Unmet Need for Family Planning and Associated Factors Among Married Women in Asebot Town,
West Hararge Zone, Oromia Regional State,
Ethiopia, Cross- Sectional Study Design, 2018
Ismael Kalayu*, Misganaw Muche, Muhammedawel Kaso and Amde Eshete
Department of Public health, University of Arsi, Ethiopia
Submission: June 11, 2019; Published: July 24, 2019
*Corresponding author: Ismael Kalayu, Department of Public health, University of Arsi, college of health sciences, Assela, Ethiopia
How to cite this article: Ismael Kalayu, Misganaw Muche, Muhammedawel Kaso, Amde Eshete. Unmet Need for Family Planning and Associated Factors Among Married Women in Asebot Town,
West Hararge Zone, Oromia Regional State,
Ethiopia, Cross- Sectional Study Design, 2018. Glob J Reprod Med. 2019; 6(5): 555699. DOI:10.19080/GJORM.2019.06.555699.
Background: Unmet need for family planning was one of the several frequently used indicators for monitoring and evaluation of family planning programs. It also helps to identify women at greatest risk of unintended pregnancy for satisfying the unmet need for modern contraception. So, this study aimed to assess the prevalence and associated factors of unmet need for modern contraceptive among women of reproductive age in Asebot town, west Harargie zone, Oromia Regional state, Ethiopia.
Methods: A community based cross-sectional study design was conducted in Asebot town. Systematic random sampling techniques were used to select 410 reproductive age women. Data collection was carried out from July 19 to August 05, 2018 using a pre- tested structured questionnaire. The collected data were entered to Epi-info version 7 and exported to SPSS version 21 for analysis. Candidate variables with p-value of <0.25 in bivariate analysis were entered into multivariable logistic regression and AOR at 95% CI with p-value of <0.05 was considered as significant.
Result: The magnitude of unmet need for modern family planning in the study area was 37.3%. [95% CI (32.7, 42.2)]. After multivariate analysis Age, monthly income, desire to have children within two years and partner approval of family planning use were statistically significantly associated factors of unmet need for family planning with their 95% CI as follows (2.00-39.83), (1.10-6.10), (4.79-15.67), (3.88-14.61) respectively.
Conclusions: Since the magnitude of unmet need for family planning in this study was very high, and a community problem, so that Oromia regional health bureau and West Hararghe zonal health bureau should increase their efforts in order to reduce this high rate of unmet need for family planning by due emphasis on those factors contributing for unmet need for family planning.
Keywords: Unmet need, Family planning, West Hararge, Ethiopia, Asebot town
Abbrevations: AOR: Adjusted Odds Ratio; CBRH: Community Based Reproductive Health; CSA: Central Statistical Agency; CPR: Contraceptive Prevalence Rate; EDHS: Ethiopian Demographic And Health Survey; EMONC: Emergency Obstetrics And Newborn Care; EPI Info: Epidemiological Information; FP: Family Planning; FGD: Focus Group Discussion; HC: Health Center; HHS: Households; IUD: Intra Uterine Device; KAP: Knowledge Attitude And Practice; MDG: Millennium Development Goal; OR: Odds Ratio; SPSS: Statistical Package For Social Science; SSA: Sub Saharan Africa; Tl: Tubal Ligation; WHO: World Health Organization.
Unmet need for family planning refers to fecund women who either wish to postpone the next birth (spacers) or wish to stop childbearing (limiters) but are not using a contraceptive method [1,2]. Worldwide; over 222 million women have unmet need for contraception  and around 137 million women in the developing world who would like to avoid childbearing are unable to do so; despite a huge increase in contraceptive access and use
globally . Many women in low and middle-income countries
would like to limit or delay getting pregnant; but do not have
access to consistent use of modern contraceptive methods [5,6].
Unintended pregnancy related to unmet need is a worldwide problem that affects women and their families and societies at large . And it is a serious public health issue both in developed and developing countries . The high level of unmet need in family planning is potential for high unwanted pregnancies .
