Prevalence of modern contraceptive utilization and associated factors among women of reproductive age from 36-49 years in Ethiopia

Background: One of the major problems in developing countries is the increasing growth of population which in fact is a serious threat for the global community. Modern Contraceptive use allows people to attain their desired number of children and determine the spacing of pregnancies. The main objective of this study is to assess the Prevalence of modern contraceptive utilization and associated factors among women of reproductive age from 36-49 years in Ethiopia. Methodology: A community based, cross-sectional study was employed from January 1 to June 30, 2016, among women of reproductive age from 36-49 years in all regions of Ethiopia. A multi-stage sampling procedure was used to select 3260 study participants. A pretested structured questionnaire was used to collect data, and data collectors who had completed high school were involved in the data collection process. A bivariate, multivariable logistic regression model was fit and statistical significance was determined with odds ratios and 95 % confidence level. Before preceding data analysis, the necessary assumptions for the application of multiple logistic regressions was checked by Hosmer and Lemeshow Test through forward LR method. Result: The overall modern contraceptive prevalence rate was found to be 17%. Being wealthy (Adjusted Odds Ratio=4.120 95%CI (2.853, 5.949), higher educated (Adjusted Odds Ratio =3.329, 95%CI (2.065, 5.368) and having more numbers of living children (Adjusted Odds Ratio =1.714, 95% (1.328, 2.212) was significantly associated with use of modern contraceptive methods. Conclusion: The utilization of modern contraceptive method was low. Contraceptive utilization was associated with some socio-economic and socio-demographic factors like age, educational status, women wealth index and number of children. Therefore, expanding contraceptive services confers substantial benefits on women, their families and society. All stakeholders, including the Ethiopian government and the private sector, should increase their investment in modern contraceptive services


Background
The history of family planning in Ethiopia started in the 1960s. So far Ethiopia faced many challenges to provide better access to family planning services for several decades (1).
Number of births and high-risk pregnancies are reduced through provision of safe and effective modern contraceptives like pills, female and male sterilization, IUD, inject-able, implants, male and female condom, diaphragm, and emergency contraception.
Modern contraceptive use enables people to make informed choices about their sexual and reproductive health rights. It creates an opportunity for women to pursue additional education and participate in public life, including paid employment in any organizations.
Therefore, having smaller families allow parents to invest more in each child.
Ability of a woman to start a successful, continuous and appropriate contraceptive method is influenced by age, level of education, family wealth, number of children, their residence (urban/rural), Knowledge, attitude, frequency of listening mass Medias (radio) and access to the health care (2).
Delay and spacing childbearing are crucial to women's social and economic advancement.
Women's ability to obtain and effectively use contraceptives has a positive impact on their education and workforce participation, as well as on subsequent outcomes related to income, family stability, mental health and children's well-being (3).
The aim of this study is to assess the Prevalence of modern contraceptive utilization and associated factors among women of reproductive age from 36-49 years in Ethiopia.
Therefore, this assessment addresses the identified gaps by answering the following assessment questions: Ethiopia has a total population of about 105,350,020 with annual growth rate of 2.8 % (22). Currently, the country has a federal system of governance with nine regional states and two chartered cities, Addis Ababa (capital city of Ethiopia) and Dire Dawa. The rising age of marriage and the increasing proportion of women remaining single have contributed to fertility reduction. All the participants of the study were women, ranging from 36 to 49 years in age, and they have lived in the study area for at least 6 months.
Women who were critically ill, could not provide informed consent or pregnant women were excluded from the study.

Data Source
This study was conducted using a secondary data obtained from the 2016 EDHS. This cross-sectional survey was administered at the household level throughout the country.
The survey was conducted under the guidance of the Ministry of Health (MOH) and was implemented by the Central Statistical Agency (CSA).
The overall aim of using 2016 EDHS dataset was to assess the prevalence and its determinants of modern contraceptive utilization like: Age, proportion of Contraceptive use, number of children, wealth index, and relevance of media listening, residence and their occupation based on representative samples (3260).

Sample Size Determination
Single population proportion formula with the assumption of 95 % confidence interval, a 5 margin of error of 5 % was used to determine the sample size of this study by taking 25% of modern contraceptive use in Ethiopia as the prevalence (18). Moreover, 10% of nonresponse rate was considered. Finally a total sample size of 3260 was obtained.

Data collection procedures
Data was obtained from EDHS 2016 which were composed of important variables like: age, educational background, place of residence, frequency of listening radio, women's wealth index, number of children and respondents' current working status.

Data Analysis Procedures
Epi-Info window version 6.5 statistical programs was used to clean and enter the data Hosmer and Lemeshow test is that the data fit the model. Therefore, we want to fail to reject the null hypothesis (i.e. we do not want to find evidence that the data differ significantly from the fitted model). Based on Hosmer-Lemeshow test output at α = 0.05 we fail to reject the hypothesis that the data fit the model (p = 0.313). Therefore, we conclude that the model provides a good fit to the data as p=0.313 (>0.05). This indicates that the model was good fit to conduct the data analysis.

Discussion
Ethiopia has the second largest population in sub-Sahara Africa. Delay and spacing childbearing are important to women's social and economic improvement (6).
In this assessment the prevalence of modern contraceptive method uses in Ethiopia among women of age (36-49 years) is very low (17%) as compared to the findings revealed in Asia and Latin America (57.4%) (9). This may be due to cultural, educational and economic status difference.
There is disparity in modern contraceptive prevalence rates within wealth indexes. The richest women were more likely utilize modern contraceptives than poorest women. This finding is supported by different studies conducted at some countries which were positively associated with the use of modern contraceptives (12). This may be due to that women having earnest wealth index could able to have enough money for transportation, FP service and procedural cost of modern contraceptive method.
Education was the most important variable which was affecting modern contraceptive use in Ethiopia. Women attended their secondary and higher levels of education were more likely to utilize modern contraceptive methods than women not attending any educational levels. This finding is similar with a study conducted across the developing world which revealed that the better educated a woman is, the more likely she is to use contraception (13). This may be due various reasons. For instance; when women became more educated, they may have better understanding about the importance of modern contraceptive use for themselves and their families.
Numbers of living children was also a significant predictor for modern contraceptive use in this assessment. Women who have more than 4 children were more likely to use modern contraceptive methods than those women who have less than or equal to 4 children. This result was parallel with a study conducted in Ethiopia in 2011 (15). This may be due to women who have more children may reach their desired number of children or family size and women who wanted to end their desire to have a child were more likely to use modern contraceptive methods than those women who wanted another child.
Women's age had almost a similar effect on modern contraceptive utilization, even if it showed statistically significant association with modern contraceptive use.
Some determinants of modern contraceptive use like: women's residence, current job and frequency of listening modern contraceptive messages with radio did not have a statistically significant association with modern contraceptive use.

Conclusion
Modern contraceptive use in Ethiopia was low. Socio-demographic factors like Educational status, wealth index, age and number of children were associated with contraceptive utilization. Therefore, expanding contraceptive services confers substantial benefits on women, their families and society. All stakeholders, including the Ethiopian government and the private sector, should increase their investment in modern contraceptive services.

Abbreviations
List of abbreviations

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