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  • Research note
  • Open Access

Factors associated with utilization of long term family planning methods among women of reproductive age attending Bahir Dar health facilities, Northwest Ethiopia

BMC Research Notes201811:926

https://doi.org/10.1186/s13104-018-4031-0

  • Received: 14 November 2018
  • Accepted: 19 December 2018
  • Published:

Abstract

Objective

This health institution based cross section study was designed to determine factors associated with utilization of long term family planning methods among women reproductive age attending Bahir Dar health facilities.

Result

A total of 406 women were interviewed in this study. The mean age (standard deviation) of the study participants was 26.96 ± 6.31. About 99% of the study participants were consisted from Amhara ethnic group and 60.6% of them urban dwellers. In this study about 90.9% of the study participants had information about LTFP methods and 26.4% of them utilizing the methods. Factors like; knowledge of the women towards LTFP, spousal discussion on FP and occupation of the women affects LTFP utilization (6 times, 3 times and 4 times, respectively) when compared with their counter parts. In addition monthly income of the household was also associated to LTFP methods. In this study less percentage (26.4%) of women’s utilizing LTFP methods that were significantly associated with the knowledge of women on LTFP, spousal discussion on FP, occupation of the women and monthly income of the household. As result continuous health education will be recommended.

Keywords

  • Long term family planning
  • Health facility
  • Reproductive age women
  • Bahir Dar

Introduction

Continuous population growth was become an imperative problem for developing countries [1]. In sub-Saharan Africa like Ethiopia the population growth increases dramatically that adversely affect the socio economic development of the country. As a result, countries are enforced to develop population policy to limit population growth [2]. Family planning (FP) is a tool to control population growth [3]. FP is central to efforts to reduce poverty, promote economic growth, raise female productivity, lower fertility and improve child survival and maternal health. FP can prevent maternal deaths up to 20–35% [4]. Long term family planning (LTFP) methods had low failure rate, safer and cost effective than short acting contraceptives. They prevent pregnancy more than a year in one action without requirement of repeated procedures [5]. Despite its effectiveness, improve maternal health, reduce population growth and reversibility of fertility the acceptance and utilization of LTFP methods were very poor [6, 7].

In sub- Sahara Africa utilization LTFP method was very low [8]. According to the Ethiopian demographic health survey (EDHS) mini report in 2014 the prevalence of LTFP method was relatively low [9]. There are several factors that contribute for low prevalence LTFP methods; side effects of the methods, lack of access to the methods, lack of information on the methods, maternal education [1012]. Monthly income of the household and residence are determinants of LTFP methods [13, 14]. This study was designed to assess the factors associated to utilization of LTFP methods among women reproductive age attending Bahir Dar health facilities, Northwest Ethiopia.

Main text

Methods

Study design, study population and sampling

Health institution based cross-sectional study was conducted at Bahir Dar town health facilities from May to June, 2017. The town had two governmental hospitals and ten health centers that provide FP services. All reproductive age (15–49) women users of FP method coming to Bahir Dar town health facilities were our source population. All reproductive age women obtaining FP methods or FP counseling service during the study period were our study population. Utilization of LTFP method was a dependent variable. Socio-demographic variables, obstetric variables and other clinical variables were considered as an independent variable. LTFP operationally defined as contraceptive methods that delay pregnancy for 1 year and above (implants and intrauterine contraceptive devices).

A simple random sampling technique was applied to get the study participants. The sample size was estimated by using single proportion formula. The total sample size was 406. The calculated sample was allocated into four governmental health facilities (Han, Shimbit, Zenzelma health centers and Addis Alem hospital) the detail sampling procedure attached as Additional file 1.

Data collection and analysis

Data was collected after we obtained informed verbal consent from each participant by using interviewer administered structured questionnaire. The questionnaire was prepared in English then translated into Amharic later retranslated into English. Four BSc midwives and two BSc nurses were selected for data collection and supervision, respectively. Training was given for data collectors and supervisors to maintain data quality. Before the actual data collection pre-test were conducted in Durebete Health Center. Based on the pretest result, questionnaires were revised. Data were analyzed by using SPSS version 20 software. Descriptive statistics, binary and multiple logistic regressions was computed. Those variables were significant at P-value ≤ 0.2 were entered into multivariate analysis. The odds ratio was calculated to assess the association and strength of association of variables. P-value < 0.05 was taken as a cut point.