Rates of unmet need for family planning remain highest among
developing countries where one in every four women in their
reproductive age remain exposed to unintended pregnancies or
are unable to postpone childbirth . Increasing contraceptive
demand; access; and uptake are key interventions to improve
maternal health outcomes and ultimately reduce maternal deaths
. In Ethiopia; fertility rates and unmet need for family planning
have traditionally been very high .
Achievement of desired number and healthy timing of births
have important benefits for women; families; and societies .
Unmet need for family planning is a valuable concept that is widely
used for advocacy; development of family planning policies;
implementation and monitoring of family planning programs
worldwide . Therefore; conducting research regarding unmet
need for family planning is mandatory to carry an intervention to
prevent the consequence of unplanned pregnancies due to unmet
need for family planning.
The study was conducted in Oromia region; Asebot town. It
was located at about 291 km East of Addis Ababa with the total
population of 27,300 as projected of 2017 CSA report of which
females were 13,377. Among the total population 6,033 were in
the reproductive age group expected to use contraceptive method.
It has one local administrative kebele and six ketena. The health
facilities available in the town were one hospital; one health center;
one health post; which were public and has 5 clinics of different
levels owned by private. A community based cross-sectional study
design was used from July 19 to August 05;2018.
Was determined using the formula for single population
proportion; using the following assumptions; the prevalence of
unmate need 41.5 % taken from study conducted on Arbaminch
; confidence level 95%;standard Z-score 1.96;marginal error
0.05 and adding 10 % non-response rate the final sample size was
Households were selected by systematic random sampling
technique with K value of 8 (N: 3330 and n: 410 (N/n:3330/410:8
i.e. every 8 house). The first house was selected by lottery
method. For households which do not fulfill inclusion criteria the
next household was selected. And if no women available in the
selected household; we repeatedly saw her at least three times.
The calculated 410 sample was proportionally allocated to the
ketenes based on the total number of households with women of
Data was collected using pre-tested; structured questionnaire;
which developed by reviewing WHO; EDHS tools and other
literatures in order to address the objective of the study. Six data
collectors (BSc nurses) and two supervisors (BSc in Health officer);
Afan Oromo speakers was selected from the woreda (other than
the selected town for the survey). The investigator was provided
to all enumerators and supervisor for two days on objective and
methodology of the research; data collection and interviewing
approach and data recording.
The questionnaire was pre-tested in 10% of the questionnaire
respondents having similar characteristics from the study area
which was not included in this study. Based on the pre-test result;
adjustments were made to the questionnaire. Then households
with reproductive age women were selected by using simple
random sampling technique. Finally; reproductive age women in
the selected household were interviewed. From households who
do have more than two reproductive age women lottery method
was used to select one study participant.
The questionnaire was prepared originally in English and
translated to Afan Oromo and back to English by language experts
to keep the consistency of the question. Training was given for
data collectors and supervisors. The investigator together with
supervisor checked and reviewed questionnaires on daily bases
to ensure completeness and consistency of information collected.
Quantitative data was entered; cleaned and edited using EPI INF
7 statistical software and then exported to SPSS version 21 for
analysis. The descriptive statistics of the collected data was done
for most variables in the study using statistical measurements.
Frequency; tables; graphs; percentages; means and standard
deviations was used.
Frequency distribution was done for categorical data. Binary
logistic regression analysis was conducted primarily to check
which variables have association with the dependent variables
individually. Variables having P value ≤ 0.25 in the bi-variable
binary logistic regression analysis was entered into multivariable
binary logistic regression analysis for controlling the possible
confounders and finally the variables which have significant
association was identified with 95% CI and <0.05 p-values.
A total of 410 reproductive age women from Asebot town
were included in a study with a response rate of 100%. 54.6% of
them were between 28 -38 years with mean age of 31.98 (±6.07
SD). 70.7% were Muslim while 75.1% of them were Oromo; and
63.9% of them were housewife. About one third (35.1 %) of the
respondents and 22.9% of their husbands were illiterate;40.7% of
the participants’ monthly income were between 1501.00 - 3000.00
birr and almost all has access to media (Table 1). 3.2 Reproductive
health characteristics of the study population.
