Trends of modern contraceptive use among young married women based on the 2000, 2005, and 2011 Ethiopian demographic and health surveys: A multivariate decomposition analysis

  • PLoS ONE, Volume 10, No. 1, Year 2015

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Study Justification:
– Accessing family planning can reduce maternal, infant, and childhood deaths.
– Modern contraceptive use in Ethiopia is low but increasing.
– This study aims to analyze the trends and determinants of changes in modern contraceptive use among young married women in Ethiopia.
Highlights:
– Modern contraceptive prevalence among young married women increased from 6% in 2000 to 16% in 2005 and 36% in 2011.
– Changes in women’s characteristics, such as age, education, religion, couple concordance on family size, and fertility preference, contributed to 34% of the overall change in modern contraceptive use.
– Changes in coefficients, particularly among the rural population (33%), Orthodox Christians (16%), and Protestants (4%), accounted for two-thirds of the increase in modern contraceptive use.
Recommendations:
– Increase access to modern contraceptive methods for young married women in Ethiopia.
– Focus on addressing factors such as age, education, religion, couple concordance on family size, and fertility preference to further increase modern contraceptive use.
– Target rural areas and specific religious groups, such as Orthodox Christians and Protestants, to improve contraceptive use behavior.
Key Role Players:
– Ministry of Health in Ethiopia
– Non-governmental organizations (NGOs) working in the field of reproductive health
– Community health workers
– Religious leaders and organizations
– Educators and schools
– Family planning clinics and healthcare providers
Cost Items:
– Training and capacity building for healthcare providers and community health workers
– Distribution and availability of modern contraceptive methods
– Awareness campaigns and education programs
– Monitoring and evaluation of program implementation
– Research and data collection on contraceptive use trends and determinants

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is strong because it is based on data from three consecutive Demographic Health Surveys conducted in Ethiopia. The study used a large sample size of young married women, and the analysis employed a logit-based decomposition technique. The results show a significant increase in modern contraceptive use over time and provide insights into the factors contributing to this change. To improve the evidence, the abstract could include more details about the methodology, such as the specific variables included in the analysis and the statistical tests used to determine significance. Additionally, it would be helpful to mention any limitations or potential biases in the data or analysis.

Introduction: Accessing family planning can reduce a significant proportion of maternal, infant, and childhood deaths. In Ethiopia, use of modern contraceptive methods is low but it is increasing. This study aimed to analyze the trends and determinants of changes in modern contraceptive use over time among young married women in Ethiopia. Methods: The study used data from the three Demographic Health Surveys conducted in Ethiopia, in 2000, 2005, and 2011. Young married women age 15-24 years with sample sizes of 2,157 in 2000, 1,904 in 2005, and 2,146 in 2011 were included. Logit-based decomposition analysis technique was used for analysis of factors contributing to the recent changes. STATA 12 was employed for data management and analyses. All calculations presented in this paper were weighted for the sampling probabilities and non-response. Complex sampling procedures were also considered during testing of statistical significance. Results: Among young married women, modern contraceptive prevalence increased from 6% in 2000 to 16% in 2005 and to 36% in 2011. The decomposition analysis indicated that 34% of the overall change in modern contraceptive use was due to difference in women’s characteristics. Changes in the composition of young women’s characteristics according to age, educational status, religion, couple concordance on family size, and fertility preference were the major sources of this increase. Two-thirds of the increase in modern contraceptive use was due to difference in coefficients. Most importantly, the increase was due to change in contraceptive use behavior among the rural population (33%) and among Orthodox Christians (16%) and Protestants (4%).

