Characteristics of the study population
Table 1 below illustrates Percentage distribution of selected characteristics of respondents in 2005, 2011 and 2016 Ethiopian Demographic and Health Surveys. It is apparent that women age group 25-34 years were the dominant percentage of women across the three successive surveys. Across the three successive surveys, there was a clear trend of decline in percentage of unmet need for spacing (from 25.5% to 14.34%) by 9.16 point percentage and unmet need for limiting (from 16.05% to 9.22%) by 6.83% point values.
Regarding educational status of the study participants, women with no education decreased by 17.2% in 11 years. However, the number of women with primary school and those with high school and above increased by 12.7 percent and 4.6 percent, respectively. Percentage of orthodox Christian declined from by 1.4 % and 2.4% from 2005 to 2011 and 2011 to 2016 respectively. Over all the total drop of Christian orthodox was 3.8 point percentage. But, percentage of Protestants and Muslim follower increased by 2.7% and 2.2% from 2005 to 2016 surveys.
With respect to wealth status of household scanty change was occurred in Ethiopia between the period of 2005 and 2016. Poorest, poorer, middle and richer shows little decrement ranging from 0.2% to 1.2% point values. But, household with the richest category shows some increment by 2.5%. In addition, the proportion of male household head fell by 5.2 percent, while the percentage of female household head rose by 4.8% percent from 2005 to 2016.
Table 1. Percentage distribution of socio-demographic characteristics among respondents, 2005, 2011 and 2016 EDHS
Characteristics
|
2005 EDHS N =7,761
|
2011 EDHS N = 9,136
|
2016 EDHS N =9,333
|
2011 - 2005
|
2016 - 2011
|
2016 - 2005
|
Unmet need of family planning
|
Unmet need for spacing
|
23.5%
|
18.81%
|
14.34%
|
-4.69%
|
-4.47%
|
-9.16%
|
Unmet need for limiting
|
16.05%
|
10.18%
|
9.22%
|
-5.87%
|
-0.96%
|
-6.83%
|
Total unmet need
|
39.55%
|
29%
|
23.6%
|
-10.6%
|
-5.4%
|
-16%
|
Age of respondents
|
15-24
|
28.9%
|
28.2%
|
26.0%
|
-0.7%
|
-2.2%
|
-2.9%
|
25-34
|
43.9%
|
45.2%
|
46.6%
|
1.3%
|
1.4%
|
2.7%
|
35+
|
27.2%
|
26.6%
|
27.4%
|
-0.6%
|
0.8%
|
0.2%
|
Region
|
Tigray
|
6.5%
|
6.5%
|
6.8%
|
0.0%
|
0.3%
|
0.3%
|
Afar
|
1.1%
|
1.0%
|
0.9%
|
-0.1%
|
-0.1%
|
-0.2%
|
Amhara
|
25.2%
|
26.3%
|
24.7%
|
1.1%
|
-1.6%
|
-0.5%
|
Oromia
|
36.9%
|
38.2%
|
38.3%
|
1.3%
|
0.1%
|
1.4%
|
Somali
|
3.8%
|
2.2%
|
2.9%
|
-1.6%
|
0.7%
|
-0.9%
|
Benishangul-gumuz
|
1.0%
|
1.2%
|
1.1%
|
0.2%
|
-0.1%
|
0.1%
|
SNNP
|
22.0%
|
19.7%
|
20.5%
|
-2.3%
|
0.8%
|
-1.5%
|
Gambela
|
0.3%
|
0.5%
|
