Characteristics of the study respondents
A total of 4,117 married men and women (aged 15–65) participated. Geographically, participants were representative of Amhara (1,634; 39.7%), Oromia (2,383; 57.9%), and Somali (100; 2.4%). Table 1 depicts their characteristics by region. The mean age of the respondents was 32.2 ±8.8 years and approximately half were male (1,968; 47.8%). The identified religion of respondents were Muslim (1,942; 47.2%) and Orthodox (1,836; 44.6%). Most respondents were unemployed (2,952; 71.7%).
(Table 1 Here)
Quantitative analysis: Binary logistic regression
Respondents in Oromia were 8.673 times more likely to use modern family planning methods compared to those from the Somali region (AOR=8.673, 95% CI: [5.160–14.581], p<.001). Moreover, those in Amhara were 5.183 times more likely to use modern family planning methods compared to those from the Somali region (AOR=5.183, 95% CI: [3.147–8.538], p<.001) (Table 2).
Based on gender, women were 1.764 times more likely to use modern family planning methods than men (AOR=1.764, 95% CI: [1.502–2.072], p<.001).
Respondents, whose occupation was housework, were 0.746 times less likely to use modern family planning methods than the no-work group (AOR=.746, 95% CI: [.566–.983, p<.05], or conversely those who were unemployed were 1.34 times more likely to use modern family planning methods compared to houseworkers. Daily workers were 1.531 times more likely to use modern family planning methods than respondents who were unemployed (AOR=1.531, 95% CI: [.999–2.346], p<.001).
Married respondents were 2.277 times more likely to use modern family planning methods than respondents who lived with a partner but were not married (AOR=2.277, 95% CI: [1.593–3.255, p<.001]. Household monthly income was not a significant factor in modern family planning methods.
Respondents who discussed family planning with their spouse were 2.426 times more likely to use modern family planning methods than those who did not. Family planning discussions with HEWs (2.430 times) or a health professional (1.806 times) were significant factors in modern family planning methods.
Respondents who received family planning messages through the media were 1.210 times more likely to use modern family planning methods than those who did not (AOR=1.210, 95% CI: [1.043–1.404], p<.05).
(Table 2 Here)
A total of 24 key informants participated in the study. Religious leaders, community leaders, HEWs, FP service providers, and heads of health centers assisted with the qualitative interviews of this study.
Some of the points that emerged from the qualitative interview respondents belonging to different religions are listed below. The results showed that family planning practices could be divided into three focal points: knowledge, interruption, and religion.
Some informants reported that they were aware of the importance of family planning for the health of both the mother and the newborn child. However, they said that opposition from their husband, spouse, or family stopped them from putting family planning strategies into practice.
“Child-spacing benefits both the mother’s and child’s health, but often husbands don’t like their wives when they have few children, and as a result they often marry a second wife to get many children. But I believe that child-spacing is good; for example, children who are born spaced are physically stronger than those who are born in succession”[Somali, female, non-user]
On the other hand, many respondents did not use family planning because of incomplete or incorrect knowledge. Some respondents reported that family planning practices would cause a physical disease (such as skin disease, back pain, etc.), illness, or decreased sexual feeling.
“… I am male, but I hear people saying once a woman uses this family planning, she will never give birth again as her reproductive organ will be closed. In cases where she lacks adequate food, the pills cause damage to her belly, skin discoloration (“madiat”) on her face, etc. These are some of the doubts or fears in our community.” [Oromia, male, non-user]
“… The drug results in weight gain and has a sensation of burning. It also makes the women aggressive and results in quarrels between husband and wife. It decreases love by reducing the sexual feelings of females; they also complain about pain during intercourse. I know many people who divorced because of this problem…”[Amhara, male, Orthodox religious leader]
Interval in childbearing
Some respondents stopped using family planning services because they faced problems like pain, disease, headaches, etc. The following quote is from an interview with a 30-year-old woman who used family planning for 7 years after the birth of her second child:
“…After the second child, she again used an injectable for some time but stopped using it because she thought that it caused aggression, headaches, an internal burning sensation, and her menses did not flow…” [Amhara, female, orthodox]
There were no answers from the Oromia and Somali regions on this topic.
Most respondents who did not practice family planning for religious reasons were Muslims. This is because the Muslim community considers family planning practices such as condoms, implants, UIDs, etc., as taboo under Sharia law. Therefore, Muslims have a low rate of practicing family planning. The following interviews were conducted with Muslims in the Amhara, Oromo, and Somali regions:
“She aspires to have at least 10 children because she believes that having more children is more prestigious in the community and she will be respected more by her husband and his relatives. On the other hand, she believes that modern family planning methods are forbidden by Sharia and she has a plan to space her children using the calendar method and breast feeding, which are acceptable in Islam.”[Somali, female, Muslim]
“….God said multiply and replenish the earth…children are gifts from God…when every child is born, he/she comes with his/her own fate/luck…” [Amhara, female, Orthodox]
“I believe that the only one who makes every decision of the household including family size and family planning use [is the man] since he is entitled under Sharia law.” [Oromia, male, Muslim]