Prevalence of Family Planning Utilization and Its Determinants among Women of Reproductive Age in Oromia and Gambella Regions, Ethiopia

This community-based cross-sectional study conducted in October 2023 across five districts in Ethiopia's Oromia and Gambella regions reveals a 60.9% family planning utilization rate, identifying limited transport access, low household wealth, low partner education, and unintended pregnancy as significant barriers while noting that farming women are more likely to utilize these services.

The Gist

Imagine a vast, bustling garden in Ethiopia, specifically in the Oromia and Gambella regions. In this garden, the "flowers" are the women of childbearing age, and "Family Planning" is the set of tools and seeds they use to decide when and how many new flowers to grow.

This research paper is like a garden inspection report. The authors walked through this garden, talked to 840 women, and asked: "Are you using the tools to plan your family? If so, what tools are you using? And what makes it easy or hard for you to get them?"

Here is the story of their findings, broken down into simple concepts:

1. The Big Picture: A Garden That's Growing, But Has Weeds

The Good News: The garden is doing better than expected! About 61 out of every 100 women are using some form of family planning. This is actually higher than the national average for the whole country. It's like finding that a specific neighborhood has more green lawns than the rest of the city.

The Catch: Most of these women are using "quick-fix" tools rather than "long-term" ones.

• The Analogy: Imagine you need to stop a leak in your roof. Most women are using band-aids (injectables and pills) that need to be replaced every month or every few months. Very few are using permanent patches (implants or IUDs) that last for years.
• The Result: While they are using something, they have to keep running back to the supply shed (the health center) constantly. If they miss a trip, the "leak" (pregnancy) happens.

2. The Roadblocks: Why Some Can't Reach the Shed

The researchers found that even though the tools are often free, getting to the "supply shed" is like trying to walk to a store in a heavy rainstorm without an umbrella. Three main things block the path:

• The Bumpy Road (Transport): If a woman doesn't have a way to travel (a bus, a car, or even a reliable path), she is half as likely to use family planning. It's like having a ticket to a concert but no way to get to the stadium.
• The Empty Wallet (Wealth): Women from the poorest households are significantly less likely to use these services. Even if the medicine is free, the cost of the journey (bus fare, time off work) is too high. It's like having a free meal voucher, but you can't afford the taxi to the restaurant.
• The Silent Partner (Education): The husband's education level matters a lot. If the husband hasn't gone to school, the wife is much less likely to use family planning. Think of the husband as the co-pilot of the family plane; if the co-pilot doesn't understand the map, the plane is less likely to take off on a planned route.

3. The Surprising Twist: The Farmers

You might think that busy farmers would be too tired to worry about family planning. Surprisingly, the study found that farmers were actually more likely to use it than unemployed women.

• The Analogy: Farming is like running a business. Farmers know that if they have too many workers (children) without enough land (resources), the business suffers. They use family planning as a strategic business plan to manage their family size so they can work the land effectively.

4. The "Oops" Factor

The study also looked at pregnancies that weren't planned. Women who had an "unwanted" pregnancy were less likely to use family planning afterward.

• The Metaphor: It's like someone who accidentally drops a ball and then decides, "Well, I dropped it once, I guess I'll just keep playing without a net." They need a little extra coaching to realize that a net (contraception) is actually helpful next time.

5. The Solution: Fixing the Garden

The authors suggest that to make this garden bloom even better, we need to do three things:

1. Build Better Roads: Improve transport so women can easily reach health centers.
2. Teach the Co-Pilots: Educate husbands so they support their wives' decisions.
3. Offer Long-Term Patches: Instead of just handing out band-aids, teach women about the "permanent patches" (long-acting methods) so they don't have to keep running back to the shed every month.

The Bottom Line

This paper tells us that in these parts of Ethiopia, women want to plan their families, and many are doing it. But the system is still a bit like a maze with broken signs and long, bumpy paths. If we smooth out the roads, fill the empty wallets, and get the husbands on board, the garden could flourish even more, giving every woman the power to choose exactly how her family grows.

Technical Summary

1. Problem Statement

Despite Ethiopia's national progress in family planning (FP), significant regional disparities persist, particularly in underserved rural areas like Oromia and Gambella. While national modern contraceptive prevalence has risen, unmet needs remain high due to resource shortages, weak governance, rural inequities, and infrastructure gaps.

• Specific Context: In Oromia, women often switch from long-acting to short-acting methods due to misconceptions and side effects. In Gambella, prevalence is lower (25.5%) and influenced by complex sociocultural factors.
• Research Gap: There is a need for granular, community-level data to understand the specific socioeconomic, demographic, and access-related determinants driving FP utilization in these specific regions to inform policies for universal coverage.

