Family planning (FP), defined as the ability of individuals and couples to have the number of children when they want, is a proven strategy to reduce maternal and child morbidity and mortality [
Modern FP service was introduced to Ethiopia by the Family Guidance Association of Ethiopia in 1966. The FP service at this time was mainly awareness creation due to social and political constraints. In 1993, the country adopted the population policy, and in 1996, the minister of health released FP guidelines to guide stakeholders on family planning service provision [
Unintended pregnancy is a public health problem in Amhara regional state [
We used secondary community-based cross-sectional regional representative 2016 EDHS data collected through a two-stage stratified cluster sampling technique from January 18, 2016, to June 27, 2016. The survey was implemented by the Central Statistical Agency (CSA) at the request of the Federal Minister of Health (FMOH) [
Initially, each region in the EDHS was stratified into urban and rural areas yielding 21 sampling strata. After strata, there were 84,915 enumeration areas. From these, a total of 645 enumeration areas (202 in urban areas and 443 in rural areas) were independently selected proportionally based on the 2007 Ethiopia Population and Housing Census [
Schematic presentation to select women included in the analysis in Amhara region, Ethiopia 2016 EDHS.
The outcome variable for this analysis was modern contraceptive use, which has two categories (yes or no). The 2016 EDHS questionnaire asked all reproductive-age women involved in the survey whether they were using contraceptives including the type of contraceptive. A woman was considered “using modern contraceptives” if she reported that she was using sterilization (tuba ligation or vasectomy), intrauterine device (IUD), injectable, oral contraceptive (pills), or condom at the time of the survey.
Demographic and socioeconomic variables are included in the analysis as predictor variables. Demographic variables included were as follows: age of women (15–34 or 35–49), family size (≤4, 5–8,or ≥9), age at first marriage (15–18, 19–24, or ≥25), number of living children (0. 1–2, 3–4, or ≥5), number of children ever birth (0, 1–2, 3–4, or ≥5), ideal number of children (≤3 or >3), future fertility preference (want more soon (within two years), want later (two years later), want time not decided, undecided, or want no more), knowledge on modern contraceptive (yes or no), and women’s religion (orthodox, Muslim) are included. Socioeconomic variables included were as follows: residence (urban or rural), women’s and partners’ educational status (no, primary, secondary, or above), women’s and partners’ occupation (not working or working), wealth index (poor, middle, or rich), exposure to FP messages on mass media (yes or no), and visits by health workers and health facility visit (yes or no). The exposure to FP messages on mass media was constructed from other data (if women heard or saw family planning messages from radio, television, magazine, or phone message). The poor wealth index category was created by merging poorer and poorest, and the variable rich was constructed by merging richer and richest.
Weighted data were analyzed with a complex survey sampling analysis technique using STATA software version 14.1. Frequency distribution and descriptive statistics (mean ± standard deviation (SD)) were used to describe the characteristics of the study participants. Chi-square analysis was also used to describe the relationship of independent variables and dependent variables. Bivariable and multivariable logistic regression analyses were done to identify factors associated with modern contraceptive use. Variables are significant with 95%, and
A total of 2207 reproductive-age married women were included in the analysis. The mean age of women was 32.0 years (SD ± 0.3 years). About three-fifth (61.0%) of women were aged 15–34 years. About 15.8% of women were Muslim, with the rest orthodox (84.2%). The majority of women (84.2%) were rural residents. The majority of women (81.6%) were married or in-union before their 19th birthday. About two-thirds (69.1%) of women were not educated. Almost half (52.2%) of women reported that they visited a health facility, and only 31.6% of women were visited by health workers at home 12 months before the survey. Almost one-fourth (24.0%) of women reported that they heard or saw family planning messages through radio, television, magazine, or phone message.
About 89.4% of women were having at least one living child, of which about 28.6% had five or above living children. The mean number of living children was 3.3 children per woman (SD + 0.1children). Thirty-seven percent of women reported that they want no more children and 19.1% want within two years (Table
Sociodemographic and other characteristics of married reproductive-age women in the Amhara region, EDHS 2016.
