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Utilization of Implant Contraceptive Methods and Associated Factors among Reproductive-Age Women in Ethiopia

Written By

Birye Dessalegn Mekonnen and Chalachew Adugna Wubneh

Submitted: January 31st, 2022Reviewed: February 22nd, 2022Published: April 14th, 2022

DOI: 10.5772/intechopen.103868

IntechOpen
ChildbirthEdited by Julio Elito Jr.

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Childbirth [Working Title]

Prof. Julio Elito Jr.

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Abstract

Implants are more effective, enable women to control their reproductive lives better, and are better options of contraception than other long-term family planning methods. Researches are required to provide up-to-date evidence for policymakers, and other stakeholders working on the family planning program in Ethiopia as the evidence from different studies conducted in Ethiopia on implants contraceptive method utilization was highly varied and not conclusive. Therefore, the current study aims to determine the magnitude of implant contraceptive utilization and its associated factors among reproductive-age women in Ethiopia. A population-based cross-sectional study has conducted using secondary data analysis from the EDHS 2016. A total of 14,593 reproductive-age women participated in this study. The analysis was performed using the SPSS version 20 statistical package. Bivariate and multivariable logistic regression analysis was performed to identify independent predictors of implant contraceptive methods utilization. Statistical significance was declared at p-value <0.05. The prevalence of implant contraceptive utilization among reproductive-age women in Ethiopia was 9.4% (95% CI: 8.8, 10.0). The results of multivariable logistic regression showed that marital status, place of residence, number of living children, history of a terminated pregnancy, husband desire for more children, decision making on contraceptive use, knowledge on contraceptives, discussed FP with the healthcare worker and heard family planning message on television were independent predictors of implants contraceptive use among reproductive-age women in Ethiopia. The study showed that the magnitude of implant contraceptive utilization among reproductive-age women in Ethiopia is very low as compared with the national 2020 plan. The finding of this study suggests any intervention strategy which is designed and being implemented to promote implants contraceptive method utilization should consider the aforementioned factors for its better success. Besides, the provision of quality counseling and information on FP, and women empowerment should be promoted so that women can freely decide on the type of contraceptive they would like to use. Moreover, emphasis should be given to rural women and no television access to implants contraceptive method utilization.

Keywords

  • implant contraceptive methods
  • reproductive age women
  • EDHS 2016
  • Ethiopia

1. Introduction

Population growth becomes an urgent global concern with an expected half of the world’s population growth will be concentrated in just nine countries [1]. With the highest rate of population growth, Africa is expected to account for more than half of the world population growth between 2015 and 2050 [2]. Ethiopia is among countries with higher fertility rates in the world and high populous nations in Africa [3]. Fertility rates are determinant actors of the human development index (HDI) affecting life expectancy, education, per capita income, and other indicators [4]. The role of family planning (FP) in decreasing fertility rate which could reduce maternal and child mortality, and other health costs thereby improving maternal and child health is widely advocated [5, 6].

Implants such as Implanon, Sino implant, and Jadelle are among the modern contraceptive methods that are long-acting, reversible, and hormonal contraceptives [7, 8]. Contraceptive implants are one of the most effective family planning methods which widely available and have increased global acceptance [9, 10]. Implants are better options of contraception than other long-term family planning methods as they easily insert and remove and have fewer side effects [10].

The high rate of implants utilization by couples is indicative of FP program effectiveness within a country in addition to couples’ success in spacing and limiting their births [11]. Also, implants play a crucial role in the prevention of unintended pregnancies and abortions as well as in the reduction of maternal mortality and morbidity related to complications of pregnancy and childbirth [12]. Furthermore, the use of implants is comparatively the preferred method of contraception than injectable contraceptives which should be taken every 3 months and daily pills as implants are effective from 3 to 5 years in preventing pregnancy as well as rapid return to usual fertility as soon as implants are removed [10]. However, an analysis of Demographic and Health Surveys (DHS) from four Sub- Saharan Africa (SSA) countries revealed that the proportion of women who utilized implants was much lower than short-acting methods [13].

