Determinants of modern contraceptive utilization among married women in Ethiopia: A multi-level mixed effect analysis

Abstract

Background: Despite the progress, the prevalence of modern contraceptive use remains low in Ethiopia. There are numerous predictors to use modern contraceptive methods. Attention has been given to individual-level factors on modern contraception while contextual characteristics are equally relevant to increase the utilization. The study implied figuring out barriers related to end-users and the community characteristics that are critical for developing appropriate family planning programs and policies to improve the uptake. Objective: This study aims to identify individual and community-level factors of modern contraceptive use, using a multilevel analytic approach. Method: The study utilized the national data collected by Performance Monitoring and Accountability 2018, Ethiopia. Multilevel mixed-effect regression analysis of 3706 married women of reproductive age group nested within 220 clusters was carried out. Results are presented using odds ratios along with their 95% confidence interval. Result: Respondents who utilize modern contraceptive methods accounted for 42.9% in Ethiopia in 2018. Analysis of the random intercept model evidenced that the between community variance of modern contraception is non-zero. The fixed-effect model showed significantly lower odds of modern contraceptive utilization among older women, women in a polygamous marriage (OR 0.67, 95%CI 0.49-0.92), women living in a community with a higher mean parity (OR 0.67, 95%CI 0.46-0.93), and women living in a community with higher mean household size(OR 0.65, 95%CI 0.46-0.84), while completing secondary level of education (OR 1.65, 95%CI 1.24-2.30), visiting a health facility(OR 1.49, 95%CI 1.25-1.79), and being wealthy(OR 1.76, 95%CI 1.26-3.06) are among the positively predicting variables of modern contraception. The effect of community variations for education implies that there is a considerable difference in modern contraceptive use among communities. Conclusion: This study revealed that both individual and community-level variables were significant determinants of modern contraceptive use in Ethiopia. The study recommends, improving women's education, wealth status, and community fertility `norms as measures that can be implemented to accelerate modern contraceptive adoption in the country.