Ethical consideration

Ethical clearance was obtained from Bahir Dar University, College of Medicine and Health Sciences ethical review committee. Permission was also requested from the administrators of four health institutions. We precede our data collection after we obtained verbal informed consent from each study participants.

Results

Socio-demographic characteristics

A total of 406 individuals included in this study. The mean age (standard deviation) of the study participant was 26.96 ± 6.31. In this study almost all (99%) of the study participants were consisted from an Amhara ethnic group. Majority of the study participants were a follower of Orthodox Christian religion (85.5) and lived in the urban area (60.6%). Most of them were married (81.5%). The mean age of marriage and first delivery was 18.82 ± 2.45 and 20.86 ± 2.87, respectively (Table 1).
Table 1

Socio- demographic characteristics of women attending Bahir Dar health facilities, Northwest Ethiopia, 2017

Variables

Response

Frequency

Percentage

Age (years)

15–19

71

17.5

20–24

145

35.7

25–29

109

26.8

≥ 30

81

20.0

Marital status

Single

56

13.8

Married

331

81.5

Divorced

4

1.0

Widowed

15

3.7

Residences

Urban

246

60.6

Rural

160

39.4

Religion

Orthodox Christian

348

85.7

Muslim

53

13.1

Other

5

1.2

Ethnicity

Amhara

402

99.0

Other

4

1.0

Educational status

No formal education

111

27.3

Primary education

149

36.7

Secondary education

74

18.3

College and university

72

17.7

Availability of health facility at a distances of 5 km

Yes

305

75.1

No

101

24.9

Occupation

Government employed

76

18.7

Housewife

144

35.5

Merchant

90

22.2

Student

56

13.8

Other

40

9.8

Monthly income in Ethiopian Birr

< 1000

44

10.8

1001–2000

50

12.3

2001–3500

112

27.6

3501–5000

72

17.7

> 5000

128

31.5

Reproductive characteristics of LTFP utilization

Almost all (99.5%) of the study participants had knowledge about modern FP methods and 90.9% of the women had information about LTFP methods. About 64.5% of the study participants were pregnant of this 51.3% of them were become pregnant two and < two times. In this study the major reason of women not utilizing LTFP method were fear of side effect, lack of information and need of more children accounts 66.9%, 12.4% and 5.4%, respectively (Table 2).
Table 2

Reproductive characteristics of women attending Bahir Dar health facilities, Northwest Ethiopia, 2017

Variables

Response

Frequency

Percent

Knowledge on contraceptive

Yes

404

99.5

No

2

0.5

Utilization of contraceptive

Yes

371

91.5

No

35

8.6

Choice of methods

Injectable

225

55.4

Implant

103

25.4

Oral contraceptive

34

8.4

Emergency

5

1.2

IUCD

4

1.0

Knowledge on LTFP methods

Yes

369

90.9

No

37

9.1

LTFP utilization

Yes

107

26.4

No

299

73.6

History of pregnancy

Yes

261

64.5

No

145

35.7

Gravidity

≤ 2 Pregnancies

134

51.3

> 2 Pregnancies

127

48.7

Parity

≤ 2 Alive children

131

54.1

> 2 Alive children

111

45.9

Desire of more children

Yes

210

51.7

No

196

48.3

Purpose of FP utilization

For spacing

304

74.9

For limiting

102

25.1

History of abortion

Yes

57

14.0

No

349

86.0

Spousal discussion on FP methods

Yes

324

79.8

No

82

20.2

Accessibility of FP methods

Yes

392

96.6

No

14

3.4

Birth interval between children (if they have ≥ 2 children) (years)

≤ 2

5

2.7

> 2

178

97.3

Reason not taking LTFP methods

Lack of information

37

12.4

Fear of side effect

200

66.9

Need of more children

16

5.4

Other

46

15.4

LTFP long term family planning, FP family planning, IUCD intrauterine contraceptive device

