Determinants and Cross-Regional Variations of Contraceptive Prevalence Rate in Ethiopia: A Multilevel Modeling Approach

Type Journal Article - American Journal of Mathematics and Statistics
Title Determinants and Cross-Regional Variations of Contraceptive Prevalence Rate in Ethiopia: A Multilevel Modeling Approach
Author(s)
Volume 5
Issue 3
Publication (Day/Month/Year) 2015
Page numbers 95-110
URL http://article.sapub.org/10.5923.j.ajms.20150503.01.html
Abstract
The Ethiopian population grew at an alarming rate hence the increasing growth of population has become an urgent problem in Ethiopia. Contraception use is the main contributor of fertility declining in all levels and groups of people. On the other hand, to reach the MDGs giving attention to the importance and benefits of lowering population growth is mandatory. Family planning workers hence should make an effort to meet the needs of existing contraceptive users, and also to address socio-economic, demographic and other barriers for contraceptive users in the society. Some studies in Ethiopia (very specific to particular areas) have been carried out using standard logistic regression analysis to assess the factors that could influence contraception use. However, these methods did not assume any higher level grouping (region) or clustering effect (households) in the population as a result the estimates obtained from such analysis that ignores population structure will often be biased. Moreover, these studies lacks generalizability to a country level of Ethiopia as being conducted in particular areas. Ethiopia is a home of multi-ethnic and multi-culture people hence current contraception use may vary between women of different clusters, individuals and regions of the country. This research hence used a three-level random effect logistic model to analyze a national survey data by taking hierarchical sources of variability into account that comes from different levels of the data, which is novel in the estimates of determinants of current contraception use. Multiple multilevel modeling found that there was significant variation of current contraceptive use across clusters and to a lesser extent across regions. About 3.11% of the total variation on current contraception use was attributable to region-level factors and 15.05% was attributable to cluster level factors. Moreover, age categories (mostly 20 to 44 years), being wealthier, being educated, urban dwellers, knowledge on family planning, being married and having access to mass medias (radio, television or reading newspapers) showed an increased pattern with respect to current contraception use. The Ethiopian National Family Planning Programme should intensify its information, education and communication programmes on family planning to cover specific population who poorly utilized contraception use and to identify key geographic areas for further investigation. The strengthening of the health programs on advocating the benefits of family planning through mass media, focusing on young women (being they are the most productive people) particularly those with no or little education, targeting on Somali region and nuwer ethnic group while designing services would greatly improve the proportion of contraception use. Moreover, efficient distribution of health care facilities offering family planning services among women of urban and rural residents are required. This multilevel approach hence provides critical evidence on current barriers to contraception use and suggests policies which could improve the proportion of contraception users. The findings of this research therefore might be helpful for health programs to notify national efforts targeting on specific population or sub-groups who mostly under-used the contraception services as well as to identify key geographic areas for further investigation. Similarly, it enhances the ability of individuals to reduce the risk of unwanted pregnancies and acquiring or transmitting of infectious disease such as HIV/AIDS. The findings could also be helpful for policy making, monitoring and evaluating the activities for the government and other concerned agencies.

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