Variables | Weighted frequency (%) |
---|---|
Educational status | |
No education | 1.526 (69.1) |
Primary | 452 (20.5) |
Secondary+ | 229 (10.4) |
Occupational status | |
Not working | 863 (39.1) |
Working | 1.344 (60.9) |
Wealth index | |
Poor | 780 (35.3) |
Middle | 530 (24.0) |
Rich | 897 (40.7) |
Family size | |
≤4 | 901 (40.8) |
5–8 | 1.198 (54.3) |
≥9 | 108 (4.9) |
Age at first marriage | |
≤18 | 1.801 (81.6) |
19–24 | 335 (15.2) |
≥25 | 71 (3.2) |
Partner education | |
No education | 1.389 (62.9) |
Primary | 508 (23.0) |
Secondary+ | 276 (12.5) |
Do not know | 34 (1.6) |
Partner occupation | |
Have no work | 42 (1.9) |
Have work | 2.157 (97.8) |
Do not know | 8 (0.3) |
Future fertility preference | |
Want more soon | 422 (19.1) |
Want later | 742 (33.6) |
Want but time not decided | 62 (2.8) |
Undecided | 116 (5.3) |
Want no | 816 (37.0) |
Declared infecund | 49 (2.2) |
Number of children ever born | |
0 | 229 (10.4) |
1–2 | 630 (28.5) |
3–4 | 567 (25.7) |
≥5 | 781 (35.4) |
Number of living children | |
233 (10.6) | |
712 (32.2) | |
631 (28.6) | |
631 (28.6) | |
Ideal number of children | |
415 (18.8) | |
1.477 (66.9) | |
315 (14.3) |
Of all married reproductive-age women, half of them (51.3%) were using modern contraceptives and 0.5% were using traditional methods. Of modern contraceptive users, the majority of them (62.4%) were using injectable followed by implant/Norplant (25.8%). About two-thirds (67.5%) of women wanted to use contraceptives to limit or spacing their birth (Table
Contraceptive use among married reproductive-age women in the Amhara region, EDHS 2016.
Variables | Frequency (%) |
---|---|
Contraceptive demand | |
Demand for spacing | 880 (39.9) |
Demand for limiting | 610 (27.6) |
Using contraceptives | |
Using for spicing | 721 (32.7) |
Using for limiting | 421 (19.1) |
Current use by method | |
No | 1, 065 (48.3) |
Traditional | 10 (0.5) |
Modern | 1.32 (51.3) |
Type of modern method used ( | |
Pill | 49 (4.3) |
IUD | 72 (6.4) |
Injectable | 706 (62.4) |
Condom | 0 (0.0) |
Sterilization | 13 (1.1) |
Implant | 292 (25.8) |
Modern contraceptive use varied by women’s age. The level of modern contraceptive use among women aged 15–34 years was 57.4% higher compared to women aged 35–49 years (
Modern contraceptive use by sociodemographic characteristics of married reproductive-age women in the Amhara region, EDHS 2016.
Variables | MC use, | |
---|---|---|
Residence | 0.064 | |
Urban | 214 (61.5) | |
Rural | 918 (49.4) | |
Educational status | <0.001 | |
No education | 701 (45.9) | |
Primary | 257 (56.9) | |
Secondary+ | 174 (76.1) | |
Religion | 0. 403 | |
Orthodox | 941 (50.6) | |
Muslim | 191 (54.9) | |
Occupational status | 0. 540 | |
Not working | 431 (50.0) | |
Working | 701 (52.2) | |
Wealth index | 0.022 | |
Poor | 339 (43.4) | |
Middle | 290 (54.7) | |
Rich | 504 (56.2) | |
Family size | 0.026 | |
≤4 | 501 (55.6) | |
5–8 | 591 (49.4) | |
≥9 | 40 (37.1) | |
Age at first marriage | 0.235 | |
≤18 | 898 (49.9) | |
19–24 | 194 (57.8) | |
≥25 | 41 (57.6) | |
Partner education | 0.106 | |
No education | 647 (46.6) | |
Primary | 289 (56.9) | |
Secondary+ | 181 (65.7) | |
Do not know | 15 (44.0) | |
Partner occupation | 0.106 | |
Have no work | 11 (27.9) | |
Have work | 1118 (51.8) | |
Do not know | 2 (29.4) | |
Future fertility preference | <0.001 | |
Want more soon | 155 (36.8) | |
Want later | 463 (62.4) | |
Want but time not decided | 32 (52.5) | |
Undecided | 67 (58.1) | |
Want no | 411 (50.4) | |
Declared infecund | 2 (4.9) | |
Number of children ever born | <0.001 | |
0 | 138 (60.5) | |
1–2 | 371 (59.0) | |
3–4 | 329 (58.0) | |
≥5 | 294 (37.6) | |
Number of living children | <0.001 | |
0 | 141 (60.8) | |
1–2 | 419 (58.9) | |
3–4 | 341 (54.0) | |
≥5 | 231 (36.6) | |
Ideal number of children | <0.001 | |
≤3 | 236 (56.9) | |
>3 | 785 (53.2) | |
Undecided | 111 (35.1) | |
Visit health facility | 0.259 | |
No | 521 (49.4) | |
Yes | 611 (53.1) |
The most common reasons for nonuse of contraceptives among married reproductive-age women were thinking that contraceptives are fatalistic (17.6%), menses not returned (15.2%), on breastfeeding (9.1%), infrequent sex or have no sex (5.9%), and fear of side effect (3.0%).
