Spatial variations and associated factors of modern contraceptive use in Ethiopia: a spatial and multilevel analysis

Objective: To assess spatial variations in modern contraceptive use and to identify factors associated with it among married women in Ethiopia. Design: Cross-sectional analysis of population-based and health facility data. Setting: Ethiopia Demographic and Health Survey data linked to Service Provision Assessment data. Population: 8473 married women and 1020 facilities that reported providing family planning services. Methods: A linked secondary data analysis of population and health facility data was carried out. Both multilevel and spatial analyses were conducted to identify key determinants of women’s use of modern contraceptive and spatial clustering of modern contraceptive use. Main outcome measure: Modern contraceptive use. Results: About 24% of the variation in the use of modern contraception was accounted for by location. A one-unit increase in the mean score of health facilities’ readiness to provide short-term modern contraceptives in a typical region was associated with a 20-fold increase in the odds of modern contraceptive use (adjusted OR (AOR) 20.49, 95% CI 1.44 to 29.54). In the spatial analysis, it was found that Addis Ababa and the Amhara region had high clusters of modern contraceptive use rates. On the other hand, low rates of contraceptive use were clustered in the Afar and Somali regions. Conclusion: There were significant variations in the use of modern contraceptives across the different regions of Ethiopia. Therefore, regions with low contraceptive rates and high fertility rates should be targeted for scaling up and tailoring of services to the culture and lifestyles of the population of those regions.