A total of 703 married women of reproductive age were interviewed, yielding a 90.89% response rate; 352 of these women are in monogamous relationships, while the remaining 351 were in polygamous relationships.
Socio-demographic Character
For monogamy and polygamy, the mean age of respondents with standard deviation were 32.77 (± 7.68) and 37.65 (± 6.59), respectively. Concerning the educational status of the respondents, 44.3% and 51.6% of monogamous and polygamous women didn’t have any formal education, respectively, and the result shows a statistically significant difference at (X2 = 13.88, P-value = 0.002) between the two groups. With regard to respondent occupation, 47.4% and 53.0% Monogamous and polygamous women are farmers, respectively. Religion type 64.2% of monogamous women and 70.9% of Polygamous woman’s are Muslim. In terms of residence, 56% of monogamous women and 71.5% of polygamous women live in rural areas, respectively. (Table 1)
Table 1
Socio-demographic character of Monogamous and Polygamous women in worebabo woreda, south wollo, Ethiopia, 2021.
Variable | Category | Monogamous women (N = 352) | Polygamous women(N = 351) | X2 | P-value |
No | No |
Respondents Age | 15–24 25–34 35–49 Total | 40 (11.4%) 166 (47.2%) 146 (41.5%) 352 | 21 (6.05%) 106 (30.2%) 224 (63.8%) 351 | 35.59 | 0.000 |
Educational status | No formal education Primary education Secondary and above Total | 156 (44.3%) 130 (36.9%) 66 (18.8%) 352 | 181 (51.6%) 138 (39.3%) 32 (9.1%) 351 | 13.88 | 0.002 |
Occupation | Farmer House Wife Business Woman Government employee Total | 167 (47.4%) 109 (31%) 60 (17%) 16 (4.5%) 352 | 186 (53%) 92 (26.2%) 60 (17.1%) 13 (3.7%) 351 | 2.76 | 0.397 |
Religion | Muslim Orthodox Total | 226 (64.2%) 126 (35.8%) 352 | 249 (70.9%) 102 (29%) 351 | 3.63 | 0.064 |
place of residence | Rural Urban Total | 197 (56%) 155 (44%) 352 | 251 (71.5%) 100 (28.5%) 351 | 18.37 | 0.000 |
Years at first marriage | < 18 years old >= 18 years old Total | 175(49.7%) 177(50.3%) 352 | 207(59%) 144(41%) 351 | 6.07 | 0.014 |
Husband age | 15–24 25–34 35–49 Total | 14(4%) 67(19%) 271(77%) 352 | 0 33(9.4%) 318(90.6%) 351 | 29.3 | 0.000 |
Husband educational status | no formal education primary education secondary and above Total | 116(33.0%) 151(42.9%) 85(24.1%) 352 | 148(42.2%) 146(41.6%) 57(16.2%) 351 | 9.48 | 0.002 |
Husband occupation | Farmer Business man Government employee Total | 218(61.9%) 113(32.1%) 21(6.0%) 352 | 190(54.1%) 140(39.9%) 21(6%) 351 | 4.8 | 0.183 |
Reproductive Character
Among all married women, 91.5% of monogamous and 78.3% of polygamous women have a history of pregnancy. Among these women, 22.2% and 21.4% of monogamous and polygamous women had 3–4 pregnancies, respectively. The result also shows that there is a statistically significant difference (X2 = 43.16, P-value = 0.001) between the two groups and the number of pregnancies they had. In terms of abortion history, 7.7% and 14.5% of monogamous and polygamous women, respectively, had a history of abortion. With regard to the number of children a respondent has, 18.2% and 34.8% of monogamous and polygamous women have more than or equal to five children, respectively. (Table 2)
Table 2
Reproductive Character of monogamous and polygamous women in worebabo woreda in 2021.