0.3%
|
0.2%
|
-0.2%
|
0.0%
|
Harari
|
0.3%
|
0.3%
|
0.2%
|
0.0%
|
-0.1%
|
-0.1%
|
Addis Ababa
|
2.7%
|
3.9%
|
3.9%
|
1.2%
|
0.0%
|
1.2%
|
Dire-Dawa
|
0.4%
|
0.4%
|
0.5%
|
0.0%
|
0.1%
|
0.1%
|
Partner’s educational status
|
No Education
|
56.7%
|
46.4%
|
44.4%
|
-10.3%
|
-2.0%
|
-12.3%
|
Primary
|
29.5%
|
41.0%
|
38.1%
|
11.5%
|
-2.9%
|
8.6%
|
Secondary& above
|
13.2%
|
11.8%
|
16.9%
|
-1.4%
|
5.1%
|
3.7%
|
Orthodox
|
45.9%
|
44.5%
|
42.1%
|
-1.4%
|
-2.4%
|
-3.8%
|
Religion
|
Catholic
|
1.2%
|
1.0%
|
0.7%
|
-0.2%
|
-0.3%
|
-0.4%
|
Protestant
|
18.9%
|
22.3%
|
21.6%
|
3.4%
|
-0.7%
|
2.7%
|
Muslim
|
31.7%
|
30.4%
|
33.9%
|
-1.3%
|
3.5%
|
2.2%
|
Traditional
|
1.4%
|
0.9%
|
1.0%
|
-0.5%
|
0.2%
|
-0.4%
|
Other
|
1.0%
|
0.9%
|
0.7%
|
-0.1%
|
-0.2%
|
-0.3%
|
Respondent’s educational status
|
No Education
|
75.8%
|
61.8%
|
58.6%
|
-14.0%
|
-3.2%
|
-17.2%
|
Primary
|
17.0%
|
30.4%
|
29.7%
|
13.4%
|
-0.7%
|
12.7%
|
Secondary& above
|
7.2%
|
7.8%
|
11.8%
|
0.6%
|
4.0%
|
4.6%
|
Wealth status
|
Poorest
|
19.3%
|
20.0%
|
19.1%
|
0.7%
|
-0.9%
|
-0.2%
|
Poorer
|
20.6%
|
20.1%
|
20.2%
|
-0.5%
|
0.1%
|
-0.4%
|
Middle
|
21.3%
|
19.6%
|
20.1%
|
-1.7%
|
0.5%
|
-1.2%
|
Richer
|
19.7%
|
18.7%
|
19.1%
|
-1.0%
|
0.4%
|
-0.6%
|
Richest
|
19.1%
|
21.6%
|
21.6%
|
2.5%
|
0.0%
|
2.5%
|
Place of residency
|
Urban
|
11.1%
|
19.1%
|
17.0%
|
8.0%
|
-2.1%
|
5.9%
|
Rural
|
89.0%
|
80.9%
|
83.0%
|
-8.1%
|
2.1%
|
-6.0%
|
Sex of household head
|
Male
|
90.7%
|
86.3%
|
85.5%
|
-4.4%
|
-0.8%
|
-5.2%
|
Female
|
9.7%
|
12.7%
|
14.5%
|
3.0%
|
1.8%
|
4.8%
|
Birth order
|
1st
|
14.76%
|
16.04%
|
16.67%
|
1.3%
|
0.6%
|
1.9%
|
2nd
|
14.79%
|
17.15%
|
15.50%
|
2.4%
|
-1.7%
|
0.7%
|
3rd
|
14.11%
|
14.21%
|
15.06%
|
0.1%
|
0.8%
|
1.0%
|
4th
|
13.15%
|
12.82%
|
12.91%
|
-0.3%
|
0.1%
|
-0.2%
|
5th & above
|
43.19%
|
39.78%
|
39.87%
|
-3.4%
|
0.1%
|
-3.3%
|
Age at first marriage
|
<18 years
|
69.8%
|
64.4%
|
62%
|
-5.4%
|
-2.4%
|
-7.8%
|
>= 18 years
|
30.2%
|
35.6%
|
38%
|
5.4%
|
2.4%
|
7.8%
|
Working status
|
Not working
|
68.8%
|
43.7%
|
49.25%
|
-25.1%
|
5.6%
|
-19.6%
|
working
|
31.2%
|
56.3%
|
50.75%
|
25.1%
|
-5.6%
|
19.6%
|
Trend of unmet need
Over the last three successive demographic health surveys, unmet need of family planning decline from 39.6% in 2005 to 23.6% in 2016 almost by 16 percent. Highest rate of decline was observed from 2005 (39.6%) to 2011 (29%) i.e. about 10.6 percent of change. 5.4% point of fall was also noticed from 2011(29%) to 2016(23.6%) (Fig 1). Over all a significant change (non over lapping confidence interval) was detected across the three period of study i.e. 2005 to 2011, 2011 to 2016 and 2005 to 2016 EDHS.