Though implant acceptance is at an increasing rate, of reproductive-age women who used contraceptive methods, only 0.3% globally, and 7% in Africa utilized implants [9, 14]. Furthermore, in many SSA countries, less than 5% of reproductive-age women are using long-acting contraceptives [15].

In Ethiopia, the ministry of health has planned to increase contraceptive implants to 33% in the method mix in 2015 [16]. However, the Ethiopian demographic and health survey (EDHS) of 2016 showed that only 8% of women utilized implants which indicated that the plan was not achieved [3]. To increase the level of implants utilization among women in Ethiopia, different strategies have been introduced such as practicing community level implants insertion by trained health extension workers (HEWs), and provision of contraceptives implants with free cost as of other contraceptives at all levels of health care [13, 17]. Still, short-acting methods are the dominant contraceptives in the current contraceptive method mix of the country [3, 18].

Studies have been done to determine the prevalence of implant utilization and to identify factors that contribute to the low utilization of implants in Ethiopia [7, 8, 9, 15, 19]. Evidence from the abovementioned studies conducted in Ethiopia was highly varied and the results are inconsistent. More research therefore required to provide up-to-date evidence for policymakers, programmers, and other stakeholders working on FP in Ethiopia to solve problems related to implants contraceptive utilization based on evidence. Therefore, the current study aims to assess the magnitude of implant contraceptive utilization and its associated factors among reproductive-age women in Ethiopia based on all-inclusive 2016 EDHS data.

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2. Methods

2.1 Study design and period

A nationwide population-based cross-sectional study was conducted using secondary data analysis from the EDHS 2016. The survey data collection was carried out from January 18, 2016, to June 27, 2016.

2.2 Data source and population

The data used for the current study was extracted from 2016 EDHS which was stratified into urban and rural areas. The EDHS data collection procedure followed a two-stage sampling technique to select representative respondents of independent enumeration areas in each stratum. A total of 645 clusters (202 in urban and 443 in rural) enumeration areas were selected using probability proportional allocation to the size of enumeration area in the first stage while 28 households per cluster with an equal probability systematic selection were selected from the newly formed household list in the second stage. Consecutively, a total of 18,008 households were selected for the 2016 EDHS out of which 16,650 households were identified and interviewed yielding a response rate of 92.5%. From 16,650 interviewed households, 15,683 were reproductive age women and completed the interview making a response rate of 94.2% [3]. Finally, women who were reported to be pregnant at the time of the survey were excluded, and data were weighted to adjust for non-response and differences in the probability of selection. Thus, the analysis for this study was restricted to the 14,593 (weighted) reproductive-age women who met the eligibility criteria. Women’s questionnaire which contains five different parts including the FP component was used to collect information.

2.3 Variables of the study

Outcome variable:The outcome variable for this study was the utilization of implants which was categorized into two outcome categories: the ‘user of implants’ women who was using either Implanon or Sino Implant or Jadelle user during EDHS data collection period) and ‘non-user of implants’ (women who were not using either Implanon or Sino Implant or Jadelle user during EDHS data collection period).

Independent variables:The independent variables were grouped into three categories to see their influence on implant contraceptive use. These included socio-demographic variables (age of the woman, educational status, place of residence, current working status, and wealth index), reproductive and fertility decision making related variables (age at first sex, age at first childbirth, history of abortion, number of living children, fertility preference, husband’s desire for more children, the decision on contraceptive use) and exposure to mass media and family planning messages variables (heard family planning messages on radio, heard family planning messages on TV, heard family planning messages on newspapers, visited by a health worker, health worker talked about family planning, visited health facility and told about family planning in the health facility) and women’s knowledge on any contraceptives.