Variable | Category | Monogamous women (N = 352) | Polygamous women(N = 351) | X2 | P-value |
No | No |
History of pregnancy | No Yes Total | 30 (8.5%) 322 (91.5%) 352 | 76 (21.7%) 275 (78.3%) 351 | 23.6 | 0.000 |
Number of pregnancy | 1–2 3–4 >=5 Total | 197 (61.2%) 46 (14.3%) 79 (24.5%) 322 | 106 (38.5%) 26 (9.5%) 143 (52%) 275 | 43.16 | 0.000 |
Number of delivery | 0 1–2 3–4 >=5 Total | 38 (10.8%) 217 (61.6%) 31 (8.8%) 66 (18.8%) 352 | 80 (22.8%) 103 (29.3%) 74 (21.1%) 94 (26.8%) 351 | 78.07 | 0.034 |
History of still birth | No Yes Total | 305 (86.6%) 47 (13.4%) 352 | 300 (85.5%) 51 (14.5%) 351 | 0.20 | 0.65 |
History of abortion | 0 1 2 Total | 235 (66.8%) 104 (29.5%) 13 (3.7%) 352 | 292 (83.2%) 59 (16.8%) 0 351 | 31.58 | 0.000 | |
Number of live children | 0 1–2 3–4 >=5 Total | 101 (28.7%) 151 (42.9%) 36 (10.2%) 64 (18.2%) 352 | 90 (25.6%) 115 (32.8%) 38 (10.8%) 108 (30.8%) 351 | 16.81 | 0.001 |
women’s desire to next child | Less than two years After two years no desire Total | 114 (32.4%) 124 (35.2%) 114 (32.4%) 352 | 99 (28.2%) 134 (38.2%) 118 (33.6%) 351 | 1.51 | 0.367 |
Respondents husband number of desired children | same number more children Fewer children Don’t know Total | 112 (31.8%) 112 (31.8%) 128 (36.4%) 0 352 | 44 (12.5%) 241 (68.7%) 46 (13.1%) 20 (5.7%) 351 | 106.1 | 0.554 |
Knowledge On Modern Contraception
From the total respondents, 94.8% and 91.5% of monogamous and polygamous women have heard about modern contraceptive, respectively, and for most of the respondents, the source of information was HEWs, which is 29.0% and 31.1%, respectively. With regard to the types of modern contraceptive methods, injectables were the most commonly mentioned by 70.7% and 60.7% of monogamous and polygamous women, respectively. Finally, when we compute the knowledge of the respondents based on knowledge related questions, 55.1% and 48.1% of monogamous and polygamous women have good knowledge of modern contraceptive methods. (Table 3)
The qualitative part of the study also found that due to discussions with HEWs and health education sessions in health posts and health centers, most key informant mothers had awareness about modern contraceptives and the benefits they yield for women and children’s health.
The key informants stated that “I have heard about family planning at healthcare facility, at home and through conversation with friends.”
Table 3
Knowledge on contraceptive methods of monogamous and polygamous women in worebabo woreda in 2021.
Variable | Category | Monogamous women(N = 352) | Polygamous women(N = 351) | X2 | P-value |
No | No |
Respondent ever heard about modern contraceptive methods | No Yes Total | 18 (5.1%) 334 (94.9%) 352 | 30 (8.5%) 321 (91.5%) 351 | 3.25 | 0.075 |
Respondent knows where modem contraceptive is provided | No Yes Total | 18 (5.1%) 334 (94.9%) 352 | 30 (8.5%) 321 (91.5%) 351 | 3.25 | 0.071 |
Knows pills(coc, pop) | No Yes Total | 105 (29.8%) 247 (70.2%) 352 | 221 (63%) 130 (37%) 351 | 77.5 | 0.000 |
Knows injectable | No Yes Total | 103 (29.3%) 249 (70.7%) 352 | 138 (39.3%) 213 (60.7%) 351 | 7.8 | 0.005 |
Knows Implants | No Yes Total | 208 (59.1%) 144 (40.9%) 352 | 196 (55.8%) 155 (44.2%) 351 | 0.76 | 0.383 |
Knows IUCD | No Yes Total | 244 (69.3%) 108 (30.7%) 352 | 243 (69.2%) 108 (30.8%) 351 | 0.001 | 0.98 |
Knows Condom | No Yes Total | 226 (64.2%) 126 (35.8%) 352 | 197 (56.1%) 154 (43.9%) 351 | 4.78 | 0.029 |
Knows surgical method | No Yes Total | 270 (76.7%) 82 (23.35%) 352 | 267 (76.1%) 84 (23.9%) 351 | 0.039 | 0.843 |
Respondent knowledge on modern contraceptive methods | Poor knowledge Good knowledge Total | 158 (44.9%) 194 (55.1%) 352 | 182 (51.9%) 169 (48.1%) 351 | 3.41 | 0.065 |
Utilization Of Modern Contraceptive
