This institutional based cross sectional study was attempted to assess the demand for long acting contraceptives and associated factors among family planning service users in Debre-Tabor town. The study showed that demand for long contraceptives was 17%. It is almost comparable with study done in Goba town and lower than a study conducted in Batu town Oromia region 18.2% and 24.4%, respectively [9,12]. But, have significant difference from study done in Iran which was 71% [1]. This high discrepancy might be due to the study setting, sample size and awareness of the participants on the methods.
In this study the utilization of long acting contraceptive methods was 9.2% which was in line with community based cross sectional study done in Goba town which was 8.04% [12]. But higher as compared with EDHS 2011 report [3]. The possible explanations might be due to difference in the study populations since EDHS used study populations including the rural area where they have low access to information and services.
Though long acting contraceptive methods which have high effectiveness, low burden to the users, good to avoid frequent visit for resupply, cost effective, and allowed rapid return to fertility after their removal, in this study there was under utilization of the methods which accounts implant 40(8.2%) and IUCD 5(1%). As study done in Tehuleder district of South Wollo zone showed implant (39%) and IUCD (8.7%) [13]. This discrepancy might be due to better awareness and promotion on the methods.
Currently, as the findings indicated higher proportions of participants were using implants than IUCD. This is in line with study done in Goba, Batu, Mekelle, Tehuleder districts of Ethiopia and EDHS 2011 report [3,11-13]. In this study large proportion of women were using short acting contraceptive methods for permanent limiting and spacing the number of children. This result was inconsistent with a study done Tehuledere district of south Wollo zone [14]. This might be due to the study set up and the design used in both studies.
The unmet need for long acting contraceptive methods in this study was 7.8%. It is almost similar with the study done in Goba town (9.4%). The reason for unmet need indicated by women who were not using long acting contraceptive methods but have a desire to use the methods were fear of complications, husband or partner opposition, proven other medical problems, and preference of short acting contraceptive methods.
According to this study, 86.2% of the respondent heard about long acting contraceptive methods of which 78.9% heard about implant and 53.2% about IUCD. It is similar with the study conducted in Goba town (86.6%) had information about long acting contraceptive methods [12]. This was higher compared to the EDHS 2011 report [3]. The possible difference might be that EDHS was a national study done both rural and urban populations and developing regions of the country.
Main source of obtaining these methods in the town were public health facilities and this was in line with EDHS 2011 report, study done in Mekelle, Batu and Goba towns [11-13].
Result of multivariate logistic regression analysis showed that occupational status, future birth intensions, number of children, being treated with respect and dignity by health care providers, frequency of discussions with husband or partner and the main decision maker to use these methods have significant association with demand for long acting contraceptive methods.
Those participants whose occupation was daily labour had 3.87 times higher demand for long acting contraceptive methods than house wives (AOR = 3.87, 95% CI = [1.06, 14.20]) which was similar with study done in Batu town [11]. Student family planning users had 2.64 times higher demand for long acting contraceptive methods than house wives (AOR = 2.64, 95% CI = [1.27, 5.47]). This finding was different from the study done in Batu [11] where student family planning users had 0.11 times demand for long acting contraceptive methods than house wives. The difference might be due to the time gap between the two studies i.e. students in this study might have better awareness and attitude to use these methods than students in the Batu town study four years ago.
Women who had more frequent discussions with their husband or partner about long acting contraceptive methods were had 3.89 times higher demand for the methods than those who had discussion once or twice (AOR = 3.89, 95% CI = [1.98, 7.65]). It was supported by the findings of the research done in Rwanda [15] which indicates that women who were discussing with their husband or partner about long acting contraceptive methods once or twice had 0.76 times less demand than women who discussed more often about the methods.
Women having five or more children had 1.67 times higher demand for long acting contraceptive methods compared to women who do not have children at all (AOR = 1.67, 95% CI = [1.58, 4.83]). It was similar with the finding of research done in Batu town [11] which indicated that women who had five or more children had 6 times higher demand for long acting contraceptive methods compared to women who didn’t have children at all (AOR = 5.85, 95% CI = [2.68, 12.8]).
Participants with no desire for more children in the future had 2.17 times higher demand for long acting contraceptive methods than those who wanted one or more children in the future (AOR = 2.17, 95% CI = [1.11, 4.23]). This was similar with the study done in Iran [1] in which women with no desire for future children had higher demand for long acting contraceptive methods compared to women having future childbearing intensions.
Women who decided together with their husband or partners had 2.73 times higher demand for long acting contraceptive methods than those who decided alone (AOR = 2.73, 95% CI = [1.40, 5.32]). This finding was almost in line with the study done in Butajira [16] in which women who had discussed and decided with their husband or partners were 2.2 times more likely to use the methods compared to those who decided alone [AOR 2.2 (95% CI: 1.8, 2.7)].
Clients treated with respect and dignity by care providers, had 42% higher demand for long acting contraceptive methods than those who were treated poorly (AOR = 0.42, 95% CI = [0.24, 0.74]) and this was similar with a study done in Kenya [17] which indicated that the health care provider quality towards to the client tends to increase the demand for long acting family planning methods.
Limitation of the study
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1.
Since the study was institutional based and conducted only in the town among only family planning users, it might undermine generalizing the result to the majority general population including rural community and none users.
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2.
The study design is cross sectional; therefore it may be difficult to establish temporal relationship.
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3.
This study was conducted among only family planning service users in the government facilities; it may not representative to general population.