Contextual influences on the choice of long-acting reversible and permanent contraception in Ethiopia: A multilevel analysis

Abstract

BackgroundLong acting reversible and permanent contraception (LARPs) offer promising opportunities for addressing the high and growing unmet need for modern contraception and helps to reduce unintended pregnancies and abortion rates in sub-Saharan Africa (SSA). This study examines the contextual factors that influence the use of long acting reversible and permanent contraception among married and fecund women in Ethiopia.MethodWe use data from the 2016 Ethiopian Demographic and Health Survey to examine the contextual factors that influence choice of long acting reversible and permanent contraception among married, non-pregnant and fecund women. The DHS collects detailed information on individual and household characteristics, contraception, and related reproductive behaviors from women of reproductive age. In addition, we created cluster level variables by aggregating individual level data to the cluster level. Analysis was done using a two-level multilevel logistic regression with data from 6994 married (weighted = 7352) women residing in 642 clusters (communities).ResultsIn 2016, 12% of married, non-pregnant and ‘fecund’ women were using long-acting reversible and permanent methods of contraception in Ethiopia. A higher proportion of women with secondary and above education (17.6%), urban residents (19.7%), in the richest wealth quintile (18.3%) and in paid employment (18.3%) were using LARP methods compared to their counterparts. Regression analysis showed that community level variables such as women’s empowerment, access to family planning information and services, region of residence and knowledge of methods were significantly associated with use of LARP methods. Age, wealth status, employment status and women’s fertility preferences were among the individual and household level variables associated with choice of LARP methods. With regards to age, the odds of using LARP methods was significantly lower among adolescents (OR, 0.53; 95% CI, 0.32–0.85) and women over the age of 40 (OR, 0.63; 95% CI, 0.44–0.90) compared to women in their 20’s.ConclusionThe findings of this study indicate that the demand for long-acting reversible and permanent contraception is influenced not only by women’s individual and household characteristics but also by the community’s level of women’s empowerment, socio-economic development, as well as access and exposure to family planning information and services. Thus, improving knowledge of long-acting reversible and permanent methods, improving women’s decision making autonomy and upgrading the capacity and skills of health workers particularly the midlevel providers and community health extension workers on the provision of LARP methods and rights-based approach is important to improve the uptake of LARP methods.

Quality of Family Planning Counseling in Ethiopia: Trends and determinants of information received by female modern contraceptive users, evidence from national survey data, (2014- 2018)

“…Our finding of injectables (short-acting method) as the predominant method of use (65% in 2018) is in line with findings in many Sub-Saharan countries including Ethiopia, where in 2016 injectables accounted for 64% of the method use [35]. Nevertheless, long-acting method users (IUDs, implant, sterilization) were identified as significantly more likely to receive good counseling.…”

“…In Ethiopia, the public sector plays a major role in the provision of family planning services and study on the technical quality of family planning counseling reported higher quality in public facilities when compared to the private sector [35,20]. Our results indicated that women whose contraception source was the public sector had higher odds of receiving good counseling.…”

Competency of Level-4 Health Extension Workers to provide Long Acting Reversible Contraceptives: A task shifting initiative in Ethiopia

“…Maternal Mortality Rate in 2016 was 412 /100,000 live births and under 5 child mortality was 67/1000 live births [2]. From 2000 to 2016, lower fertility rates and increased family planning utilization was documented in Ethiopia [2][3][4]. The total fertility rate was reduced from 5.5 in 2000 to 4.6 in 2016 with significant regional variability.…”

“…Ethiopia is the second most populous and tenth biggest country in Africa [1]. According to the 2016 Ethiopian Demographic and Health Survey (EDHS), the estimated total population is 102 million, with 80.2% living in rural parts [2]. Maternal Mortality Rate in 2016 was 412 /100,000 live births and under 5 child mortality was 67/1000 live births [2].…”

“…According to the 2016 Ethiopian Demographic and Health Survey (EDHS), the estimated total population is 102 million, with 80.2% living in rural parts [2]. Maternal Mortality Rate in 2016 was 412 /100,000 live births and under 5 child mortality was 67/1000 live births [2]. From 2000 to 2016, lower fertility rates and increased family planning utilization was documented in Ethiopia [2][3][4].…”