99 % of the respondents were ever been pregnant of which
98.8 % were ever giving birth and 2.2% were currently pregnant.
One hundred thirty-seven (32.4 %); One hundred forty (34.1%)
and One hundred thirty-two (32.2 %) women had 1-2;3-4 and
≥5 total living children respectively. Majority of respondents
335(81.7 %) of women wish to have more than 5 children in their
life and majority 314(76.6%) states family planning service was
free of charge (Table 2).
About two-third 62.7% of the respondents were using
contraceptive methods at time of survey. Among current
users;60.7% and 2 % were using family planning for spacing and
limiting respectively. The most commonly used methods were;
Implant 78.3 %; followed by Injectable 74.6 % (Table 3).
The reasons of not using family planning were being
pregnancy 9(2.2%); fear of side effects 10(2.4 %); due to breast
feeding 17(4.1 %); desire of child 78(19 %) and other reasons like
religious prohibition 39(9.5%) (Table 4).
Concerning the knowledge level of the respondents; majority
99.51% of the respondents know oral contraceptive pills;98.78% know injectable;96.59% know implants; and 92.44% know Intra
uterine contraceptive device (IUCD) but almost the whole respondents
do not know permanent family planning method such as
Tubal Ligation (TL) and Vasectomy. Three hundred five (74.4%)
reported; they know that the sources of modern FP were health
facility of these;92.9%;and 15.1% of the respondents mentioned
government facilities and private clinics respectively as the source
of modern FP. Respondents got information about family planning
from Radio 90% followed by TV 9.3%.
Bivariate analysis was done to see the association between the
dependent and independent variables. Later; controlling possible
confounders; multivariate analysis has shown that monthly
income; desire to have children in 2 years; partner approval to use
family planning and age had statistically significantly associated
with unmet need for family planning.
Among the respondents; age between 28 to 38 years were 9
times more likely to have unmet need as compared to respondents
whose age category was 17 to 27;[AOR: 8.92;95% CI: 2.00;39.83]
and respondents with 39-49 years of age were 5 times more likely
to have unmet need compared to 17 to 27 years of age;[AOR:
5.23;95% CI: 1.09;25.12]. Concerning to respondent’s income;
respondents who have family income of less than 1500 birr were
2.6 times more likely to have unmet need for family planning as
compared to respondents whose income was more than 3000
birrs; [AOR: 2.59;95% CI: 1.10;6.10]. Respondents who have no
desire to have children within two years were 8.7 times more
likely to have unmet need compared with respondents who have
desire to have children within two years; [AOR: 8.66;95% CI:
4.79;15.67]. Respondents who have no approval of using family
planning services by their partner were 7.5 times more likely to
have unmet need for family planning as compared to respondents
who have partner approval; [AOR: 7.53;95% CI: 3.88;14.61] (Table
Family planning has been one of the most broadly discoursed
concepts in recent years around the world. While real progress
has been made in improving access to family planning globally; the
unmet needs of family planning that is; the number of individuals
who would like to use family planning methods but do not have
access to a full range of modern contraceptives and information
continues to grow. Thus; the aim of the current study was to
determine the magnitude of unmet need of family planning and
its associated factors.
The magnitude of unmet need for family planning among
reproductive age women from the current study was 37.3%. This
finding was higher than from Ethiopian Demographic and Health
survey (EDHS 2016); and form studies conducted in different
areas such as Oromia; Awi zone; Shire; Butajira; Nigeria [16-21].
These differences might be because this research was conducted
in small town compared to the above. And the other possible
reason for the observed variation in the prevalence could be due
to the definition of unmet need; research design and it may also be
because of recall bias as all reproductive age women were asked
about their FP related experiences in this research.
However; the findings of this research were lower than similar
studies conducted in Dessie; Jimma and Nepal [22-24] respectively.