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3. Statistical analysis

After getting permission, the data was downloaded from the MEASURE DHS database: https://www.dhsprogram.com/data/dataset_admin/login_main.cfm. Statistical package for social science (SPSS) version 20 was used for statistical analysis. Descriptive analysis was used to summarize the distribution of selected background characteristics of the study participants. Frequency tables and graphs were used to summarize and present findings. The data were weighted to adjust for non-response and account for the disproportionate sampling. Bivariate logistic regression analysis was used to select variables fitted for multivariable logistic regression. Variables with a p-value of less than 0.2 in the bivariate logistic regression were included in the multivariable logistic regression. Before running the final model, multicollinearity between candidate variables was checked using variance inflation factor (VIF). Multivariable logistic regression analysis was performed to identify independent predictors of implant contraceptive methods utilization among reproductive-age women in Ethiopia. Adjusted odds ratio (AOR) and 95% confidence interval (CI) were respectively calculated to measure the association between predictor variables and implant contraceptive utilization. Results were considered statistically significant for p-values <0.05. finally, model fitness was checked using Hosmer and Lemeshow’s test.

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4. Results

4.1 Socio-demographic and socio-economic characteristics of women

The study result was analyzed based on 14,593 reproductive age women in the 2016 EDHS dataset. The mean age of women was 27.1 (± 8.11) years with the majority (24.8%) of women were aged 15–19 years. The majority, 11,468 (78.6%) of women were married, and 9707 (66.5%) were Orthodox religious followers. Out of reproductive age women interviewed, 1760 (12.1%) were from the Oromia region. Concerning the residence of participants, 10,613 (72.7%) were rural residents. About, 9559 (65.5%) of women were not working at the time of the survey. Regarding educational status, 6880 (47.1%) were not educated and 4662 (31.9%) women had completed primary education. About, 4713 (32.3%) of the women were from the poorest family (Table 1).

VariablesFrequencyPercent
Age
15–19
20–24
25–29
30–34
35–39
40–44
45–49

3612
2277
2885
2626
1997
833
363

24.8
15.6
19.8
18.0
13.7
5.7
2.5
Marital status
Married
Never married/divorced/widowed/separated

11,468
3125

78.6
21.4
Religion
Orthodox
Muslim
Protestant
Catholic

9707
4194
504
188

66.5
28.7
3.5
1.3
Place of residence
Urban
Rural

3980
10,613

27.3
72.7
Educational level
No formal education
Primary school
Secondary school
Higher education

6880
4662
1965
1086

47.1
31.9
13.5
7.5
Respondents’ current working status
Yes
No

5034
9559

34.5
65.5
Monthly income
Poorest
Poorer
Middle
Richer
Richest

4713
2611
2594
2389
2286

32.3
17.9
17.8
16.4
15.6
Region
Tigray
Afar
Amhara
Oromia
Somalia
Benishangul
SNNPR
Gambela
Harari
Dire Dawa
Addis Ababa

1297
1365
1309
1760
1592
1027
1659
1017
895
1089
1583

8.9
9.4
9.0
12.1
10.9
7.0
11.4
7.0
6.1
7.4
10.8

Table 1.

Socio-demographic and socio-economic characteristics of reproductive age women in Ethiopia, 2016.

4.2 Reproductive and obstetric characteristics of women

More than three out of five (61.8%) reproductive-age women have started their first sex before the age of 18 years with the mean age of 17.1 (SD ± 5.58) years. The mean age of first childbirth for those who gave birth was 24.88 (SD ± 4.64) years with about half (50.1%) of women giving birth in their age of 18–24 years. The mean number of living children was 2.0 (SD ± 1.8) with more than two-fifths (42.6%) of women having 1–2 living children. Only, 1107 (7.6%) of women had a history of terminated pregnancy. Around, 4961 (34%) of the women want to have children after 2 years. Concerning partners’ desire to have children, 9494 (65.1%) reported that their husbands need to have more children. Regarding decision-making on contraceptive use, 3079 (21.1%) reproductive age women made the decision jointly with their husbands (Table 2).