With regard to the current utilization of modern contraceptive methods, 45.7% and 43.0% of
Monogamous and polygamous women use modern contraceptive methods. Among the monogamous women who use modern contraceptive methods, 57.7% rely on injectables, 17.4% on implants, 16.8% on pills, and 8.1% on IUCD, while among polygamous women, 43.7% rely on Injectable, 36.4% on Implants, 4.0% on pills, and 15.9% on IUCD.( Fig. 1) Concerning reasons for not using the method 23.5% since they practice sex infrequently, 3.1% because of health-related problems, 16.1% because of fear of side effects, 22.8% because of partner opposition, 11.5% because they need to get pregnant, 11.5% because of fear of rumors 5.7% and 11.3 because of religious opposition are mentioned by monogamous and polygamous women.( Fig. 2)
Most of the participants of the key informant interview mention that they prefer to use injectable due to its simplicity to use the method, can be used for a short period of time, no procedure is needed to discontinue and also easy to hide. (Table 4)
“I prefer using injectable since my husband didn’t allow me to use any methods”
Most of the key informant mentions some sociocultural factors as hindrance of modern contraceptive utilization. Myths and misconceptions about modern methods which include exaggerated or inaccurate reports about side effects, misconceptions about short- or long-term health problems and negative stereotypes about persons who practice family planning is mentioned by participants.
“As I heard from my friends and neighbors using modern contraceptive causes infertility, birth defects, cancer, stomach ache and condoms were associated with promiscuity, decreased libido, un healthy weight gain and loss”
“Using modern contraceptive methods such as implants causes painful arms on women especially when they perform their day today activity, made them to need additional food, cause psychosis and headache.”
“They implement the family planning program in order to limit and decrease our population since modern family planning methods cause infertility and other medical problems such as cancer, diabetes, hypertension, anemia, kidney stone and other disease.”
The other socio-cultural factor that mentioned by participants is fear of tags given by husbands and community members to women who use modern contraceptive methods.
“I am afraid to use modern contraceptive methods because if my husband finds out am using he will think that i am cheating on him or will leave him to another man”
“I heard when some people talked behind women who uses modern contraceptive as she was unfaithful to her husband and sleep with others easily because of this e and my friend afraid utilizing methods.”
The other topic mentioned by participants as a hindering factor to utilize modern contraceptive method is its lack of acceptance by culture and religious leaders.
“One day when my husband and I discuss, I asked him to give me permission to use modern contraceptive method but he said that we should decide after consulting our religious leader who told as using modern contraceptive is not allowed since it is an act of violating the will of God.”
Key informant women in polygamous relation mentions that the nature of their marital relationship affects their utilization of modern contraceptive since they are in competitions with co-wives to win their husband.
“I do not want to use modern contraceptive method because I need to have as many children as I can. Having many children will help me to win my husband beside my children will help me when I get older even if my husband stop supporting me.”
Table 4
Utilization of modern contraceptive methods by monogamous and polygamous women in worebabo woreda in 2021.
