Spatial Analysis of Modern Contraceptive use among women who need it in Ethiopia: Using geo-referenced data from Performance Monitoring for Action

Abstract Background: One of the main challenges to achieving maternal and neonatal health-related goals in developing countries is high fertility, resulting, in part, from lower family planning coverage. In Ethiopia, the coverage of modern contraceptive use among all women under reproductive age is below 40%. To inform program efforts to effectively meet contraceptive needs, it is essential to identify factors associated with the uptake of contraception and design geographically targeted intervention mechanisms guided by up-to-date prevalence maps that show the geographic distribution of contraceptive use across different administrative areas in the country. Objective: Our objectives were to explore the spatial distribution of modern contraceptive use and identify determinant factors that affect the uptake of modern contraception among women who need it. Method: We used data from the Performance Monitoring for Action Ethiopia (PMA Ethiopia) survey of women of reproductive age and the service delivery point (SDP) survey conducted in 2019. A total of 4,390 women who need contraception was considered as the analytical sample. To account for the study design, sampling weights were considered to compute the coverage of modern contraceptive use disaggregated by socio-demographic factors. Bayesian geostatistical modeling was employed to identify potential factors associated with the uptake of modern contraception and produce spatial prediction to unsampled locations. Result: The overall weighted prevalence of modern contraception among women who need it was 44.2% (with 95% CI: 42.4% - 45.9%). Across regions of Ethiopia, contraceptive use coverage varies from 0% in Somali region to 52.3% in Addis Ababa. The average nearest distance from a woman's home to the nearest SDP was high in the Afar and Somali regions. The spatial mapping shows that contraceptive coverage was lower in the eastern part of the country. At zonal administrative level, relatively high (above 55%) proportion of modern contraception use coverage were observed in Adama Liyu Zone, Ilu Ababor, Misrak Shewa, and Kefa zone and the coverage were null in majority of Afar and Somali region zones. Among modern contraceptive users, use of the injectable dominated the method-mix. The modeling result reveals that, living closer to a SDP, having discussions about family planning with the partner, following a Christian religion, no pregnancy intention, being ever pregnant and being young increases the likelihood of using modern contraceptive methods. Conclusion: Areas with low contraceptive coverage and lower access to contraception because of distance should be prioritized by the government and other supporting agencies. Women who discussed family planning with their partner was more likely to use modern contraceptives unlike those without such discussion. Thus, to improve the coverage of contraceptive use, it is very important to encourage/advocate women to have discussions with their partner.