VariablesFrequencyPercent
Age at first sex
Less than 18 years
18–24 years
25 and above years

9024
5143
426

61.8
35.1
2.9
Age at first childbirth
Not had childbirth
Less than 18 years
18–24 years
25 and above years

318
5737
7319
1219

2.2
39.3
50.1
8.4
Number of living children (parity)
None
1 to 2
3 to 4
5 and more

4440
6216
3133
804

30.4
42.6
21.5
5.5
Does husband want to have an additional child?
Yes
No

9494
5099

65.1
34.9
History of a terminated pregnancy
Yes
No

1107
13,486

7.6
92.4
Fertility preference
Wants within 2 years
Wants after 2 years
Wants no more children
Undecided

3714
4961
2785
3133

25.5
34.0
19.1
21.4
Decision maker for using contraception
Mainly respondent
Mainly husband/partner
Jointly
Others

2247
8355
3079
912

15.4
57.3
21.1
6.2

Table 2.

Reproductive and obstetric characteristics of reproductive age women in Ethiopia, 2016.

4.3 Exposure to mass media and family planning messages

About three-fourths, 10,978 (75.2%) of women did not hear family planning messages on the radio for the last few months. The majority, 13,666 (93.6%) of women did not hear family planning messages in newspaper/magazines last few months, and almost three-fourths, 10,929 (74.9%) of women did not hear family planning messages on television last few months. Only, 5636 (38.6%) of women reported that they were visited a health facility in the last 12 months. Out of reproductive-age women who have visited a health facility in the last 12 months, 1935 (34.3%) had a discussion about FP with the healthcare worker and 1606 (28.5%) were counseled by healthcare workers regarding the side effects of contraceptives. Out of women counseled regarding the side effects of contraceptives, 754 (46.9%) of women were told how to deal with side effects. The survey indicated that the majority (93.8%) of women had good knowledge about any contraceptive methods (Table 3).

VariablesFrequencyPercent
Heard family planning on the radio last few months
Yes
No

3615
10,978

24.8
75.2
Heard family planning on television last few months
Yes
No

3664
10,929

25.1
74.9
Heard family planning in the newspaper/magazine last few months
Yes
No

927
13,666

6.4
93.6
The visited health facility in the last 12 months
Yes
No

5636
8957

38.6
61.4
Discussed FP with healthcare worker (n = 5636)
Yes
No

1935
3701

34.3
65.7
Counseled by healthcare worker regarding the side effects (n = 5636)
Yes
No

1606
4030

28.5
71.5
Counseled by healthcare worker how to deal with side effects (n = 1606)
Yes
No

754
852

46.9
53.1
Knowledge of any contraceptives
Good
Poor

13,686
907

93.8
6.2

Table 3.

Exposure to mass media and family planning messages among reproductive age women in Ethiopia, 2016.

4.4 Utilization of implant contraceptive methods

The magnitude of implant contraceptive methods utilization among reproductive-age women in Ethiopia was 9.4% (95% CI: 8.8, 10.0). There was a disparity of implant contraceptive utilization based on regions of Ethiopia; 212 (1.5%) reproductive age women utilized implant contraceptives from the Amhara region, and 186 (1.3%%) women utilized implants contraceptive from Addis Ababa city administration (Figure 1).

Figure 1.

Utilization of implant contraceptive methods among reproductive age women by region of Ethiopia, 2016.

The overall prevalence of current contraceptive utilization among reproductive-age women in Ethiopia was 26.9%. The most preferred contraceptive method for reproductive-age women was injectable 1824 (12.5%) whereas emergency contraception 8 (0.1%)was the least preferred contraceptive method (Figure 2).

Figure 2.

Utilization of currently contraceptive methods by method type among reproductive age women in Ethiopia, 2016.