Variable | Category | Monogamous women(N = 352) | Polygamous women(N = 351) | X2 | P-value |
No | No |
current use any modern contraceptive | No Yes Total | 191 (54.3%) 161 (45.7%) 352 | 200 (57%) 151 (43%) 351 | 0.526 | 0.468 |
Type of contraceptive method used | Pills(COC, POP) Injectable IUCD Implants Total | 27 (16.8%) 93 (57.8%) 13 (8.1%) 28 (17.4%) 161 | 6 (4%) 66 (43.7%) 24 (15.9%) 55 (36.4%) 151 | 29.71 | 0.000 |
Duration of contraceptive use | < 1 year 1–2 years 3–5 years 6–10 years > 10 years Total | 38 (23.6%) 42 (26.1%) 40 (24.8%) 20 (12.4%) 21 (13.0%) 161 | 18 (11.9%) 65 (43%) 23 (15.2%) 24 (15.9%) 21 (13.9%) 151 | 16.73 | 0.421 |
Reason to use a method | Limiting birth Spacing birth Total | 70 (43.5%) 91 (56.5%) 161 | 68 (45%) 83 (55%) 151 | 0.076 | 0.783 |
Place where a respondent get a method | Private clinic District hospital Health Center health post Total | 37 (23.0%) 15 (9.3%) 67 (41.6%) 42 (26.1%) 161 | 24 (15.9%) 0 84 (55.6%) 43 (28.5%) 151 | 19.3 | 0.046 |
Getting clear information by Health care provider (HCP) | No Yes Total | 175 (49.7%) 177 (50.3%) 352 | 177 (50.4%) 174 (49.6%) 351 | 0.036 | 0.850 |
Respondent intention to continue using method | No Yes Total | 60 (37.3%) 101 (62.7%) 161 | 45 (29.8%) 106 (70.2%) 151 | 1.94 | 0.164 |
Respondent reason to discontinue using method | Husband disapproval and fear religious opposition Need to get pregnant Fear of Rumor Fear of side effect of methods Total | 0 11 (18.3%) 34 (56.7%) 7 (11.7%) 8 (13.3%) 60 | 5 (11.1%) 7 (15.6%) 26 (57.8%) 3 (6.7%) 4 (8.9%) 45 | 7.90 | 0.101 |
Respondent ever start using method and discontinue | No Yes Total | 238 (67.6%) 114 (32.4%) 352 | 226 (64.4%) 125 (35.6%) 351 | 0.815 | 0.367 |
Respondent reason to discontinue method | Husband disapproval religious opposition Need to have many children Fear of Rumor Fear of side effect of methods Total | 11 (9.6%) 7 (6.1%) 11 (9.6%) 34 (29.8) 51 (44.7%) 114 | 16 (12.8%) 16 (12.8%) 13 (10.4%) 40 (32%) 40 (32%) 125 | 5.937 | 0.039 |
Respondent Attitude On Modern Contraceptive Methods
Among all married women interviewed about their attitude towards modern contraception methods 46.9% and 58.1% monogamous and polygamous women perceive that using modern contraceptive methods is important for the wellbeing of children and family. As for either do they haven’t fear of social stigma by the community or not 66.2% and 42.2% of monogamous and polygamous women haven’t fear of social stigma by the community. Among the respondents, 67.6% and 47.0% of monogamous and polygamous women have a family pressure to use of modern contraceptive methods. (Table 5)
Table 5
Perception of modern contraceptive methods among monogamous and polygamous women in worebabo woreda in 2021.
Variable | Category | Monogamous women(N = 352) | Polygamous women(N = 351) | X2 | P-value |
No | No |
Do you think FP is important to the wellbeing children and the family? | No/not sure Yes Total | 187 (53.1%) 165 (46.9%) 352 | 147 (41.9%) 204 (58.1%) 351 | 8.91 | 0.003 |
Do you haven’t fear of social stigma? | No Yes Total | 119 (33.8%) 233 (66.2%) 352 | 203 (57.8%) 148 (42.2%) 351 | 40.87 | 0.000 |
Do you think religious leaders support FP use? | No Yes Total | 158 (44.9%) 194 (55.1%) 352 | 147 (41.9%) 204 (58.1%) 351 | 3.99 | 0.046 |
Who is responsible to make decisions about number of children in a family? | Husband Both Respondent Total | 127 (36.1%) 168 (47.7%) 57 (16.2%) 352 | 132 (37.6%) 105 (29.9%) 114 (32.5%) 351 | 33.63 | 0.011 |
Don’t you accept myths about contraceptives | No Yes Total | 146 (41.5%) 206 (58.5%) 352 | 186 (53%) 165 (47%) 351 | 9.34 | 0.002 |
Do you have family pressure to use of modern contraceptive methods? | No Yes Total | 114 (32.4%) 238 (67.6%) 352 | 186 (53%) 165 (47%) 351 | 36.48 | 0.000 |
Factors associated with modern contraceptive use among married reproductive age women who are in monogamous relationship
Bivariate and multivariate logistic regression models were fitted to determine the presence of an association between the dependent variable and the independent variables at (P < 0.05) level of significance. Those variables that had a P-value ≤ 0.2 with modern contraceptive utilization in the bivariate analysis were hired for multiple logistic regression analysis.