Regionally, Oromia showed largest amount of point decline in proportion of unmet need of family planning i.e. 5.6% decrement. Next to Oromia region, SNNP (by 5%), followed by Amhara region (4.7%). Lowest decrease in unmet need was noticed from region; Somali, Benishangul-Gumuz, Harari and Gambella region. But, Addis Ababa and Dire Dawa city administration shows slight increment in unmet need for family planning from 2005 to 2016. Even though, between 2005 and 2016 the amount of unmet need diminished by 16 percent, but there have been steady decrease of unmet need in urban areas i.e. 0.1% only. Regarding religion relatively considerable decrease in unmet need for family planning was shown among orthodox, protestant and Muslim followers from 2005 to 2016 by 9%, 4% and 2.2% respectively. (Table 2)
Table 2: Trends of unmet need for family planning among reproductive age from 2005, 2011 and 2016 EDHS.
Characteristics
|
2005 EDHS N =7,761
|
2011 EDHS N = 9,136
|
2016 EDHS N =9,333
|
2011 - 2005
|
2016 - 2011
|
2016 - 2005
|
Age of respondents
|
15-24
|
10.5%
|
7.2%
|
4.8%
|
-3.3%
|
-2.4%
|
-5.7%
|
25-34
|
16.8%
|
12.3%
|
10.3%
|
-4.5%
|
-2.0%
|
-6.5%
|
35+
|
12.3%
|
9.5%
|
8.4%
|
-2.9%
|
-1.1%
|
-3.9%
|
Region
|
Tigray
|
1.77%
|
1.57%
|
1.21%
|
-0.20%
|
-0.36%
|
-0.56%
|
Afar
|
0.19%
|
0.18%
|
0.17%
|
-0.01%
|
-0.01%
|
-0.02%
|
Amhara
|
8.96%
|
6.81%
|
4.25%
|
-2.15%
|
-2.56%
|
-4.71%
|
Oromia
|
17.63%
|
13.14%
|
12.06%
|
-4.49%
|
-1.08%
|
-5.57%
|
Somali
|
0.55%
|
0.61%
|
0.37%
|
0.06%
|
-0.24%
|
-0.18%
|
Benishangul-Gumuz
|
0.36%
|
0.34%
|
0.24%
|
-0.02%
|
-0.10%
|
-0.12%
|
SNNP
|
9.60%
|
5.61%
|
4.60%
|
-3.99%
|
-1.01%
|
-5.00%
|
Gambella
|
0.10%
|
0.09%
|
0.07%
|
-0.01%
|
-0.02%
|
-0.03%
|
Harari
|
0.06%
|
0.08%
|
0.05%
|
0.01%
|
-0.02%
|
-0.01%
|
Addis Ababa
|
0.32%
|
0.47%
|
0.43%
|
0.15%
|
-0.04%
|
0.11%
|
Dire-Dawa
|
0.07%
|
0.10%
|
0.11%
|
0.02%
|
0.02%
|
0.04%
|
Partner’s educational status
|
No Education
|
22.9%
|
14.8%
|
12.1%
|
-8.14%
|
-2.64%
|
10.8%
|
Primary
|
13.0%
|
12.4%
|
9.1%
|
-0.64%
|
-3.25%
|
-3.9%
|
Secondary& above
|
3.9%
|
2.0%
|
2.8%
|
-1.9%
|
0.8%
|
-1.2%
|
Religion
|
Orthodox
|
16.8%
|
11.1%
|
7.7%
|
-5.7%
|
-3.4%
|
-9.0%
|
Catholic
|
0.6%
|
0.4%
|
0.3%
|
-0.3%
|
-0.1%
|
-0.4%
|
Protestant
|
8.3%
|
6.5%
|
4.3%
|
-1.8%
|
-2.1%
|
-3.9%
|
Muslim
|
12.8%
|
10.6%
|
10.6%
|
-2.3%
|
0.1%
|
-2.2%
|
Traditional
|
0.6%
|
0.3%
|
0.4%
|
-0.3%
|
0.1%
|
-0.2%
|
Respondent’s educational status
|
No Education
|
31.6%
|
19.5%
|
15.4%
|
-12.1%
|
-4.1%
|
-16.2%
|
Primary
|
6.7%
|
8.7%
|
6.6%
|
2.0%
|
-2.0%
|
0.0%
|
Secondary& above
|
1.3%
|
0.9%
|
1.5%
|
-0.4%
|
0.7%
|
0.3%
|
Wealth status
|
Poorest
|
7.5%
