EDHS programs permitted data access, and data were used for only the current study.

Izinto zokwakha

Emisha

Based on the information provided, it appears that the study focused on analyzing trends and predictors of change in the unmet need for family planning among Ethiopian women of reproductive age. The study utilized data from the Ethiopian Demographic Health Surveys conducted in 2005, 2011, and 2016.

Some potential innovations that could be recommended to improve access to maternal health based on the findings of this study include:

1. Targeted education and awareness campaigns: Given that education level was identified as a factor contributing to the change in unmet need for family planning, implementing targeted education and awareness campaigns can help improve knowledge and understanding of family planning methods among women of reproductive age.

2. Improved access to contraception: Since the unmet need for family planning is associated with women who desire to delay or limit pregnancies but are not using any modern contraception methods, efforts should be made to improve access to a wide range of contraceptive options. This can include increasing the availability and affordability of contraceptives in both urban and rural areas.

3. Strengthening healthcare infrastructure: Enhancing the availability and accessibility of healthcare facilities, particularly in remote or underserved areas, can help ensure that women have access to quality maternal health services, including family planning. This can involve building or upgrading healthcare facilities, training healthcare providers, and improving transportation networks for better access to healthcare.

4. Community-based interventions: Engaging community leaders, local organizations, and community health workers can play a crucial role in promoting family planning and addressing cultural and social barriers. Community-based interventions can include conducting awareness campaigns, providing counseling and support services, and involving men in discussions about family planning.

5. Integration of family planning services: Integrating family planning services with other reproductive health services, such as antenatal care and postpartum care, can help ensure that women have access to comprehensive care throughout their reproductive journey. This can be achieved by training healthcare providers to offer a range of services and by promoting a holistic approach to reproductive health.

It is important to note that these recommendations are based on the information provided and may need to be tailored to the specific context and needs of the Ethiopian healthcare system.

AI Innovations Description

The recommendation that can be developed into an innovation to improve access to maternal health based on the study is to focus on addressing the socio-demographic factors that contribute to the unmet need for family planning among women of reproductive age in Ethiopia. Specifically, targeting women with higher birth orders, women with secondary education, and women who desire fewer children overall could help increase access to family planning services and reduce the unmet need.

To implement this recommendation, the following strategies could be considered:

1. Education and awareness campaigns: Implement targeted education and awareness programs to increase knowledge about family planning methods and their benefits, particularly among women with higher birth orders and those with secondary education. These campaigns can be conducted through various channels, including community health workers, schools, and media platforms.

2. Access to family planning services: Improve access to family planning services by increasing the availability of contraceptive methods, ensuring their affordability, and expanding the reach of healthcare facilities in rural areas. This could involve training healthcare providers, establishing mobile clinics, and strengthening the supply chain for contraceptives.

3. Counseling and support: Provide comprehensive counseling and support services to women who desire fewer children. This can include discussions about contraceptive options, family planning methods, and the importance of birth spacing for maternal and child health. Additionally, offering counseling services for women with higher birth orders can help them make informed decisions about family planning.

4. Empowerment and gender equality: Promote women’s empowerment and gender equality through initiatives that address social norms and cultural barriers related to family planning. This can involve engaging community leaders, religious institutions, and men in discussions about the benefits of family planning and the importance of women’s reproductive health.

5. Monitoring and evaluation: Establish a robust monitoring and evaluation system to track the progress of interventions aimed at reducing the unmet need for family planning. This can help identify gaps and areas for improvement, ensuring that resources are allocated effectively and interventions are evidence-based.

By implementing these recommendations, it is possible to develop innovative approaches that address the socio-demographic factors contributing to the unmet need for family planning, ultimately improving access to maternal health services in Ethiopia.

AI Innovations Methodology

Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Increase awareness and education about family planning: Implement comprehensive education programs that provide accurate information about family planning methods, their benefits, and how to access them. This can be done through community outreach programs, school-based education, and media campaigns.

2. Improve availability and accessibility of family planning services: Ensure that family planning services are easily accessible to all women, especially in rural and remote areas. This can be achieved by establishing more health facilities that provide family planning services, training healthcare providers, and implementing mobile clinics to reach underserved populations.

3. Address cultural and social barriers: Develop culturally sensitive approaches to address misconceptions and cultural barriers surrounding family planning. Engage community leaders, religious leaders, and influential individuals to promote the importance of family planning and dispel myths and misconceptions.

4. Strengthen healthcare infrastructure: Invest in improving healthcare infrastructure, including facilities, equipment, and supplies, to ensure that women have access to quality maternal health services. This includes adequate staffing, skilled healthcare providers, and emergency obstetric care.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define indicators: Identify key indicators that measure access to maternal health, such as the percentage of women utilizing family planning services, the number of maternal deaths, or the percentage of women receiving antenatal care.

2. Collect baseline data: Gather data on the current status of these indicators before implementing the recommendations. This can be done through surveys, interviews, or existing data sources.

3. Implement interventions: Implement the recommended interventions, such as education programs, improving service availability, addressing cultural barriers, and strengthening healthcare infrastructure.

4. Monitor and collect data: Continuously monitor the progress and collect data on the selected indicators after implementing the interventions. This can be done through surveys, routine data collection systems, or monitoring and evaluation frameworks.

5. Analyze and compare data: Compare the baseline data with the post-intervention data to assess the impact of the recommendations. Use statistical analysis techniques to determine if there have been significant improvements in the selected indicators.

6. Evaluate and adjust: Evaluate the effectiveness of the interventions and make adjustments as needed. This may involve refining the interventions, scaling up successful approaches, or addressing any unforeseen challenges.

By following this methodology, it will be possible to simulate the impact of the recommendations on improving access to maternal health and make evidence-based decisions for further interventions.

Ababhali & Co-Ababhali

Statistics:

Authors: 6

Identifiers:

DOI: 10.1371/journal.pone.0272701

Research Areas:

Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants

Study Countries:

Ethiopia

Study Design:

Cross Sectional Study

Study Approach:

Quantitative

Participants Gender:

Female

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