Increase modern contraceptive utilization has a major role of improving health by decrease child and maternal health. To increase utilization of modern contraceptive, knowing its geographical variation and associated factor will bring considerable effect in future improvement.
In this study modern contraceptive utilization among young married women in this study was 36.7% [95% CI: 34.8%, 38.7%]. It was similar with study done in Uganda(7),and the possible reason may be similar emphasizing given by the local health programmers. It was higher than study done in Malawi (36). But it was low when compared to study done in Bangladesh(37), Ghana (5). The possible explanation for this variation might be due to the involvement of health extension workers in awareness creation activity, difference in provision of health service including in school through different club related to reproductive health programmers, availability of youth friendly health service or difference of study population (38–40).
The spatial distribution of modern contraceptive among young married women across Ethiopia region showed significant variation and clustering at zonal level. The Global Moran’s I values 0.42 (p value < 0.001) indicated spatial heterogeneity modern contraceptive among young married that need to identify gaps and to prioritize intervention (21). Gettis-OrdGi* statistics indicate highest prevalence zone for modern contraceptive utilization were detected in Addis Ababa, West and East Gojam. One the other hand zone 1 of Afar region, Borena zone of Oromia region and all zone of Somalia regions were lowest prevalence area zone (Figure). It was consistence with study done in Kenya and India which indicate modern contraceptive utilization across districts were significant variation and clustering (41, 42).
Spatial scan statistics identified primary cluster(LLR = 113.3, P < 0.001) encompass all zone of Amhara region, East Shewa, South and West Shewa, South Shewa, East and H.G. Wellega and North Shewa zone of Oromia region, Metekel and kinashi zone of Benishangual has 2.28 times more likely to use modern contraceptive utilization than married women outside these zone(RR = 2.28). Additionally secondary cluster (LLR = 19.1, P < 0.001) encompass in Sheka, Sidamo, keff and northern Benchi Maji zone has 2.15 times more likely to use modern contraceptive utilization than married women outside these zone. Geographical variation and clustering of modern contraceptive utilization reported by similar study done Rwanda and Ethiopia(43, 44). These s studies explain geography, cultural factors, demographic characteristics of respondents, health service delivery capacity and community awareness about FP is possible explanation for regional variations of modern contraceptive utilization (41–44)
The multilevel analysis shows that there is a big variation in use of modern contraceptive at both at the individual and community level variable. In this study religion wealth index, religious, health facility visits within 12 months, husband desire more children, perception of distance from health facility, region, community health services utilization and community educational level were statically significant variables for modern contraceptive utilization (Table 7).
Religious of respondent were significantly associated with modern contraceptive utilization. Muslim followers were less likely to use modern contraceptive .This finding had agreement with study done in Malawi(36), Ethiopia(44) and Bangladesh and (45). This might be due religion is critical sociocultural dimensions that had significant impacts on attitudes towards and the uptake of contraceptive methods. Religious prohibitions hinder the acceptability of contraceptives even in area with adequate FP services despite who perceive FP to be of benefit to their well-being are more likely to use contraceptive methods(46). This condition ultimately has an impact on the successful implementation of FP programs.
High household wealth was positivly associated with modern contraceptive utilization those young women in poorest household were less likely to use modern contraceptive when compared to richest household. It is comparable to study conducted in Tanzania and Nigeria(47, 48). The possible explanation could be related to the implicit costs needed to access health care services, mass media and education, as well wealthier background ought to have better decision making power on contraceptive use (44) .
Health facility visits associated factor with women’s use of modern contraceptive utilization. Young married women who visit health facility in last 12 month were more likely to use modern contraceptive. Study revealed in Malawi(36), India and Zambia (49, 50). The possible explanation may be related to getting information about family planning and easily accessing contraceptive service (49, 51) .Favorable quality of care and opening hours of the family planning facilities was also found to be strongly associated with modern family planning use(52).
Husband desire more children where associated with modern contraceptive utilization those young women whose husband want more children were less likely to use modern contraceptive. This has agreement with study done in Egypt (44) and Ghana (53). The reason may be those decide desire number of children is tendency to access family planning services (54).Women’s internal motivations to achieve their child spacing goal could be the possible reason for higher level of contraceptive use.
Perception of distance from health facility positively affected modern contraceptive utilization. Those young married women who have big problem to access health services were less likely to use modern contraceptive. Studies done in Uganda(7), Egypt(44) revealed that those women lived distance to family planning facilities influenced use of contraceptive methods. Since the group is young they faced difficulty to access family planning by traveling long distance. The challenge may be finical, norm and decision making in about family planning is may be addition possible reason for traveling far distance to access family planning.
This study also revealed geographical region where a woman lived was found to be an important predictor of modern contraceptive utilization. This supported by study done in Malawi(36), Bangladesh(37) and Uganda(7). This might be due to the fact that attributable to the tendency of some region to have higher fertility compared to others .Additional reason may be family planning services ,cultural and religious reason (55).
Community access to health services found to have a positive significant association with modern contraceptive utilization. Those young married women who have no big problem to access health services in community were more likely to use modern contraceptive. It is in line with study done in Sub Saharan country, Zimbabwe and Boston (17, 56, 57). Evidence show that family planning among young women in static health facility is not enough but geographical access has attracted huge attention as a possible major constraint on uptake of services(21). It might be due to provision of community-based programmers have had high success in raising contraceptive use in many settings including social marketing and conventional health facilities ,and have been central to achievements in some countries(23).
Community educational level found to have a positive significant association with modern contraceptive utilization. Young married women who lived in high educated community were more likely to use modern contraceptive. Likewise, this is support by study done in low and middle-income countries and Zimbabwe (17, 18). The possible explanation might be increasing education might help the discussion on contraceptive and would increase knowledge and utilization of FP methods. Education improves cognitive skills, awareness about health, financial resources and decision-making power. It provides improved access to the mass media, knowledge and attitude about family planning, access to contraception, correct use of contraception, and finally promotes contraceptive use(58).
LIMITATION OF STUDY
Including GPS can contribute to show more information about modern contraceptive utilization but all cluster has no GPS which few cluster is excluded from this study. This would limit to show modern contraceptive utilization in some area of country. This study not include modern contraceptive utilization among unmarried woman those who are sexually active which need further research to encompass all issue of modern contraceptive utilization. Moreover, this research has limitation to dig out why women not use family planning that needs qualitative study in cold spot area of modern contraceptive utilization.