Study Setting
The 2016 Ethiopia Demographic and Health Survey (2016 EDHS) was implemented by the Central Statistical Agency (CSA) from January 18, 2016, to June 27, 2016.to provide up-to-date estimates of key demographic and health indicators in all regions of Ethiopia. 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.
This study was conducted using a 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 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 prevalence (18). For this study 10% of non-response 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 respondent’s current working status with exclusion criteria.
Epi- Info window version 6.5 statistical programs was used to clean and enter the data into a computer. For further data, exporting and analysis SPSS windows version 23.0 was used. Modern contraceptive use between each predictors and predicted variable was initially performed by bivariate analysis. Each predictors’ odds ratios (OR) at 95 % confidence intervals (CI) and p-values were calculated. Then all statistical significant variables at p <0.05 were entered into multivariate analysis using the logistic regression model. Finally, the results were presented in the form of tables, figures, and summary statistics.
1.6. Operational definition
Family Planning: - method to regulate the number and spacing of children in a family among none married and marred, through the practice of contraceptive or other method of birth control (23).
Modern contraceptive Methods: -Female sterilization, male sterilization, the pill, the intrauterine device (IUD), injectables, implants, condom and diaphragm/ foam/jelly.
Traditional methods - rhythm (Calendar method), withdrawal and folk.
- Results
- Socio-demographic characteristics
Ethiopian Demographic and Health Survey (EDHS 2016) data set was examined to assess modern contraceptive use with respect to their demographic, socio-economic and proximate factors. The total number of women covered in this study is 3260 of reproductive age group from 36–49 years. The mean age of women was 41.7 years (SD ± 3.879) among 36–49 years of users. Of these reproductive age groups women having less than or equal 4 children account 963(29.5%) while 2297(70.5%) were had greater 4 children. Only 1268(39%) women respond as they were currently engaging with work but the rest 61% of women were not engaging at work. Women resides in rural areas covers 2432(74.6%) whereas 828(25.4%) resides in urban centres. Women who listened about Modern contraceptive information via radio accounts 1772(54.4%) not at all, 918(28.2%) less than once a week and 570(17.5%) at least once a week. See table 1
As the graph 1 show; less 554 (17%) women were utilize modern contraceptive methods in their life time as compared to large number of women 2706(83%) that did not experience to take any modern contraceptive methods at their reproductive ages. See Graph 1
As we see from table 2, Wealth index is an important factor to utilize modern contraceptive methods in order to minimize unintended pregnancies. Regarding to Women’s wealth index about 858(26.3%) was observed among the richest women followed by 848(26%), 550(17%), 503(15.5%) & 501(15%) were the poorest, poorer, middle & and richer women respectively. Among the groups there was a variation of modern contraceptive utilization practice which was 53(6.2%) in poorest, 93(16.7%) was in poorer 84 (16.7%) was in middle, 100(20.0%) was in richer, and 224(26.1%) was in the richest women (see table 2).
The graph 2 indicates that Women’s educational level had its own contribution on modern contraceptive use practice. Majority of women 2402(73.7%) were not attending any educational level whereas about 602(18.5%) women were attending primarily level but only 147(4.5%) and 109(3.3%) women reached at their secondary and higher educational levels. Those women who were attending their secondary 55/147(37.4%) and higher educational levels 41/109(37.6%) had used more modern contraceptive methods than those women attended their primary 142/602(23.6%) and those did not attend any educational levels 316/2402(13.1%).
- Factors associated with contraceptive method utilization
Before preceding data analysis, the necessary assumptions for the application of multiple logistic regressionswas checked by Hosmer and Lemeshow Test through forward LR method. 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.
From this multivariable binary logistic regression analysis: women’s level education, Women’s Wealth index, Age, Educational level, and Number of children were significantly associated with use of modern contraceptive methods. The most important factor significantly associated with use of modern contraceptive methods is women’s age, for one-year increase in the age of the woman, the log odds of modern contraceptive use decreases by 0.886 or 12% (AOR; 0.886 & 95% CI (0.863, 0.910). The richest women had 4.120 times more likely to use modern contraceptives than the poorest women did (AOR; 4.120 & CI (2.853, 5.949). Women who were attending higher education 41(37.6%) were 3.329 times more likely to utilize modern contraceptive as compared to women not attending any education (AOR; 3.329 & 95%CI (2.065, 5.368). The number of living children a woman had was significantly associated with use of modern contraceptive methods. Women who have more than four children (16%) were 1.714 times more likely to utilize modern contraceptives than women who have less than equal to four children (AOR; 1.714 & 95% CI (1.328, 2.212). But socio demographic variables like their working behaviour, frequency of radio listening and place of residence did not show any statistically significant difference with modern contraceptive use (see table 2)