Trend, geographical distribution, and determinants of modern contraceptive use among married reproductive-age women, based on the 2000, 2005, 2011, and 2016 Ethiopian demographic and health survey | BMC Women’s Health


Family planning (FP) is the ability of individuals or couples to anticipate and attain their desired number of children, spacing, and timing of their births [1]. Most common family planning methods are modern contraception, which includes female sterilization, male sterilization, the contraceptive pill, intrauterine contraceptive devices, injectable, implants, condoms, diaphragms, contraceptive foam, and contraceptive jelly, lactation amenorrhea methods (LAM), standard days methods (SDM), country-specific modern methods, and respondent-mentioned other modern contraceptive methods (including cervical caps, contraceptive sponges, and others), but does not include abortions and menstrual regulation [2].

Modern contraceptives are a cost-effective way to reduce maternal and neonatal morbidity and mortality, and they create opportunities for women to make informed choices about their reproductive and sexual health, thus enabling them to pursue educational advances and careers [3, 4]. Modern family planning service in Ethiopia started to implement by Family Guidance Association (FGAE), which established in 1966 [5] but showed few signs of expansion for a long period of time. After 1980, the Ministry of Health expanded its family planning services with support programs by UNFPA and other stakeholders. Due to the adoption of the population policy numerous local and international partners in family planning have worked with the government in addressing FP programs and services [6].

In 1996, the Ministry of Health released Guidelines for Family Planning Services in Ethiopia to support health providers and managers as well as expand and ensure quality family planning services in the country [5]. The Government of Ethiopia and NGOs have expanded community-based distribution, social marketing, and work-based services in addition to the preexisting facility-based and outreach family planning services since 2002. Moreover, in the last decade, to increase family planning utilization, integration and linkage between family planning services and HIV/AIDS care, along with maternal and other reproductive health services, have been emphasized in guidelines and strategic documents [5].

Globally, the trends of modern contraceptive utilization have increased slightly, from 54% to 1990 to 57.4% in 2015. While in Africa, the trends of modern contraceptive utilization have increased a little from 23.6% to 2008 to 28.5% in 2015, they continue to be low in sub-Saharan Africa [7].

According to the Ethiopian mini-demographic health survey, the 2019 report indicates that the contraceptive prevalence rate was 41%, but the 2015/16 Ethiopian HSTP planned to achieve a contraceptive prevalence rate of 55% in 2019/20. It shows some increment in the contraceptive prevalence rate, but the increment was not sufficient to achieve the country plan [8].

Globally, nearly 350,000 women die each year, while another 50 million suffer illness and disability from complications of pregnancy and childbirth [9]. Contraceptives help to prevent an estimated 2.7 million infant deaths and the loss of 60 million lives in a year [10]. Family planning in countries with high birth rates has the potential to reduce poverty and hunger and halt 32% of all maternal deaths; nearly 10% of childhood deaths, 90% of abortion-related morbidity and mortality, and 20% of pregnancy-related morbidity and mortality also make a huge contribution to the achievement of universal primary schooling and female empowerment [11, 12]. However, the need for 225 million women to prevent or delay pregnancy is unmet due to significant barriers to obtaining and using modern contraceptive methods [13,14,15].

Assuring access to all people for their preferred contraceptive methods helps advance several human rights, including the right to life, liberty, freedom of opinion and expression, the right to work and education, and the right to health. For women, especially adolescent girls, the use of contraception prevents pregnancy-related health risks. When births are separated by less than two years, the infant mortality rate is 45% higher than when they are separated by 2–3 years and 60% higher than when they are separated by four or more years apart [16].

The risk of morbidity and mortality associated with pregnancy and childbirth is much higher when pregnancy is unintended, while most pregnancies among young girls in sub-Saharan Africa are unintended or untimed [8].

Along with India, Nigeria, Pakistan, Afghanistan, and the Democratic Republic of the Congo, Ethiopia has contributed about 50% of the maternal deaths [9]. The Ethiopia Demographic Health Surveys of 2000, 2005, 2011, and 2016 gave figures of 871, 673, 676, and 412 and maternal mortality ratios per 100,000 live births, respectively [8]. Different literature shows contraceptive prevalence is still low in Ethiopia but is slowly ascending among women age 15–49, who are at risk of morbidity and mortality related to pregnancy and childbirth.

Factors associated with contraceptive utilization in developing countries, studies showed that the age of the respondent, education status of the respondent, religion, marital status, knowledge about modern contraceptives and side effects, method acceptance by self and partners, geographical location, distance to health service facilities, media exposure, residence, and wealth quintiles [17,18,19,20,21,22] justified domestic violence [23] displayed according to the literature review [7, 14, 15, 17, 19, 23] displayed the conceptual framework in Fig. 1. Region (low prevalence clusters were seen in Afar, Somalia, and some parts of Gambela Regional State of Ethiopia.) [24], family size concordance, the desire for more children, and the number of living children [22, 25], were factors in the utilization of contraceptives. Similarly, studies in Ethiopia show that age, residence, maternal educational status, couple discussion, perceived partner approval, discussion with health extension workers, perceived cultural acceptance, the desire for more children, monthly income, and numbers of living children were determined by modern contraceptive utilization [15, 24, 26, 27].

Identifying factors associated with changes in contraceptive use among women is vital to improving contraceptive use. The reigning trend in contraceptive use could be due to current changes in demographic composition, including expansion of urbanization, education of girls, and other development activities, or it could be due to changes in contraceptive utilization behavior. Hence, determining the major factors contributing to such a drastic change helps to plan strategies for family planning programs. Therefore, this study is conducted to determine the levels, trends, geographical distribution, and determinants of modern contraceptive use and change among reproductive-aged women in Ethiopia.

Fig. 1
figure 1

Conceptual framework of modern contraceptive use among married reproductive age women



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