Health Education and Behavioral Science Unit, School of Public Health, Mekelle University, Mekelle, Ethiopia.
Department of Medical Laboratory Science, Debre Tabor University, Debre Tabor, Ethiopia.
PLoS One. 2018 May 22;13(5):e0197366. doi: 10.1371/journal.pone.0197366. eCollection 2018.
Use of modern contraceptive methods reduces the risk of unwanted pregnancy, and is influenced by individual-level factors. Willingness to use modern contraceptive methods maybe a useful metric when considering health outcomes as it could predict health behaviors. Therefore, the current study aimed to assess the willingness of women to use modern contraceptives in Afar pastoralist communities.
A community-based cross-sectional study was conducted from May 1 to 30, 2016. Three hundred forty-five women of childbearing age (15-49 years) were systematically sampled with proportionate allocation from seven randomly selected kebeles (neighborhoods) in Aballa District of Afar Region, Ethiopia. All women meeting the inclusion criteria in each selected household were interviewed at home using a semi-structured questionnaire. Construct validity was assured using factor analysis. A combination of individual behavioral models were applied in order to measure willingness to use modern contraceptive methods. Multiple logistic regressions were utilized to identify factors associated with willingness to use contraceptive at P-value of less than 0.05.
Three hundred twenty-two women participated in the study, for a response rate of 93.3%. The mean age of respondents was 27 (±6) years. About one-third (N = 106, 32.9%) of the participants reported that they were willing to use modern contraceptives. Orthodox Christians (AOR = 4.22, 95% CI 1.94-8.92), women aged 19 or older at first marriage (AOR = 2.89, 95% CI 1.16-7.23), and women who had never experienced a stillbirth (AOR = 3.85, 95%CI 1.37-10.78) were more likely to report being willing to use modern contraceptives. Additionally, perceived severity of an unwanted pregnancy (AOR = 1.71, 95% CI 1.57-1.93) and perceived self-efficacy to use contraceptives (AOR = 1.26, 95% CI 1.17-1.65) were positively associated with the willingness. Women who had never had an abortion were less likely to express willingness to use modern contraceptives (AOR = 0.41, 95% CI 0.19-0.92) and perceived importance of cultural and religious norms (AOR = 0.85, 95% CI 0.62-0.90) was also negatively associated with willingness.
The majority of women in this study were not willing to use modern contraceptive methods. A previous pregnancy outcome of stillbirth was associated with reduced willingness, while a prior abortion was associated with increased willingness. Perceived severity of unwanted pregnancy and higher self-efficacy surrounding contraceptive use were strong predictors of increased willingness to use contraceptives. Religious and cultural norms also appear to influence perception towards modern contraception. Thus, involvement of cultural and religious leaders and consideration of a woman's reproductive history are recommended when designing health education messages on contraception for Afar pastoralist women.
使用现代避孕方法可以降低意外怀孕的风险，并且受到个体层面因素的影响。使用现代避孕方法的意愿可能是一个有用的指标，因为它可以预测健康行为。因此，本研究旨在评估阿法尔牧民社区中妇女使用现代避孕药具的意愿。
这是一项 2016 年 5 月 1 日至 30 日在埃塞俄比亚阿法尔地区阿巴拉区从七个随机选定的街区（社区）中进行的基于社区的横断面研究。从每个选定的家庭中系统地抽取了 345 名符合条件的育龄妇女（15-49 岁）进行采访。所有符合条件的妇女均在家中使用半结构式问卷进行访谈。使用因子分析来确保结构有效性。应用了个人行为模型的组合来衡量使用现代避孕药具的意愿。采用多因素逻辑回归来确定与使用避孕药具意愿相关的因素，P 值小于 0.05。
322 名妇女参加了研究，应答率为 93.3%。受访者的平均年龄为 27（±6）岁。约三分之一（N=106，32.9%）的参与者表示愿意使用现代避孕药具。东正教信徒（AOR=4.22，95%CI 1.94-8.92）、19 岁或以上首次结婚的妇女（AOR=2.89，95%CI 1.16-7.23）和从未经历过死产的妇女（AOR=3.85，95%CI 1.37-10.78）更有可能表示愿意使用现代避孕药具。此外，对意外怀孕的严重程度的感知（AOR=1.71，95%CI 1.57-1.93）和对使用避孕药具的自我效能的感知（AOR=1.26，95%CI 1.17-1.65）与意愿呈正相关。从未堕胎的妇女表示愿意使用现代避孕药具的可能性较低（AOR=0.41，95%CI 0.19-0.92），对文化和宗教规范重要性的感知（AOR=0.85，95%CI 0.62-0.90）也呈负相关。
在这项研究中，大多数妇女不愿意使用现代避孕药具。死产的先前妊娠结局与降低意愿有关，而先前的堕胎与增加意愿有关。对意外怀孕严重程度的感知和对避孕措施使用的更高自我效能感是增加使用意愿的有力预测因素。宗教和文化规范似乎也会影响对现代避孕的看法。因此，在为阿法尔牧民妇女设计有关避孕的健康教育信息时，建议让文化和宗教领袖参与，并考虑妇女的生殖史。