4.5 Factors associated with implant contraceptive utilization

In bivariate logistic regressions analysis; marital status, place of residence, educational status of women, current working status, number of living children, age at first childbirth, abortion history, fertility preference, husband desire for more children, decision making on contraceptive use, discussed FP with a healthcare worker, counseling about contraceptive side effects, knowledge on contraceptives, heard family planning message on radio, heard family planning message in newspaper and heard family planning message on television were identified candidate variables for multivariable logistic regression at p-value less than 0.2. Accordingly, the result of multivariate logistic regression analysis revealed that marital status, place of residence, number of living children, history of a terminated pregnancy, husband desire for more children, decision making on contraceptive use, knowledge on contraceptives, discussed FP with the healthcare worker and heard family planning message on television were significantly associated with utilization of implant contraceptives.

Married reproductive-age women were 1.94 times (AOR = 1.94, 95%CI: 1.42, 2.65) more likely to use implants as compared to those women who are never married, divorced, and widowed. Urban women were 1.66 times (AOR = 1.66, 95%CI: 1.32, 2.10) more likely to use implants as compared to their rural counterparts. Women having 1–2 living children was 39% times (AOR = 0.61, 95%CI: 0.42, 0.88) less likely to use implants as compared to women having five and more children. Likewise, women having 3–4 living children was 42% times (AOR = 0.58, 95%CI: 38, 0.90) less likely to use implants as compared to women with five and more children. Besides, those women who reported their husband’s desire for more children were 36% times (AOR = 0.64, 95% C.I: 0.48, 0.84) less likely to use implants than those who reported that their husband would not want more children. Women who had a history of terminated pregnancy were 1.48 times (AOR = 1.48, 95% C.I: 1.11, 1.98) more likely to use implants as compared to those women who had no history of terminated pregnancy. Women who had a joint decision on contraception were having 2.09 times (AOR = 2.09, 95% C.I: 1.27, 4.11) higher odds of using implants than those who decided with the help of other persons. Women who had good knowledge of contraceptives were 9 times (AOR = 9.01, 95% C.I: 4.59, 18.90) more likely to use implants as compared with those who had poor knowledge. Women who discussed FP with healthcare workers were 1.59 times (AOR = 1.59, 95% C.I: 1.22, 2.06) more likely to use implants as compared to those women who did not discuss FP with a healthcare worker. Women who heard family planning messages on television were 1.60 times (AOR = 1.60, 95% C.I: 1.45, 2.81) more likely to use implants than those women who did not hear family planning messages on television (Table 4).

VariablesUtilization of implantsCOR (95% CI)AOR (95% CI)
YesNo
Marital status
Married
Never married/divorced/widowed

1217
161

10,251
2964

2.19 (1.85, 2.59)
1

1.94 (1.42, 2.65)*
1
Residence
Urban
Rural

456
922

3524
9691

1.36 (1.21, 1.53)
1

1.66 (1.32, 2.10)*
1
Educational status
No formal education
Primary school
Secondary school
College/University

826
311
140
101

6054
4351
1825
985

1.33 (1.07, 1.65)
0.70 (0.55, 0.88)
0.75 (0.57, 0.97)
1

0.74 (0.52, 1.06)
0.77 (0.55, 1.07)
0.88 (0.61, 1.28)
1
Respondents’ current working status
Yes
No

595
783

4439
8776

1.50 (1.34, 1.68)
1

1.08 (0.93, 1.69)
1
Number of living children (parity)
None
1 to 2
3 to 4
5 and more

538
573
170
97

3902
5643
2963
707

1.01 (0.80, 1.27)
0.74 (0.59, 0.93)
0.42 (0.32, 0.54)
1

0.83 (0.56, 1.22)
0.61 (0.42, 0.88)*
0.58 (0.38, 0.90)*
1
History of a terminated pregnancy
Yes
No

151
1227

956
12,259

1.58 (1.32, 1.89)
1

1.48 (1.11, 1.98)*
1
Age at first childbirth
Not had childbirth
Less than 18 years
18–24 years
25 and above years

