Spatial Distribution and Factors Associated with Unmet Need for Family Planning Among Married Women Aged Between 15-49 Years: Spatial and Multilevel Analysis of EDHS 2016

Abstract

Introduction: Worldwide 12% of married women with age range of 15-49 have an unmet need for contraception. In Ethiopia unmet need of family planning was high when compared to a developed country (24.5% vs. 10%). This high unmet need for family planning show gap between women reproductive desire to avoid pregnancy and contraceptive behavior. Objective: The aim of the study was to assess the spatial distribution of unmet need for family planning and associated factor among married women aged between 15- 49 year in Ethiopia. Methods: Cross-sectional study design was applied on sample of Ethiopia demographic and health survey 2016. The sample size was 10,223 married women aged between 15-49 years. Spatial analysis was done using spatial autocorrelation Moran’s I, and spatial scan statics to identify local significant clusters based on Bernoulli model. The data were analyzed using a two level-mixed-effects logistic regression model to determine the individual and community level factors associated with unmet need of family planning. Result: In Ethiopia, prevalence of unmet need for family planning was 22.3% [95% CI: 21.5%, 23.1%] which was 13% for spacing 9.3% for limiting among currently married women. Spatial scan statistics identified primary clusters (LLR= 55.74, P<0.001) and secondary clusters (LLR= 20.26, P<0.001). Both individual and community-level factors were associated with unmet need for family planning. Age, wealth index, place of residence, number of living children, desire more children, decision maker about family planning and region were factor associated with unmet need for family planning. Conclusions and Recommendation: Unmet need for family planning is important to prioritize family planning strategy. This strategy need to know about distribution of unmet need for family planning across region. It is also important to include factor associated with unmet need for family planning in individual and community level factors of the married women. Therefore, the efforts to decrease unmet need for family planning in Ethiopia should focus both on individuals and on communities. Funding Statement: The study was funded by Amhara National Regional State Health Bureau, Ethiopia. Declaration of Interests: The authors declare that they have no competing interest. Ethics Approval Statement: Ethical clearance was obtained from the institutional ethical review board of the Institute of Public Health, College of medicine and health sciences, University of Gondar, Ethiopia.