Factors affecting LTFP utilization

Thirteen independent variables were analyzed in logistic regression to know their association. Variables which were significant at P ≤ 0.2 entered into multivariate logistic regressions. Out of thirteen variables four were significantly associated with LTFP methods. These are knowledge to LTFP, spousal discussion on FP methods, occupation and monthly income. Those participants who were merchants in occupation had 4 times more likely to use LTFP than others. Women who have knowledge on LTFP were about 6 times more likely to practice LTFP methods than women who don’t have knowledge. Women who discussed about LTFP methods with their partners had 3 times more likely to utilize LTFP than their counterparts (Table 3).
Table 3

Logistic regression analysis of women attending Bahir Dar health facilities, Northwest Ethiopia, 2017

Variables

Response

Utilization of LTFP

COR at 95% CI

Sig

AOR at 95% CI

Yes

Total

Age of the respondent (years)

15–19

12

71

2.070 (0.946, 4.528)

0.068

0.945 (0.401, 2.231)

20–24

32

145

1.487 (0.802, 2.757)

0.208

0.526 (0.197, 1.405)

25–29

39

109

0.756 (0.408, 1.401)

0.374

0.534 (0.178, 1.604)

≥ 30

24

81

1

1

1

Marital status

Single

8

56

1

1

1

Married

97

331

0.402 (0.183, 0.881)

0.023

0.394 (0.061, 2.556)

Others

2

19

1.417 (0.273, 7.342)

0.678

0.415 (0.078, 2.208)

Residence

Urban

69

246

0.799 (0.505, 1.263)

0.337

1.581 (0.815, 3.067)

Rural

38

160

1

1

1

Educational status

No formal educated

21

111

1

1

1

Primary education

43

149

0.789 (0.400, 1.557)

0.494

0.787 (0.263, 2.357)

Secondary education

14

74

1.000 (0.472, 2.119)

1.000

1.188 (0.422, 3.339)

College and university

29

72

0.346 (0.177, 0.675)

0.002

2.245 (0.832, 6.058)

Occupation

Government employed

33

81

0.301 (0.112, 0.805)

0.017

1.798 (0.678, 4.770)

Merchant

23

89

0.594 (0.219, 1.612)

0.306**

3.873 (1.155, 12.986)

Student

6

57

1.759 (0.519, 5.956)

0.364

1.509 (0.552, 4.122)

Housewife

39

144

0.557 (0.215, 1.444)

0.229

1.772 (0.460, 6.823)

Other

6

35

1

1

1

Availability of health facility at 5 km

Yes

83

305

0.834 (0.494, 1.406)

0.495

0.988 (0.425, 2.296)

No

24

101

1

1

1

Monthly income in Ethiopian Birr

< 1000

6

44

1.855 (0.714, 4.823)

0.205**

0.319 (0.104, 0.977)

1001–2000

20

50

0.439 (0.218, 0.886)

0.021

0.754 (0.249, 2.284)

2001–3500

29

112

0.838 (0.464, 1.515)

0.559

0.676 (0.208, 2.201)

3501–5000

23

72

0.624 (0.327, 1.190)

0.152

1.047 (0.337, 3.249)

> 5000

29

128

1

1

1

Knowledge of LTFP Methods

Yes

105

369

0.144 (0.034, 0.608)

0.008**

6.250 (1.326, 29.472)

No

2

37

1

1

1

Spousal discussion on FP

Yes

98

324

3.517 (1.692, 7.312)

0.001**

2.398 (1.021, 5.633)

No

9

82

1

1

1

Desire of more children

Yes

62

210

1

1

1

No

45

196

1.406 (0.900, 2.195)

0.134

0.937 (0.539, 1.627)

History of pregnancy

Yes

81

261

0.486 (0.295, 0.800)

0.005

1.294 (0.607, 2.758)

No

26

145

1

1

1

History of abortion

Yes

14

57

1.116 (0.584, 2.133)

0.740

0.896 (0.416, 1.932)

No

93

349

1

1

1

Accessibility of FP methods

Yes

103

392

1.122 (0.344, 3.657)

0.848

0.344 (0.076, 1.549)

No

4

14

1

1

1

** Shows statistical significant association in the adjusted odds ratio

Discussion

In this study the overall utilization of LTFP methods among reproductive age women was 26.4%. The finding of this research was almost similar in studies conducted in Mbarara district and Areka town [11, 15]. The prevalence of this research result was slightly higher than in studies conducted in different parts of Ethiopia [1621]. This higher prevalence might be due to the accessibility of health facilities, increased awareness of the community due to health extension workers and the study design.