|
7.0%
|
5.3%
|
-0.5%
|
-1.7%
|
-2.2%
|
Poorer
|
9.2%
|
6.2%
|
5.7%
|
-3.0%
|
-0.5%
|
-3.5%
|
Middle
|
9.1%
|
6.5%
|
5.0%
|
-2.6%
|
-1.5%
|
-4.1%
|
Richer
|
8.5%
|
5.8%
|
4.3%
|
-2.7%
|
-1.5%
|
-4.2%
|
Richest
|
5.2%
|
3.6%
|
3.2%
|
-1.7%
|
-0.4%
|
-2.0%
|
Place of residency
|
Urban
|
2.1%
|
3.2%
|
2.1%
|
1.0%
|
-1.1%
|
-0.1%
|
Rural
|
37.4%
|
25.9%
|
21.5%
|
-11.5%
|
-4.4%
|
-16.0%
|
Sex of household head
|
Male
|
36.0%
|
25.2%
|
20.0%
|
-10.8%
|
-5.1%
|
-16.0%
|
Female
|
3.6%
|
3.8%
|
3.5%
|
0.3%
|
-0.3%
|
0.0%
|
Birth order
|
1st
|
4.8%
|
3.3%
|
2.4%
|
-1.5%
|
-0.9%
|
-2.4%
|
2nd
|
4.5%
|
3.8%
|
2.6%
|
-0.7%
|
-1.2%
|
-2.0%
|
3rd
|
5.7%
|
3.5%
|
2.9%
|
-2.2%
|
-0.6%
|
-2.8%
|
4th
|
5.0%
|
3.5%
|
2.9%
|
-1.4%
|
-0.7%
|
-2.1%
|
5th & above
|
20.4%
|
15.6%
|
13.8%
|
-4.8%
|
-1.7%
|
-6.6%
|
Age at first marriage
|
<18 years
|
11.8%
|
8.9%
|
7.9%
|
-2.9%
|
-1.0%
|
-3.9%
|
>= 18 years
|
28.1%
|
20.2%
|
15.7%
|
-7.8%
|
-4.5%
|
-12.3%
|
Working status
|
Not working
|
12.0%
|
15.8%
|
11.3%
|
3.8%
|
-4.5%
|
-0.7%
|
working
|
27.6%
|
13.2%
|
12.3%
|
-14.4%
|
-0.9%
|
-15.3%
|
Additionally, there was decrease in magnitude of unmet need for family planning in women’s who had no education from 2005 to 2016 at 16.2% point percentage decrement. On the other hand, slight rise i.e.0.3% was observed among women who accomplished high school during the period of 2005 to 2016. Women with primary school showed almost constant trend of unmet need for family planning over the periods of 11 years.
As birth order (parity) increases the proportion of unmet need for family planning also increases. In 2005 EDHS huge difference in unmet need was noticed between women having 1st birth order and having 5 and above birth, which was 4.8% to 20.4% respectively. Similar pattern of difference was also occurred in 2016 EDHS i.e. 2.4% in first birth order and 13.8% in women having five and above birth history. Also, there has been similar drop in the prevalence of unmet need over the last 11 years in every categories of wealth quintile group.
Decomposition analysis
Table 3: summary of overall Decomposition Results of unmet need for family planning in Ethiopia 2005 to 2016 EDHS.
High outcome group: year==1 --- Low outcome group: year==0
Unmet need for family planning
|
Coefficient
|
p-value
|
95% CI
|
percent
|
E
|
-.014762
|
0.000
|
(-.0219 ,-.0076)
|
8.93
|
C
|
-.15047
|
0.000
|
(-.1747 ,-.126)
|
91.066
|
R
|
-.16523
|
0.000
|
(-.1877, -.1427)
|
|
E = difference as a result of Endowment; C = difference as a result of coefficients; R = Residual
|
Table4: Decomposition of change in underweight among under five children in Ethiopia, 2005 to 2016.