In the final multi-variable logistic regression model, variables such as educational status, number of live children, fertility desire, getting clear information by Health care provider, who decide on the number of children in respondents family, family pressure, and accept myths about contraceptives were significantly associated with the utilization of modern contraceptive methods.
Factors associated with modern contraceptive use among married reproductive age women who are in polygamous relationship
Bivariate and multivariate logistic regression models were fitted to determine the presence of an association between the dependent variable and the independent variables at (P < 0.05) level of significance. Those variables which had a P-value ≤ 0.2 with modern contraceptive utilization in the bivariate analysis were hired for multiple logistic regression analysis.
In final multi-variable logistic regression model variables such as educational status, religion, fertility desire, getting clear information by Health care provider, who decide on the number of children in respondents family, fear of social stigma, and accept myths about contraceptives were significantly associated with utilization of modern contraceptive methods.
Factors associated with modern contraceptive use among married reproductive age women who are in monogamous and polygamous relation
Bivariate and multivariate logistic regression models were fitted to determine the presence of an association between the dependent variable and the independent variables at (P < 0.05) level of significance. Those variables which had a P-value ≤ 0.2 with modern contraceptive utilization in the bivariate analysis were hired for multiple logistic regression analysis.
In final multi-variable logistic regression model variables using such as educational status, religion, fertility desire, getting clear information by Health care provider, who decide on the number of children in respondents family, fear of social stigma, family pressure, and accept myths about contraceptives were significantly associated with utilization of modern contraceptive methods. (Table 6)
Table 6
Factors associated with modern contraceptive use among married reproductive age women who are in monogamous and polygamous relation in 2021.
Variable | Modern contraceptive utilization | COR(95 CI) | AOR(95 CI) |
Non users | Users |
Educational status of respondent No formal education Primary level education Secondary level and above | 221(65.57) 132(49.25) 38(38.77) | 116(34.42) 136(50.74) 60(61.22) | 1 1.963(1.413,2.726) 3.008(1.891,4.786) | 1 2.143(1.428,3.216)*** 1.843(1.044,3.253)* |
Type of respondents religion Muslim Orthodox | 273(60.93) 118(46.27) | 175(39.06) 137(53.72) | 1 1.726(1.256,2.374) | 1 1.704((1.144,2.539)** |
Desire time for another child Less than two year After two year No desire | 149(69.95) 148(50) 94(50) | 64(30.07) 148(50) 94(50) | 1 1.730(1.180,2.538) 3.418(2.307,5.064) | 1 1.672(1.06,2.639)* 3.17(1.939,5.183)*** |
Getting clear information by Health care provider (HCP) No Yes | 249(70.73) 142(40.45) | 103(29.26) 209(59.54) | 1 3.558(2.601,4.867) | 1 4.624(3.132,6.828)*** |
Who decide on number of children Husband Both Respondent | 196(75.67) 124(45.42) 71(41.52) | 63(24.32) 149(54.57) 100(58.47) | 1 3.738(2.581,5.415) 4.382(2.890,6.643) | 1 3.054(1.93,4.832)*** 4.775(2.850,8.003)*** |
Do you haven’t fear of social stigma? No/Not sure Yes | 233(72.36) 158(41.469) | 89(27.63) 223(58.53) | 1 3.695(2.688,5.079) | 1 2.482(1.666,3.699)*** |
Do you have family pressure to use of modern contraceptive methods? No/Not sure Yes | 214(69.70) 177(44.69) | 93(30.29) 219(55.30) | 1 2.847(2.080,3.897) | 1 1.855(1.351,2.75)** |
Don’t you accept myths about contraceptives No Yes | 227(68.37) 164(44.20) | 105(31.62) 207(55.79) | 1 2.729(2.003,3.717) | 1 1.878(1.278,2.761)** |
*P-value < 0.05, **P-value < 0.01, ***P-value < 0.001.Back ward stepwise multiple logistic regression was used to assess the independent effect of explanatory variables. |