This variation might be due to the difference in study population;
expansion of health facilities; improved access of health services
and awareness of people on modern contraceptives; and
availability of method choice and time. After multivariate logistic
regression age; monthly income; partner approval of family
planning use and desire to have children within two years were
independent predictors of unmet need for FP.
Thus; from this study; respondents who were in the age group
of 28-38 years had 5.5 times more likely to have unmet need as
compared to women in the age group of 17-27 years. Similar
finding was observed in other studies conducted in Shire; Lesotho
and Kenya [19,25,26]. This may be because as the age of the
mother increases; she might have more children and might want
to limit or postpone her pregnancy. Therefore; this finding was
supported from the descriptive explanation of the current finding
as it is showed about 91.5% of the respondents was above the age
of 28 years and 75% of them have three or more children. Another
possible explanation could be as a woman’s gets older; the
probability of having more children will be higher and this in turn
could have a negative impact on their financial access for family
planning. This finding was contradicted with other findings/
studies done in Ethiopia and India in which prevalence of unmet
need was significantly higher in younger age group [27,28].
Another predictor variable which affect the dependent
variable was monthly income of the family. And from this study
the finding revealed that those respondents who do have higher
monthly income were more likely to use family planning than
those respondents who do have lower monthly income. because
as income increases; the families’ access to information also
increases. On the other hand; as women’s income increase a
woman’s autonomy increases and improving financial decision
making within a household.
This can contribute to an increase in the uptake of FP and
thus in a reduction in unmet need. This finding was supported by
studies in different areas such as Kenya; Uganda; India; Zambia;
and Eritrea [26 & 29-32] which showed that women who were
poorer tend to have higher unmet need. The other possible reason
could be women from lower socio-economic status were less
likely to have educational access which in turn affect the right and
the power to choose method use.
The role of men in decision making has been instrumental in
traditional patriarchal societies like Ethiopia. Partner support to
family planning was important predictors because men decide
almost in every aspect of life including reproductive health
service choices. It could also be husband wife communications
on family planning provides an enabling environment for women
to implement their fertility desires and contraceptive needs and
men’s involvement in family planning method use has also showed
significant association with unmet need for family planning in
studies done in Lesotho; Awi Zone and Enemay district [25,18,33].
But the present finding showed partner support for family
planning was not statistically significant to unmet need.
The overall prevalence of unmet need for FP was high; age;
monthly income; partner approval of family planning use and
desire to have children within two years were independent
predictors of unmet need for FP in the study area. The West
Hararghe zonal health bureau should increase their efforts in
order to reduce this high rate of unmet need for family planning
by due emphasis on those factors contributing for unmet need for
Based on the findings of this research the following recommendation
was given. Encouraging communication between reproductive
age group couples and involving men more in family
planning were the keys to improve unmet need. The regional and
federal government has to work to increase the economic status
of women. Health care workers should promote appropriate and
active IEC programs that address provision of accurate information
about availability of the services and various contraceptive options. Further researchers should be conducted to identify the
extent of unmet need of different population groups; Including unmarried
women and couples together
Ethical clearance was obtained from Arsi University;
Department of Public Health and the local authorities were
informed about the study objectives through a letter from Arsi
University; Collage of Health Science to study woreda and kebele
administration offices to enhance cooperation. Verbal consent was
taken from each selected participant to confirm willingness. Honest
explanation of the survey purpose; description of the benefits and
an offer to answer all inquiries was be made to the respondents. In
addition; affirmation that they were free to withdraw consent and
to discontinue participation without any form of prejudice was
made. Privacy and confidentiality of collected information was
ensured throughout the process.
We would like to thank the Department of Public Health;
College of Health Science of Arsi University for giving this research
opportunity. Our deepest thanks also go to Mieso woreda health
office; Asebot Health center staffs; the populations of study site;
data collectors; supervisors and study participants who were
providing Us with the necessary information. Last but not the least
we extend our deepest gratitude to all our families and friends
who had contributions to the success of our work.
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