50
693
492
143

268
5044
6827
1076

1.40 (0.99, 1.99)
1.03 (0.85, 1.25)
0.54 (0.45, 0.66)
1

1.33 (0.79, 2.26)
1.07 (0.84, 1.64)
0.34 (0.24, 1.06)
1
Fertility preference
Wants within 2 years
Wants after 2 years
Wants no more children
Undecided

297
273
121
687

3417
4688
2664
2446

0.31 (0.27, 0.36)
0.21 (0.18, 0.24)
0.16 (0.13, 0.20)
1

0.35 (0.27, 1.46)
0.35 (0.72, 1.12)
0.75 (0.49, 1.50)
1
Does husband want to have more children?
Yes
No

986
392

8508
4707

1.39 (1.23, 1.57)
1

0.64 (0.48, 0.84)*
1
Decision maker for using contraception
Mainly respondent
Mainly husband/partner
Jointly
Others

163
742
190
283

2084
7613
2889
629

0.17 (0.14, 0.22)
0.22 (0.19, 0.25)
0.15 (0.12, 0.18)
1

0.41 (0.59, 1.09)
0.82 (0.39, 1.16)
2.09 (1.27, 4.11)*
1
Knowledge on contraceptives
Good
Poor

1336
42

12,350
865

2.23 (1.63, 3.05)
1

9.01 (4.59, 18.90)*
1
Discussed FP with the healthcare workers
Yes
No

204
388

1731
3313

1.01 (0.84, 1.20)
1

1.59 (1.22, 2.06)*
1
Counseled by healthcare worker about side effects
Yes
No

168
424

1438
3606

0.99 (0.82, 1.20)
1

1.29 (0.98, 1.68)
1
Heard FP’s message on the radio
Yes
No

255
1123

3360
9855

0.67 (0.58, 0.77)
1

0.91 (0.68, 1.20)
1
Heard FP’s message on television
Yes
No

198
1180

3466
9749

0.47 (0.40, 0.55)
1

1.60 (1.45, 2.81)*
1
Heard FP message in newspapers
Yes
No

63
1315

864
12,351

0.69 (0.53, 0.89)
1

0.92 (0.58, 1.48)
1

Table 4.

Bivariable and multivariable analysis for implant contraceptive utilization among reproductive age women in Ethiopia, 2016.

Statistically significant (p-value <0.05).


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5. Discussion

This all-inclusive study provides vibrant evidence on the utilization of implant family planning services and associated factors among reproductive-age women in Ethiopia. Besides, the finding of this study revealed that the current utilization of implants was very low as compared to the national family planning coasted implementation targets which planned to increase contraceptive prevalence rate to 55% at the end of 2020 by increasing the share of the implant to 33% in the method mix [18]. This may imply the need to evaluate and strengthen the designed interventions like community health education and behavioral change communication (BCC) to avert attitudinal and informational barriers and misconceptions towards implants family planning methods. Moreover, the finding may also infer the poor quality of family planning counseling, especially on the prevailing myths and misconceptions of implant contraceptive methods by health care professionals. This study also indicated that the proportion of women using implant contraceptive methods was much lower than the level of use at the global level [20].

The overall prevalence of implant contraceptive utilization among reproductive-age women in Ethiopia was 9.4% (95% CI: 8.8, 10.0). The finding is almost consistent with the result of other previous studies [21, 22, 23]. However, the current prevalence is lower than the findings of other studies [24, 25, 26]. The reason for these discrepancies could be due to differences in the provision of reproductive health services, availability, and accessibility of long-acting family planning methods in safe and convenient services for all women. The variation might also be due to socio-demographic, religious belief, norm, and other cultural differences which could have a paramount effect on implant contraceptive utilization.

The current prevalence is also lower than the results of other studies done in different parts of the country [10, 27, 28]. The discrepancy might have occurred due to a difference in the study population. This study was conducted among reproductive-age women residing in both urban and rural areas, whereas those studies were conducted based on urban settings which increase the proportion of women using implant contraceptive methods.

