Modern contraception use and associated factors in Ethiopia: Evidence from the 2019 Ethiopian Mini Demographic and Health Survey

Background: The use of contraceptive is key in reducing unsafe abortion from unintended pregnancies, infant mortality, adolescent pregnancies, slowing population growth and helps to prevent HIV/AIDS. However, less than one-third of women within reproductive age in Ethiopia uses modern contraceptive methods. Hence, this study aims to identify potential factors on use of modern contraceptive method. Methods: Data from 2019 Ethiopian min Demographic and Health Survey were used in this analysis. A total of 8,885 women within the ages of 15–49 years across 305 enumeration areas in nine regions and two city administrations were included in the analysis. Logistic regression model used to examine the association between women’s background characteristics and modern contraceptives use. Results: Only 28.1% of women used modern contraceptives. About 40% of the modern contraceptive users were between age of 25-29 and 30–34 years. There was signicant association between women’s age, level of education, region, religion, parity, wealth quintile and marital status on use of modern contraceptives. Women who were married and living with partners were about 20 and 24 times more likely to use modern contraceptives compared to sexually active unmarried women. Conclusion: The study showed that the use of modern contraceptive method is low and inuenced by socio-demographic characteristics of women in Ethiopia. Therefore, increasing the awareness of women to use modern contraceptive methods is vital.


Study setting
Data from 2019 Ethiopian min Demographic and Health Survey were used in this analysis.
The sample for the survey was strati ed and selected in two stages.
In the rst stage, 305 enumeration areas (EAs) from a frame of all EAs created for the 2019 Ethiopia Population and Housing Census by Central Statistical Agency selected with probability proportional to EAs size.
In the second stage, a xed number of 30 households per EAs selected with an equal probability systematic selection from the newly created household listing. All women age 15-49 who were either permanent residents of the selected households or visitors who slept in the household the night before the survey were eligible for interview.

Study variables
The dependent variable is use of modern contraceptive methods during the survey, categorized as 'Yes' for those who uses PILL, IUD, injectable, implants, male condom, emergency contraception, standard days method (SDM), lactational amenorrhoea (LAM) and other users, while "No" for those who uses rhythm, withdrawal, other, and none users of family planning methods.
Individual-level variables include respondent age, residence, region, education and wealth quintile.

Data analysis
To summarize initially the study variables alone and to explore association between study variables with utilization of modern contraceptive methods; univariate descriptive and bivariate analysis implemented, respectively. For these analyses, survey-weighting variable used. To examine the crude association between use of modern contraceptive methods and study variables, univariate binary logistic regression model applied. To examine the overall adjusted association, variables indicated association at 5% level of signi cance in bivariate analysis were included in a multivariate logistic regression. Finally, measure of associations of the study variables on use of modern contraceptive methods examined using adjusted Odds Ratio (OR) at 95% con dence interval (CI). All the analyses done using SPSS Version 20. Table 1 presents background characteristics of women who were included in the survey.

Results
From the total 8,885 women in the survey, those in age group 15-19 years were the highest proportion (24.9%) followed by women in age group 25-29 (18.8%). Most of women in the survey were completed primary level of education (41.7%) while 5.7% of the women have more than secondary educational level.

Discussion
About a quarter of women in reproductive age who were included in the study used modern contraceptive. This study also identi ed women's age, educational level, region, religion, parity, wealth quintal and marital status to be signi cant factors that were in uencing modern contraceptive use.
This study used national and regional representative data to re ect the prevalence of the reproductive age women modern contraceptive utilization and its possible associated factors. The data were collected through adapted DHS program's standard questionnaires.
Since Mini-DHS is a cross-sectional type of survey, temporal relationship between contraceptive use and associated factors cannot be assured and the evidence should be used in caution.

Findings in 2019 Ethiopian
Mini Demographic and Health survey shows that uptake of weighted modern contraceptive method at national level has improved to 28.1% from previous years Ethiopian Demographic and Health Survey, that is 9.7% in 2005, 18.7% in 2011 and 24.9% in 2016 (2,5,11,12).
Although improvements have been shown, the contraceptive acceptance rate in Ethiopia by 2020 was 69% while its HSTP target for this year was 85% (13).
The utilization of modern contraceptive cannot be generalized to the general population. It only represents the study population. However, a large number of women were included in this study so that the association made could be considered as a robust.
Our study shows that place of residence that is living in urban or rural was not a signi cant factor in uencing modern contraceptive use among women in reproductive age. This was in contrast with ndings from other studies in Ghana and Democratic Republic Congo (14,15).
The likelihood of modern contraceptive use was higher among married and living with partner women compared to those who are unmarried but sexually active. Possible explanations for this might be good husband's/partner support on contraceptive use (16)  Our study ndings also indicated similar patterns with these studies; that is women from highest wealth quintal, primary level of education, SNNPR/Amhara regions and 1 to 2 parity being more likely to use modern contraceptive compared to women in lowest wealth quintal, with no education, from Tigray and with no parity, respectively.
It implies to improve the gap of up taking modern contraceptive, the policy makers who are working in the area need to give more attention for reproductive age women from lowest quintile, for Afar and Somali regions and with no education.
Focusing on married women, result of 2019 Ethiopia mini-DHS showed that the contraceptive prevalence rate equals 41.4% that is still below HSTP-II target of 50% planned for 2024/25. In order to achieve this target in the remaining 2 years, interventions like health education on advantage of contraceptive use, community mobilization and improvement in family planning accessibility are among the key strategies.

Conclusion
Modern contraceptive utilization in Ethiopian women in the reproductive age is found to be low. This study also pointed out a disparity in modern contraceptive use among regions, and wealth quintiles. In addition, we found low utilization of modern contraceptive among unmarried women, 15  Table2. Distribution and association between utilization of modern contraceptive on study variables