Determinants of unmet need for modern contraceptives in Ethiopia

Abstract

Objective To identify the determinants of the unmet need for modern contraceptives in Ethiopia.Design Community-based cross-sectional study.Setting Ethiopia.Participants A group of 6636 women of reproductive age (15–49 years) who were sexually active were included in the study.Outcome Unmet need for modern contraceptivesMethod The study used data from the 2019 Performance Monitoring for Action-Ethiopia survey, which was community-based and cross-sectional. The sample consisted of women aged 15–49 from households randomly selected to be nationally representative. Multinomial logistic regression and spatial analysis were performed to determine the factors influencing unmet needs for modern contraceptives. The descriptive analysis incorporated svy commands to account for clustering.Results The proportion of unmet need for modern contraceptives was 19.7% (95% CI: 18% to 21.5%). Women with supportive norms towards family planning had a lower risk of unmet need for spacing (relative risk ratio (RRR)=0.92, 95% CI: 0.86 to 0.99). Older age lowered the risk of unmet need for spacing 40–44 (RRR=0.28, 95% CI: 0.13 to 0.59) and 45–49 (RRR=0.11, 95% CI: 0.04 to 0.31). Being married increased the unmet need for spacing (RRR=1.9, 95% CI: 1.36 to 2.7) and limiting (RRR=3.7, 95% CI: 1.86 to 7.4). Increasing parity increases the risk of unmet need for spacing (RRR=1.27, 95% CI: 1.16 to 1.38) and limiting (RRR=1.26, 95% CI: 1.15 to 1.4). Contrarily, older age increased the risk of unmet need for limiting 40–44 (RRR=10.2, 95% CI: 1.29 to 79.5), 45–49 (RRR=8.4, 95% CI: 1.03 to 67.4). A clustered spatial unmet need for modern contraceptives was observed (Global Moran’s I=0.715: Z-Score=3.8496, p<0.000118). The SaTScan identified 102 significant hotspot clusters located in Harari (relative risk (RR)=2.82, log-likelihood ratio (LLR)=28.2, p value<0.001), South Nations Nationalities and People, Oromia, Gambella and Addis Ababa (RR=1.33, LLR=15.6, p value<0.001).Conclusions High levels of unmet need for modern contraceptives were observed in Ethiopia, showing geographical variations. It is essential to address the key factors affecting women and work towards reducing disparities in modern contraceptive unmet needs among different regions.