The risks of pregnancy are greater at young maternal ages. The association between poor contraceptive use and teenage pregnancy is supported by studies suggesting that contraceptive use can prevent unintended pregnancy and early childbearing and their consequences. (15–17). Ensuring access and choice to family planning to improve maternal and neonatal health is crucial.
This paper examined the trend and correlates of contraceptive use among female adolescents aged 15 to 19 in Ethiopia, using national demographic and health survey. We found that the number of young women using contraception is increasing from time to time over the last decade and knowledge about contraceptive method among adolescents is almost universal in Ethiopia. However, more than three fifth of the sexually active female adolescents are still not using the contraceptive, which could put them in risks for teenage pregnancy, unintended birth, adverse birth outcomes and health outcomes. This figure was slight lower than the report on patterns and trends in adolescents’ contraceptive use in developing countries, 42–68% of married and unmarried sexually active adolescent females in all the Latin American countries (except Guatemala and Haiti) and in Bangladesh, Indonesia, Kazakhstan and Turkey were currently using contraceptives. However, among the African countries, contraceptive prevalence was 20–35% except Namibia in which it reached at least 40%(18).
Similarly, only one third of adolescents use contraceptive from Zimbabwe (35%) and Malawi (33%)(16). Finding from the current study was slightly higher compared to figures from Nepal. In Nepal 23.1 % of married women age 15-19 currently uses any method of contraception, (14.5% modern contraceptive use and 8.6% traditional method(19)
There were significant variations in the use of modern contraception by demographic and socioeconomic characteristics of adolescent girls in Ethiopia. According to this study, there is significant inequality among sexually active adolescent regarding modern contraception use by their education, partner’s occupation, wealth status and had been told information about family planning at health facility. Adolescents who have secondary and higher educational level, who had told about Family planning at health facility, and who are in the highest wealth quintiles use significantly more modern contraception as compared to their peers who have not attended formal education, had not told about Family planning at the health facility, or who belong to the lowest wealth quintiles.
This study revealed that respondent education was an independent predictor for contraceptive use among sexually active female adolescent. This finding was similar with a study from Nigeria and Burkina Faso that stated that, prevalence of contraceptive use among adolescents with a secondary-level education or above was 5.9 and 2.4 times higher in Nigeria and Burkina Faso respectively than those who had completed only primary-level education(4). Similarly, the study conducted in Ghana identified education as a determinant for contraceptive use, the odds of contraceptive use were 7.39 and 11.53 times among female adolescents who had primary and secondary or higher education respectively compared to their counterparts who had no formal education [prevalence and correlates of(20). Educational status was also a significant predictor of contraceptive use in Bangladesh- low contraceptive use among illiterate female adolescents was reported (21). This may be due to the fact that educated women are more likely to appreciate the returns/dividend that contraceptives use has on their lives. Also educated women may have a plan to pursue highest career with in their education as a result they want to delay their childbearing time.
The likelihood of contraceptive use among the female adolescents increased significantly with the increase in their household economic status. As a result, female adolescents in the household with highest wealth index were more likely to use contraceptives than their poor counterparts. This finding was in line with DHS analysis from three African countries: Nigeria, Burkina Faso and Ethiopia, across all three countries, there is a significant equity gap in modern contraception use because of wealth index(4). Similarly, the analysis conducted using the 2016 Ethiopian demographic and health survey to identify factors associated with long acting and permanent contraceptive methods use showed that women in the richer wealth index were more likely use long acting and permanent contraceptive methods compared to those in poor wealth index(22). This may be for the reason that most of the small resources obtained from the petty jobs done by women and their spouses in poor households are diverted to take care of the family and less is shifted to the health of the mothers themselves. As a result, poor household preferred not to use the service as they encountered difficulties to cover direct and indirect costs incurred in seeking the services(23)
This study also identified that the occupation of husbands was determining the use of contraception. Sexually active adolescent women whose husbands’ occupation is sales workers practice less contraception methods than those husbands are not working. The possible reason for this is that, if the husband has no work, the possibility of being at home is there as a result; during home to home visit health extension workers may inform him to support his wife for contraceptive use. This access to information from fieldworkers offers the opportunity to for the husband to influence his wife to use family planning. In another way round due to economic insecurity, husband did not work, women may motivate to use contraceptive to space or limit the birth because there are inadequate resources at home.
Further, those had been told about family planning during health facility visit was a significant predictor for contraceptive use. Contraceptive use among respondents who had told about family planning information was 3.7 times compared to their counterparts who had not told about family planning information at the health facility. The existing body of literature, considered in parallel with our own findings, strongly indicated that, adolescents’ girls’ access to family planning information via different sources increases use of modern contraceptive methods. For instance, study from Nigeria were found that hearing about family planning on mass media was associated with the use of modern contraceptives among these adolescents(24). In addition, Bangladesh it was highlighted that being frequently visited by Family planning worker resulted the more they respond favorably to their use of contraception(20). Access to information play a significant role in the use of contraception as it has the capacity to raise an individual’s awareness, and influence their attitude. In addition, the information could guide people to make an informed decision to use the services. Our study has limitations, the data is from a cross-sectional survey and unable to establish any causal relationship between our outcome of interest (contraceptive use) and the covariates of interest.