Individual and community-level determinants of non-use of contraceptive among women with no fertility desire in Ethiopia: a multilevel mixed-effect analysis

Contraception is one of the cost-effective safe motherhood initiatives implemented to improve maternal and child health through the promotion of optimal birth spacing [1, 2]. Existing evidence showed that the growing use of contraceptive methods is associated with reduction in fertility rates, unintended and high-risk pregnancies, and maternal and infant mortality [3,4,5,6]. Studies also revealed that contraceptive use is attributable to a decline in the number of unsafe abortions [3,4,5].

Despite their benefit in improving maternal and child health, a great proportion of women do not use contraceptives with a considerable variation within and across different geographical areas. Globally, less than half (43%) of married reproductive-age women who wanted to avoid pregnancy did not use any method of contraception in 2019, indicating a slow decline from 45% in 2000 [2, 6, 7]. In Sub-Saharan African countries, where the unmet need for family planning is high, nearly three-fourth (72%) of women of reproductive age do not use any contraceptive method, which ranges from 48% in Namibia to 96% in South Sudan [2, 6].

Studies in various regions of the globe show a disparity in the proportion of non-users of contraceptives among women. For instance, 87% of women in Burkina Faso, 2017 [8], 70% in Gambia, 2020 [9], 66% in Tanzania, 2020 [10], and 63% in Ghana, 2020 [11] do not use contraceptive methods. In Ethiopia, according to the 2016 demographic and health survey (DHS) report, 64% women do not use any method of contraception [12]. Furthermore, community-based cross-sectional studies in different parts of the country reported that non-utilization of contraceptives varied from 17 to 81% [13,14,15,16,17,18,19,20].

Evidences have shown that factors like women’s age [13, 18, 20,21,22,23], women education [13, 22,23,24], women occupation [18, 21, 22], husband education [15, 18, 21], place of residence [13, 16, 18, 25], number of children [13, 18, 22, 23], couple discussion on contraception [19, 21, 26], contraceptive knowledge [15, 20], distance to health facility [8, 27], wealth index [8, 13, 18, 22, 24], religion [13, 23, 24] and media exposure [13, 18] were found to predict whether a woman use or not use contraceptive methods.

In Ethiopia, different strategies were implemented to increase the uptake of contraceptive methods in the last decade. Implementation of the health extension programs to change attitude and improve awareness of the community about contraception was among the efforts taken to increase utilization of contraceptives [28, 29]. An increase in health workforce and expansion of health centers and health posts and upgrading of primary health care units to improve access to health care service were also the measures taken to partly remove health system barriers to contraceptive use [28]. Despite the efforts made at a national level, the proportion of women using contraceptive methods is low [12].

In Ethiopia, although different studies have been conducted to determine the predictors of non-use of contraceptives among women, some of them were limited to the specific geographical areas and used relatively a small sample size [14, 17, 20, 25, 26, 30,31,32]. In addition, these studies did not consider some community-level factors like region, residence, cluster, women illiteracy status, women’s non-exposure to mass media status. Moreover, evidence on non-use of contraceptives and its determinants among women with no fertility desire at a national level is scarce. In this regard, consideration of these community-level variables and using relatively large sample size could help to make inferences at a national level. Therefore, the current study was aimed to assess non-utilization of contraceptives and its determinants at individual and community levels among women with no fertility desire in Ethiopia using multilevel logistic regression analysis.

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