The data for this study were accessed from the DHS program official database. The DHS collects data through nationally representative cross-sectional surveys in over 40 developing countries. The survey is usually conducted at five-year intervals in a country. Ethiopia has undertaken three consecutive DHS surveys, in 2000, 2005, and 2011. The Ethiopian DHS was planned to have estimates according to the 11 regional states (9 regions and 2 city administrations) (Fig. 1) In this study, our data are restricted to married and non-pregnant women aged 15–24. Based on these criteria, our sample sizes from the three Ethiopian Demographic and Health Surveys (EDHS) were 1,990 women in 2000 (2157 weighted cases), 1,877 in 2005 (1904 weighted cases), and 2,167 in 2011(2146 weighted cases) (Fig. 2)). The study variables were classified into dependent and independent variables. The dependent variable was current modern contraceptive use, categorized dichotomously as a “Yes/No” variable. Respondents who were currently using a modern contraceptive method were categorized as “Yes”, otherwise as “No”. In this study, modern contraceptive methods include female and male sterilization, oral contraceptive pill, Intra-uterine device (IUD) injectables, implants, and condom. The key independent variables were the following: Socio-demographic variables. Age [15–19, 20–24], residence [rural, urban], region (9 regions and 2 administrative areas), religion [Orthodox, Muslim, Protestant, Others], wealth index [poorest, poorer, middle, richer, richest], women’s education [no education, primary, secondary and above], partner’s education [no education, primary, secondary and above], working status [not working, working but not paid/paid in kind, paid in cash], and number of living children [0,1, 2, 3+]. Fertility preference and decision-making. Family planning size concordance [both want the same, husband wants more, husband wants fewer, do not know/missing]; women’s participation in decision-making [not participated, participated]; and fertility preference [wants soon, wants later, wants no more]. Family planning program exposure. For the study, being visited by family planning workers in the last 12 months was dichotomized as “Yes” and “No”. Similarly, knowing about different contraceptive methods is likely to have a positive effect on modern contraceptive use. Thus in the study being knowledgeable about family planning was classified as “Yes” for knowledgeable and “No” for non-knowledgeable. This study employed trend analysis of modern contraceptive use and decomposition of changes in modern contraceptive use. The trend in modern contraceptive use was analyzed using descriptive analyses, stratified by region, urban-rural residence, and selected socio-demographic characteristics. The trend was examined separately for the periods 2000–2005, 2005–2011, and 2000–2011. Multivariate decomposition analysis of change in modern contraceptive use was employed to answer the major research question of this study. The analysis was a regression decomposition of the difference in modern contraceptive use between two surveys (the 2000 and 2011 EDHS data). The purpose of the decomposition analysis was to identify the sources of changes in the use of modern contraception in the last decade. Both changes in population composition and population behavior related to contraceptive use (effect) are important. This method is used for several purposes in demography, economics, and other fields. The present analysis focused on how use of contraception responds to changes in women’s characteristics and how these factors shape differences across surveys conducted at different times. The technique utilizes the output from logistic regression model to parcel out the observed difference in contraceptive use in to components. This difference can be attributed to compositional changes between surveys (i.e. differences in characteristics) and to changes in effects of the selected explanatory variables (i.e. differences in the coefficients due to changes in population behavior). Hence, the observed difference in modern contraceptive use between different surveys is additively decomposed into a characteristics (or endowments) component and a coefficient (or effects of characteristics) component. STATA 12 was employed for data management and analyses. STATA commands were applied during the process of analysis. All calculations presented in this paper were weighted for the sampling probabilities and non-response using the weighting factor included in the EDHS data. During testing of statistical significance or associations (95% confidence interval calculations), complex sampling procedures were considered. The process was done by using the SVY STATA command to control the clustering effect of complex sampling (stratification and multistage sampling procedures). Ethiopian DHS obtained ethical clearance from Ethiopian Health Nutrition and Research Institute (EHNRI) Review Board, the National Research Ethics Review Committee (NRERC) at the Ministry of Science and Technology of Ethiopia, the Institutional Review Board (IRB) of ICF International, and the Center for Disease Control (CDC). During the data collection, the interviewer read aloud a statement to get consent from the respondents. The respondents provided verbal consent, as DHS is conducted in areas where not all respondents are able to write. The interviewers then signed their name to document that the statement was read and that consent was granted or declined. Children were not respondents to interview; however, parent/guardians gave consent for measurements. Detailed information on the methodology and ethical issue was published in the Ethiopian Demographic and Health Survey reports [4,5,22]. The authors have submitted proposal to 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 were used solely for the purpose of the current study.

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

1. Mobile Health (mHealth) Applications: Develop mobile applications that provide information and resources on maternal health, including family planning methods, prenatal care, and postpartum care. These apps can be easily accessible to women in rural areas with limited access to healthcare facilities.

2. Telemedicine: Implement telemedicine services to connect pregnant women in remote areas with healthcare providers. This allows for remote consultations, monitoring, and guidance throughout pregnancy, reducing the need for travel and improving access to healthcare services.

3. Community Health Workers: Train and deploy community health workers who can provide basic maternal health services, including education on family planning, prenatal care, and postpartum care. These workers can reach women in remote areas and provide essential care and support.

4. Mobile Clinics: Establish mobile clinics that travel to remote areas, providing comprehensive maternal health services, including prenatal care, family planning, and postpartum care. This brings healthcare services directly to women who may not have access to traditional healthcare facilities.

5. Public-Private Partnerships: Foster collaborations between public and private sectors to improve access to maternal health services. This can involve leveraging private sector resources, such as transportation or technology, to reach women in remote areas and provide necessary care.

6. Health Education Campaigns: Launch targeted health education campaigns to raise awareness about the importance of maternal health and family planning. These campaigns can be conducted through various mediums, such as radio, television, and community gatherings, to reach a wide audience.

7. Maternal Health Vouchers: Implement voucher programs that provide pregnant women with access to essential maternal health services, including prenatal care, delivery, and postpartum care. These vouchers can be distributed to women in need, ensuring they receive the necessary care regardless of their financial situation.