In the current study, marital status was an independent predictor of implant contraceptive method utilization among reproductive-age women in Ethiopia. Married reproductive-age women were 1.94 times more likely to use implants contraceptives as compared to those women who are never married, divorced, and widowed. The finding is consistent with a study conducted in Nigeria [24]. This is because married reproductive age women have a higher probability of practicing regular sexual intercourse than those women who are never married, divorced, and widowed [29, 30]. Furthermore, most married reproductive age women might have the desired number of children which might have a paramount effect on implant contraceptive utilization.

The residence was also independently associated with implant contraceptive utilization. Urban women were 1.66 times more likely to use implants as compared to their rural counterparts. The finding is supported by a systematic review and meta-analysis conducted on factors associated with long-acting family planning service utilization in Ethiopia [31]. This could be because urban women are more likely to be better educated, have better access to the health care service, and better access to family planning messages through mass media than rural women which have a vital impact on implants contraceptive utilization [32]. Conversely, rural women may need more children to get help for their fieldwork which has a negative effect on their implant’s contraceptive utilization [33, 34, 35, 36]. This may imply the need to strengthen the community-based implant family planning service provision through the effort of health extension workers which could have a contribution to the increasing use of contraceptive implants by rural women.

Women having 1–2 living children were 39% times less likely to use implants as compared to women with five and more children. Likewise, women having 3–4 living children were 42% times less likely to use implants as compared to women with five and more children. The finding is supported by a systematic review and meta-analysis done in Ethiopia [31], and other previous studies [27, 37, 38]. The reason could be women with five and more children may think that the number of children that they already have could be enough for them. This may also be due to the reason that reproductive-age women having a fewer number of children may need to bear more children to attain the desired family size [39]. Additionally, women with more births would be more likely to be older and they could likely prefer a longer period of spacing pregnancies than younger women [40]. Different literature reported that utilization of modern contraceptives including implants could increase as the number of living children increases [10, 41, 42].

Furthermore, women who reported their husband’s desire for more children were 36% times less likely to use implants than those who reported that their husband would not want more children. The finding is supported by a systematic review and meta-analysis done in Ethiopia [31], and other similar studies [24, 27, 37, 38]. This is attributable to gender expectations which can limit women’s autonomy and the benefits that women can gain when they do a decision to contraceptive use. In most parts of the Ethiopian community, husbands’ opposition could delay the decision to use contraceptives. Thus, this entails enhanced efforts in the empowerment of women as part of family planning programs [43].

Women who had a history of terminated pregnancy were 1.48 times more likely to use implants as compared to those women who had no history of terminated pregnancy. This finding is consistent with a study in Luanda, Angola, which indicated that a history of abortion was associated with implant contraceptive use [44]. The reason could be explained by those women with a history of terminated pregnancy might be had an unintended pregnancy, but they may not desire to have children currently or within a few years. Thus, to achieve their wish women may use implant contraceptives or will use long-acting methods.

Women who had a joint decision on contraception were having 2.09 times higher odds of using implants than those who decided with the help of other persons. The finding is consistent with other studies [24, 27, 37]. This indicated that the involvement of women regarding fertility and choice of contraception decision had an increased possibility of modern contraceptive use including long-term methods [45]. This strengthens evidence reported on the importance of male involvement in joint couple’s decisions on family planning method choice, and contraceptive utilization [7].

Women who had good knowledge of contraceptives were nine times more likely to use implants as compared with those who had poor knowledge. The finding is supported by other studies conducted in different settings [24, 26, 27, 37]. This might be due to the fact that having a better understanding and knowledge of contraceptive methods could help women to know more about the duration of protection, advantage, safety, and side effect of each contraceptive as well as where to get the methods.

