Study design and setting
This study was conducted in major cities of Ethiopia identified as targets for Kefeta Integrate Youth Activities, namely: Adama, Addis Ababa, Assosa, Bahir Dar, Bishoftu, Dilla, Dire Dewa, Gambella, Harar, Jigjiga, Jimma, Hawassa, and Shashemenie. Youth, youth-serving organizations, and policy actors in these cities and higher education institutions found in the cities were targets for this study. According to data from the World Health Organization trendline, the number of women of reproductive age in Ethiopia amounts to 31,664 individuals (10).
Datasource
This study utilized secondary data from the original formative assessment data set of the USAID-funded Integrative Youth Activities Project. The dataset consisted of 3,215 young people aged 18 to 29 years who were from community and HEI (Higher Education Institution) settings. Data collection took place from December 12, 2021, through January 21, 2022, across 13 cities. A total of 680 young married women data extracted and analyzed.
Study variables
The dependent variable in this study is the use of modern contraceptive methods at the time of data collection. The “Yes” category comprises individuals themselves or their husbands who are currently using a range of modern contraceptive methods, including pills, implants, injectables, intrauterine devices (IUDs), condoms, emergency contraceptives, standard days method (SDM), the lactational amenorrhea method, and female sterilization. The category referred to as “No” encompasses individuals who employ contraceptive methods such as the rhythm method, withdrawal, other traditional methods, and no contraceptive method at all.
This study includes the following independent variables: respondent age (18 to 24 years, 25-29 years), exposure to radio media (yes, no), exposure to TV media (yes, no), knowledge about contraceptives (labeled as ‘yes’ if the respondents know at least two contraceptive methods and no if respondents know only one contraceptive method), family size (labeled as ‘yes’ if the respondents’ family size is less than three and ‘no’ if the respondents’ family size is greater than or equal to three). Additionally, the presence of partner communication norms was assessed using a composite of three variables: (1) a girl can suggest to her boyfriend that he can use a condom, (2) it wouldn’t be too embarrassing for someone like me to buy or obtain condoms, and (3) if a girl suggested using condoms to her partner, it wouldn’t mean that she didn’t trust him.
Data analysis
Descriptive statistics were used to summarize: the contraceptive use among young women in selected urban cities of Ethiopia, the distribution of contraceptive use across cities and individual-level factors, sources for obtaining contraceptives and contraceptive information sources. Data were analyzed using STATA Version 18 software. Data quality assurance and control procedures were applied throughout the data collection fieldwork.
A multilevel binary logistic regression analysis was done to measure the association between contraceptive use and the variation across cities. Cities were considered as random effects to cater for the unexplained variability at the individual-level. The selection of variables for the multilevel models was based on their statistical significance at the bivariate analysis at a p < 0.05. Further, the statistical significance of the associations between each of the factors and current use of contraceptives was determined at a p-value of less than 0.05.
Two models, comprising the null model (model 0) and model 1 were fitted. Model 0 showed the variance in modern contraceptive use attributed to the clustering of the primary sampling units without the explanatory variables. Model 1 is progressive containing the individual factors: age, media exposure through radio, media exposure through TV, knowledge on contraceptives, family size & partner communication norms. Model comparison was done using the log likelihood and Akaike’s Information Criterion (AIC) tests. The lowest AIC (818.3) and highest log likelihood (−401.2) were used to determine the best fit model. For model one, Odds ratio and associated 95% confidence intervals (CIs) were calculated. Using the variance inflation factor (VIF), a test for multicollinearity was done and there was no evidence of high collinearity.
Operational definition
In this study, the term “young women” refers to individuals aged 18 to 29. “Media exposure” refers to those young married women who had listened to radio or watched to television at least once a week. The study categorized modern contraceptive methods as pills, implants, injectables, intrauterine devices (IUDs), condoms, emergency contraceptives, the standard days method (SDM), the lactational amenorrhea method, and female sterilization. On the other hand, the rhythm method and withdrawal method were classified as traditional contraceptive methods (11). Respondents who demonstrated knowledge on at least two types of the contraceptive methods were considered to be knowldgeable.
Ethics declarations
Ethics approval and consent to participate
The study proposal was reviewed and approved by the Institutional Review Board (IRB) of the Ethiopian Public Health Association (EPHA) before any data collection activities commenced. Permission was obtained from the administrations of participating cities. Before interviews were conducted, all interviewees were provided with adequate information about the purpose of the study, contents of interviews, and contact details of the principal investigator (PI) and IRB chairperson. Verbal consent was obtained from each informant before they were interviewed.