8. Supply Chain Management: Improve supply chain management systems to ensure the availability of essential maternal health commodities, such as contraceptives, prenatal vitamins, and delivery kits. This helps to prevent stockouts and ensures that women have access to the necessary resources for their maternal health needs.

9. Maternal Health Financing: Develop innovative financing mechanisms to support maternal health services, including microinsurance schemes or community-based financing models. This helps to reduce financial barriers and ensures that women can afford the necessary care.

10. Data Analytics and Monitoring: Utilize data analytics and monitoring systems to track maternal health indicators and identify areas of improvement. This information can be used to inform targeted interventions and ensure that resources are allocated effectively to improve access to maternal health services.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health would be to focus on increasing the use of modern contraceptive methods among young married women in Ethiopia. This can be achieved through the following steps:

1. Increase awareness: Implement comprehensive awareness campaigns to educate young married women about the benefits and importance of modern contraceptive methods in preventing maternal, infant, and childhood deaths. This can be done through various channels such as community health workers, schools, religious institutions, and media.

2. Improve availability: Ensure that modern contraceptive methods are readily available and accessible to young married women in both urban and rural areas. This can be achieved by strengthening the supply chain and distribution systems, as well as increasing the number of healthcare facilities that provide contraceptive services.

3. Address cultural and religious barriers: Work closely with religious leaders and community influencers to address any cultural or religious misconceptions and myths surrounding modern contraceptive methods. This can help to dispel any negative beliefs and encourage acceptance and utilization of these methods.

4. Enhance family planning services: Strengthen family planning services by training healthcare providers on modern contraceptive methods and counseling techniques. This will enable them to provide accurate information, guidance, and support to young married women in making informed decisions about their reproductive health.

5. Empower women: Promote women’s empowerment and gender equality by providing opportunities for education and economic empowerment. This can help young married women to have more control over their reproductive choices and access to healthcare services.

6. Monitor and evaluate: Establish a robust monitoring and evaluation system to track the progress and impact of interventions aimed at improving access to maternal health. This will help to identify any gaps or challenges and inform future strategies and interventions.

By implementing these recommendations, it is expected that there will be an increase in the use of modern contraceptive methods among young married women in Ethiopia, leading to improved access to maternal health services and a reduction in maternal, infant, and childhood deaths.
AI Innovations Methodology
Based on the information provided, here are some potential recommendations for improving access to maternal health:

1. Increase awareness and knowledge about modern contraceptive methods: Implement comprehensive education and awareness campaigns to ensure that women and their partners have accurate information about different contraceptive methods, their benefits, and how to access them.

2. Strengthen family planning programs: Invest in and expand family planning programs, including increasing the availability and accessibility of modern contraceptive methods in both urban and rural areas. This can be done through the establishment of more family planning clinics and the training of healthcare providers.

3. Address socio-cultural barriers: Develop strategies to address socio-cultural barriers that may prevent women from accessing modern contraceptive methods, such as religious beliefs, gender norms, and stigma. This can be achieved through community engagement, involving religious and community leaders, and promoting gender equality.

4. Improve access to healthcare facilities: Ensure that healthcare facilities, particularly in rural areas, are equipped with the necessary resources and trained healthcare providers to provide maternal health services, including family planning and antenatal 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 contraceptive prevalence rate, antenatal care coverage, and skilled birth attendance.

2. Collect baseline data: Gather data on the current status of these indicators in the target population. This can be done through surveys, interviews, or analysis of existing data sources.

3. Develop a simulation model: Create a simulation model that incorporates the identified recommendations and their potential impact on the selected indicators. This model should consider factors such as population size, geographic distribution, and socio-economic characteristics.

4. Input data and run simulations: Input the baseline data into the simulation model and run multiple simulations to estimate the potential impact of the recommendations on the selected indicators. This can be done by adjusting the relevant variables based on the expected effects of the recommendations.

5. Analyze results: Analyze the results of the simulations to determine the potential changes in the selected indicators. This can include comparing the baseline data with the simulated data to assess the magnitude of the impact.

6. Refine and validate the model: Refine the simulation model based on the analysis of the results and validate it using additional data sources or expert input. This will help ensure the accuracy and reliability of the simulations.

7. Communicate findings and make recommendations: Present the findings of the simulations, including the potential impact of the recommendations on improving access to maternal health. Use this information to inform policy and decision-making processes, and make recommendations for further action.

It is important to note that the methodology described above is a general framework and may need to be adapted based on the specific context and data availability. Additionally, the accuracy of the simulations will depend on the quality and reliability of the input data and the assumptions made in the model.

Statistics:
Citations: 28
Authors: 3
Identifiers:
DOI: 10.1371/journal.pone.0116525
Research Areas:
Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Sexual and Reproductive Health, Technology and Innovations
Study Countries:
Ethiopia
Study Design:
Cross Sectional Study, Grounded Theory
Study Approach:
Quantitative
Participants Gender:
Male & Female
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