Women who discussed FP with healthcare workers were 1.59 times more likely to use implants as compared to those women who did not discuss FP with a healthcare worker. The finding is consistent with a study conducted in Nigeria [24]. This implies that counseling and informed choice are important principles in the provision of family planning services that could help women to use contraceptive methods they preferred. Furthermore, women may understand the benefit of implants over short-acting methods in its longer protection of pregnancy and convenience to use while discussing with a healthcare worker.

Women who heard family planning messages on television were 1.60 times more likely to use implants than those women who did not hear family planning messages on television. The finding is supported by a systematic review and meta-analysis done in Ethiopia [31], and other previous studies [24, 27, 37, 38]. This could be explained by the fact that women who heard family planning messages on mass media may have a better understanding and a good insight on implant contraceptives, and can compromise unreasonable misconceptions and other barriers which preclude family planning service utilization.

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6. Strength and limitations of the study

The study used nationally representative data with a large sample size which better reflects the proportion of reproductive-age women using implant contraceptive method and its associated factors at the national level. The temporal relationship between implants contraceptive use and the determinant variables cannot be assured since the study used data from a single time survey, and the evidence should be utilized with caution. The analysis did not incorporate some important factors like distance to a health facility, quality of family planning services, peer-related factors that could influence reproductive-age women’s implant contraceptive behavior as this is not collected in the EDHS data. Besides, the association of qualitative variables like sociocultural factors to implants contraceptive utilization was not addressed as qualitative information was not fully available in the EDHS dataset.

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7. Conclusions

The study showed that the magnitude of implant contraceptive utilization among reproductive-age women in Ethiopia is very low. The finding of this study also showed that marital status, place of residence, number of living children, a history of a terminated pregnancy, husband desire for more children, decision making on contraceptive use, knowledge on contraceptives, discussed FP with the healthcare worker and heard family planning message on television were independent predictors of implants contraceptive use among reproductive-age women in Ethiopia. The finding of this study suggests any intervention strategy which is designed and being implemented to promote implants contraceptive method utilization should consider the aforementioned factors for its better success. In addition, the provision of quality counseling and information on FP, and women empowerment should be promoted so that women can freely decide on the type of contraceptive they would like to use. Moreover, emphasis should be given to rural women to implants contraceptive method use.

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Acknowledgments

We thank the Demographic Health Survey Program (http://www.dhsprogram.com) for the data.

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Authors’ contributions

BDM wrote the proposal, analysis, report writing, and drafted the manuscript. CAW made revisions to the proposal, participated in data analysis, and drafted the manuscript. All authors reviewed, revised, and approved the manuscript for publication.

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Funding

No funding has been obtained from any source to carry out this study.

Competing interests

The authors declare that they have no competing interests.

Declarations

Ethics approval and consent to participate

After developing a protocol, permission to access the 2016 EDHS data was obtained from the MEASURE DHS website at: www.dhsprogram.com by agreeing with the conditions of DHS data use stated on the DHS consent letter to the author. Ethical clearance to conduct the survey was approved by the Ethical Review Board of Ethiopia Central Statistical Agency (CSA) and the Ethiopian Health and Nutrition Research Institute (EHNRI) Review Board, the National Research Ethics Review Committee (NRERC) at the Federal Democratic Republic of Ethiopia. As indicated in the EDHS 2016 publications, written informed consent for participation was taken from study participants and written informed consent for participation was also obtained from their parent or guardian for those children (under 16 years old).

Availability of data and material

The dataset of the EDHS is not available as a public domain survey dataset but can be accessed with the request by registration on the MEASURE DHS website at: www.dhsprogram.com

Abbreviations

AORadjusted hazard ratio
CIconfidence interval
EDHSEthiopian Demographic and Health Survey
FPFamily planning
MEASURE DHSmonitoring and evaluation to assess and use results demographic and health surveys
SNNPRSouthern Nations, Nationalities, and Peoples’ Region.

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Written By

Birye Dessalegn Mekonnen and Chalachew Adugna Wubneh

Submitted: January 31st, 2022Reviewed: February 22nd, 2022Published: April 14th, 2022