Characteristics
|
Difference as a result of Characteristics (E)
|
Difference as a result of coefficient (C)
|
|
Coefficient
|
Percent
|
Coefficient
|
percent
|
Age of respondents
|
15-24
|
0
|
|
0
|
|
25-34
|
-.0010019
|
.60637
|
.016105
|
-9.747
|
35+
|
-.00057132
|
.34577
|
.01105
|
-6.6876
|
Respondent’s educational status
|
None
|
0
|
|
0
|
|
Primary
|
.004574
|
-2.7682
|
.0097783
|
-5.9179
|
Secondary
|
.00013899
|
-.084116
|
.0090975*
|
-5.5059
|
Higher
|
.0018623
|
-1.1271
|
.0018788
|
-1.1371
|
Wealth status
|
Poor
|
0
|
|
0
|
|
Middle
|
.0003296
|
-.19948
|
-.0063293
|
3.8306
|
Rich
|
-.00068838*
|
0.41661
|
-.018811
|
11.384
|
Age at marriage
|
>=18 years
|
0
|
|
0
|
|
<18 years
|
.001422
|
-.86062
|
.0013496
|
-.81681
|
Place of residency
|
Urban
|
0
|
|
0
|
|
Rural
|
-0.00010*
|
2.4612
|
-.039155
|
23.697
|
Birth order
|
1st
|
0
|
|
0
|
|
2nd
|
.000085443
|
-.051711
|
.0064771
|
-3.92
|
3rd
|
.00070729
|
-.42806
|
-.00056055
|
.33925
|
4th
|
-.00074*
|
.45165
|
.01124
|
-6.8025
|
5th & above
|
-.0084***
|
5.101
|
.045756**
|
-27.692
|
Desired no. of children
|
5+
|
0
|
|
0
|
|
<5
|
-.00023756
|
.14378
|
-.032901**
|
19.912
|
Perceived distance from health facility
|
big problem
|
|
|
0
|
|
Not big problem
|
-.010593***
|
6.4108
|
-.01289
|
7.8013
|
Constant
|
---
|
------
|
-.1492
|
90.295
|
*: p-value <0.05 ,**: p-value<0.01 & ***: p-value <0.001
|
Difference due to characteristics (Endowment)
Generally, there have been decrement in unmet need for family planning among reproductive age group women in Ethiopia from 2005 to 2016. The multivariate decomposition analysis result showed that about 9 % of change in unmet need for family planning among reproductive age group women was due to the difference in composition (endowment) the two surveys. Among the various important compositional factors, such as wealth index, birth order (parity), place of residence and perceived distance from health facility had a significant effect on unmet need for family planning among reproductive age group women.
A decrease in the composition of women with rich wealth index between 2005 and 2016 significantly contributed to the rise of unmet need for family planning by 0.41 %. Similarly, 2.5 percent increment in unmet need for family planning was due to decrease in the composition of women who reside in rural areas. Additionally, a decreased composition of women having birth order of four and birth order of five and above had significant impact in increasing unmet need for family planning among reproductive aged women by 0.45% and 5.15% respectively over the study period (2005–2016). And also, the decrement in composition of women who reported distance from health facility is not big problem showed significant contribution to positive change in unmet need for family planning i.e. rise of unmet need rate by 6.4 percent from 2005 to 2016.
Difference due to effects of the coefficient
Holding the effect of change in compositional characteristics constant, about nine in ten changes in unmet need for family planning was attributable to the difference in coefficients. This means, change in unmet need for family planning among reproductive-age women was due to difference in coefficient (effects of characteristics) across the two surveys.Factors that associated with the change of unmet need for family planning over the last 11 years were educational status, birth order, and desired number of children. Among these, high birth order made the largest contribution to the decrement of unmet need for family planning in the last 11 years, accounted more than one fourth changes [Coefficient=0.04756, P< 0.01]. However, being a woman with less than five ideal number of desired children was the largest positive (increase) contributor through rising unmet need for family planning nearly by one fifth point percent (20%). Women who had secondary education showed a significant negative contribution to the observed percentage decrease in unmet need for family planning over the study period which contributed about 5.5 % with [Coefficient=0.0092, P< 0.05].