In this study almost all 99. 5% of study participant have information about modern contraceptive methods and 90.9% of the study participant had information on LTFP methods. This is in line with 2014 Ethiopian Demographic Health survey mini report (96.5%). The prevalence of mothers that use any modern contraceptive methods and LTFP methods in this study was 91.4% and 26.4%, respectively [9]. This result lower than studies conducted in Kampala and Ethiopia [7, 12, 17, 22]. In this study factors like; knowledge of women towards LTFP method, habit of partner discussion, less than 1000 Ethiopian birr monthly income and become merchant by occupation of the women were found to be determinants of LTFP methods.

This study revealed that women who discussed with their husband about LTFP methods were three times more likely to use LTFP methods than their counter parts. This is supported by studies conducted in Uganda, Rwanda and Ethiopia [1, 4, 8, 16, 20, 22, 23]. Out of the variables which showed significant associations at the multi-variable logistic regression analysis, high odds of using LTFP methods were seen among women with knowledge of LTFP methods. This finding suggests that women with knowledge of LTFP methods are more likely to practice FP services than their counter parts. This finding was strengthened by other studies conducted in Ethiopia [1, 2, 7, 19, 23, 24]. In this study, merchants by occupation more likely to utilized LTFP methods than their counter parts. Occupation of the women was associated to FP utilization in different studies conducted in Ethiopia [15, 2527]. Monthly income of the household was positively associated with LTFP utilization. However, after adjustment it doesn’t show significant association. This is supported by studies conducted in Ethiopia [21].

In this study knowledge of LTFP was relatively high (90.9%). However, its utilization was low (26.4%). This is due to factors like; knowledge of women to LTFP methods, habit of partner discussion, monthly income of the household and becoming merchant by occupation were found to be determinants of LTFP utilization. As a result, improving the norms of partner discussion and continuous health education will be encouraged. In addition to explore factors in detail another longitudinal study will be recommend.

Limitations of the study

This study isn’t free from limitation. Its limitation relies on the method part; health institution based cross sectional study doesn’t much explore the determinants about LTFP methods like community based and longitudinal studies. As a result another longitudinal study will be necessary to explore determinants in detail. Numbers related to knowledge of FP methods might be relatively higher to give an inference to general population.

Abbreviations

FP: 

family planning

LTFP: 

long term family planning

IUCD: 

intrauterine contraceptive devices

CI: 

confidence interval

COR: 

crude odds ratio

AOR: 

adjusted odds ratio

HC: 

health center

Declarations

Authors’ contributions

ET Involved in method development, data collection tool development, data analysis, write up of the manuscript and HG also participated in method and data collection tool development, data analysis, write up of the manuscript. Both authors read and approved the final manuscript.

Acknowledgements

The authors want to acknowledge the management of the four health facilities. In addition we wish to thank the data collectors and study participants for their valuable time.

Competing interests

The authors declare that they have no competing interests.

Availability of data materials

All relevant data are included within the manuscript. If it is necessary it is possible to contact the corresponding author to get additional material.

Consent of publication

Not applicable.

Ethics approval and consent to participate

Ethical clearance was obtained from Bahir Dar University, College of Medicine and Health Sciences ethical review committee. Permission was also requested from the administrators of four health institutions. We precede our data collection after we obtained verbal informed consent from each study participants. Even though our study population includes reproductive age women between 15 and 49 years unfortunately there were no study participants under 16 years. So, we haven’t imposed to parent or guardian permission.

Funding

There is no funding organization.

Publisher’s Note

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Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Department of Biochemistry, College of Medicine and Health Science, Bahir Dar University, P.O. Box 79, Bahir Dar, Ethiopia
(2)
Department of Nursing, College of Medicine and Health Science, Bahir Dar University, P.O. Box 79, Bahir Dar, Ethiopia

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Copyright

© The Author(s) 2018

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