2. Methodology

• Study Design: A community-based cross-sectional study.
• Setting: Five districts (woredas) across Oromia (Omo Nada, Metu Zuria, Boset, Digalu/Tijo) and Gambella (Gambella Zuria) regions. These are Health Information System (HIS) intervention sites supported by Jimma University.
• Participants: 840 women of reproductive age (15–49 years) selected from 12 health centers serving 24 kebeles (smallest administrative units).
• Sampling:
  • Technique: Multistage sampling. 12 health centers were purposively selected; two kebeles were randomly chosen per facility; 840 women were systematically drawn from household lists.
  • Sample Size Calculation: Based on a 38% national prevalence, 95% confidence level, 5% margin of error, a design effect of 2, and a 10% non-response rate.
• Data Collection:
  • Tool: Structured, interviewer-administered questionnaire adapted from the Demographic and Health Survey (DHS).
  • Platform: SurveyCTO (digital data collection).
  • Languages: Translated into Oromiffa, Amharic, and Anuak.
  • Timing: October 15–25, 2023.
• Statistical Analysis:
  • Software: SPSS Version 25.
  • Methods: Descriptive statistics, bivariable logistic regression (variables with $p < 0.25$ entered into the model), and multivariable logistic regression using a backward stepwise procedure.
  • Outcome Measure: FP utilization (binary: user vs. non-user).
  • Metrics: Adjusted Odds Ratios (AOR) with 95% Confidence Intervals (CI). Significance set at $p < 0.05$.

3. Key Contributions

• Regional Specificity: Provides rare, high-resolution data on FP determinants in the Oromia and Gambella regions, which are often underrepresented in national aggregate data.
• Determinant Analysis: Identifies specific, actionable barriers including transport access, household wealth, partner education, and pregnancy intention, moving beyond general demographic factors.
• Methodological Rigor: Utilizes digital data collection (SurveyCTO) and robust multivariable modeling to control for confounders, offering a more accurate picture of independent predictors of FP use.
• Programmatic Insight: Links findings to Health Information System (HIS) interventions, suggesting a potential correlation between strengthened data systems and improved service monitoring/uptake.

4. Key Results

• Prevalence:
  • Overall Utilization: 60.9% of women were currently using family planning.
  • Method Mix: Heavy reliance on short-acting methods.
    • Injectables: 48.2%
    • Implants: 30.4%
    • Pills, Lactational Amenorrhea, and others: ~7% each.
  • Method Type: 68.8% used short-acting methods vs. 31.2% long-acting methods.
• Sources of Supply:
  • Government Health Centers (51.5%) and Health Posts (32.7%) provided >84% of services.
  • Private clinics and hospitals contributed minimally (<3%).
• Significant Determinants (Multivariable Analysis):
  • Transport Access: Women lacking transport were significantly less likely to use FP (AOR = 0.49, 95% CI: 0.36–0.67).
  • Wealth:
    • Poorest quintile: AOR = 0.48 (95% CI: 0.29–0.77).
    • Poor quintile: AOR = 0.47 (95% CI: 0.29–0.74).
    • (Reference: Richest quintile).
  • Partner Education:
    • No formal education: AOR = 0.46 (95% CI: 0.30–0.70).
    • Primary education only: AOR = 0.64 (95% CI: 0.44–0.92).
    • (Reference: Secondary+ education).
  • Occupation: Farming women were more likely to use FP compared to unemployed women (AOR = 1.64, 95% CI: 1.11–2.42).
  • Pregnancy Intention: Women reporting an unwanted pregnancy were less likely to use FP (AOR = 0.54, 95% CI: 0.32–0.92).

5. Significance and Recommendations

• Policy Implications: The study highlights that while FP utilization in these specific intervention sites exceeds national averages, the reliance on short-acting methods indicates a gap in long-term reproductive planning.
• Targeted Interventions:
  • Logistics: Strengthening transport support or mobile outreach is critical to overcome geographic barriers.
  • Economic: Addressing poverty-related barriers is essential, even when services are nominally free.
  • Male Involvement: Programs must target male education and spousal communication, as partner education is a strong predictor of female FP use.
  • Counseling: Enhanced counseling on long-acting reversible contraceptives (LARCs) is needed to shift the method mix away from injectables.
• Limitations: As a cross-sectional study, causality cannot be inferred. Self-reporting may introduce recall or social desirability bias. The findings are specific to the study regions and may not generalize to urban populations.
• Conclusion: The findings underscore the need for integrated, community-based strategies that address socioeconomic and geographic inequities to achieve equitable FP access in line with Ethiopia's FP2030 commitments.