Spatial Disparities and Determinants of Modern Contraceptive Use Among Reproductive Age Women in Ethiopia: Application of Multilevel Spatial Analysis

Abstract

<title>Abstract</title> Background Contraception involves the intentional prevention of conception or pregnancy during sexual activity. Globally, unintended pregnancies can occur due to the non-use, misuse, or failure of modern contraceptive methods. Non-use of modern contraceptives is a significant contributor to maternal and infant mortality rates in Sub-Saharan Africa, including Ethiopia. Hence, the main purpose of this study was to determine the factors of modern contraceptive use among reproductive-age women in Ethiopia. Method The 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) dataset with 8,196 weighted samples of reproductive women aged 15 to 49 was used. Data management was done using STATA version 17 software, R version 4.2.2, and Arc GIS 10.8 software was used for mapping. To investigate the determinants factor, we used both multilevel and spatial analysis. Results In this study, 26% of women used modern contraceptives, with significant spatial clustering (Global Moran’s Index = 0.237776, p &lt; 0.001). Hot spot areas were observed in Benishangul gumuz, Gambela, SNNP, and Eastern parts of the Oromia region. The model that includes individual-level, community-level variables, and spatial auto covariate variables was the best-fitted model for the data based on lower AIC and BIC fit statistics compared to the other models. The estimated intra-class correlation coefficient (ICC) indicates that 15.57% of the total variability for modern contraceptive use was due to the difference between clusters, leaving 84.43% of the variability to be accounted for the women or other unknown factors. The estimated odds of women at a higher educational level using modern contraceptives were 91.9% higher than the estimated odds of women with no education. Conclusions This study revealed that the use of a modern contraceptive method among women varies across the clusters. There is a low magnitude of modern contraceptive use among women in Ethiopia. Based on the result of the selected model, Women’s Aged (25–34), educated, married, living in Amhara Region, having higher community education, and having higher community wealth index were positively associated with the use of modern contraceptive methods. While the women aged 35–49, having 3 or more children, living in Somali Region were negatively associated with the use of contraceptive methods. The intervention measures should be undertaken by the concerned body at the community level to enhance the use of modern contraceptive methods among women across the clusters.