On the bivariable analysis, age, age at first marriage, family size, exposure to FP message, educational status, wealth index, the ideal number of children, future fertility preference, visited by health workers, and residence were significantly associated with modern contraceptive use among married or in-union reproductive-age women. On multivariable analysis, age, future fertility preference, educational status, and wealth index were significantly associated. The odds of modern contraceptive use among women aged 35–49 years were 30% less compared to women aged 15–34 years (AOR = 0.7; 95% CI: 0.5–0.9). Women with a secondary or higher level of education had 3 times (AOR = 3.0; 95% CI: 1.4–6.2) higher odds of modern contraceptive use compared to women with no education. The odds of modern contraceptive use among women who belonged to the rich wealth index were 3 times higher compared to women who were in the poor wealth index category (AOR = 3.0; 95% CI: 1.4–6.2) (Table
Factors associated with modern contraceptive use among married or in-union reproductive-age women in the Amhara region, Ethiopia 2016 EDHS.
Variables | COR (95% CI) | AOR (95% CI) |
---|---|---|
Age | ||
≤34 | 1 | 1 |
35–49 | 0.5 (0.4–0.7) | 0.7 (0.5–0.9) |
Residence | ||
Urban | 1 | 1 |
Rural | 0.7 (0.4–1.0) | 1.1 (0.7–1.9) |
Age at the first marriage | ||
≤18 | 1 | |
19–24 | 1.4 (0.9–2.0) | 1.0 (0.6–1.7) |
≥25 | 1.4 (0.6–3.2) | 1.1 (0.5–2.5) |
Education status | ||
No education | 1 | 1 |
Primary | 1.6 (1.1–2.2) | 1.3 (0.9–1.7) |
Secondary+ | 3.7 (2.0–7.1) | 3.0 (1.4–6.2) |
Wealth index | ||
Poor | 1 | 1 |
Middle | 1.5 (1.0–2.4) | 1.6 (1.0–2.5) |
Rich | 1.7 (1.1–2.5) | 1.6 (1.1–2.5) |
Visited by health workers | ||
No | 1 | |
Yes | 1.4 (1.1–1.8) | 1.2 (0.8–1.6) |
Exposed to FP message | ||
No | 1 | |
Yes | 1.4 (1.0–1.9) | 0.8 (0.6–1.7) |
Family size | ||
≤4 | 1 | |
5–8 | 0.8 (0.6–1.0) | 1.0 (0.6–1.3) |
≥9 | 0.5 (0.3–0.9) | 0.6 (0.3–1.3) |
Ideal number of children | ||
1–3 | 1 | 1 |
3–12 | 0.9 (0.6–1.2) | 1.1 (0.8–1.6) |
Undecided | 0.4 (0.3–0.7) | 0.6 (0.4–1.0) |
Future fertility preference | ||
Want more soon | 1 | |
Want 2 years later | 2.7 (2.0–4.1) | 2.6 (1.9–3.7) |
Want but time not decided | 1.9 (0.9–4.1) | 2.3 (1.0–5.4) |
Undecided | 2.4 (1.3–4.4) | 3.2 (1.7–6.0) |
Want no more | 1.7 (1.2–2.5) | 2.4 (1.6–3.5) |
Declare infecund | 0.1 (0.0–0.6) | 0.1 (0.0–0.8) |
4According to this analysis, 51.3% (95% CI: 47.0–55.6) of married or in-union reproductive-age women in Amhara regional were used modern contraceptives. Of which, 63.3% were for spacing and 36.7% for limiting. The majority of them (62.4%) were used injectable followed by implant/Norplant (25.8%).
The overall level of modern contraceptive use was consistent with studies done in Northwest Ethiopia (51.3%) [
The proportion of women’s modern contraceptive use increased with their husbands’ educational level (0.003). This finding was consistent with other studies [
On multivariable analysis, the age of women, future fertility preference, educational status, and household wealth index were significantly associated with modern contraceptive use. Women with secondary or higher levels of education had more odds of using modern contraceptives compared to women with not educated. This finding was in line with other studies done in Ethiopia [
This study revealed that women’s future fertility preference was significantly associated with modern contraceptive use. The odds of modern contraceptive use among women who want no more children and want to space were higher compared to women want soon. This finding was in line with previous studies [
Women from households with the wealth index rich had higher odds of using modern contraceptives compared to those with the poor wealth index. This finding was in line with studies conducted in Ethiopia [
Modern contraceptive use among married or in-union reproductive-age women was relatively high compared to other studies done in the region. Age of women, educational status, future fertility preference, and wealth index were statistically significant factors associated with modern contraceptive use. Strengthening women’s and community education may improve modern contraceptive use. Health care providers should be given special attention for women aged 30 and 40 years when they provide family planning counseling. Also, more emphasis should be given to income generation activities.
The data used for this analysis are available in the repository (
The 2016 EDHS protocol was reviewed and approved by the Federal Democratic Republic of Ethiopia Ministry of Science and Technology and the Institutional Review Board of ICF International.
The authors declare that they have no conflicts of interest.
MBA conceived, designed, and performed the analysis. GWD, GAF, and YMG were equally involved in the analysis, interpretation, and writing of the results. All authors read and approved the final manuscript.
The authors would like to acknowledge the DHS program for allowing to use the data.