African Population and Health Research Center, Manga Close, Kitisuru, Nairobi, Kenya.
Center for Population Studies and Institute of Development and Policy Research, Addis Ababa, University, Addis Ababa, Ethiopia.
PLoS One. 2019 Jan 16;14(1):e0209602. doi: 10.1371/journal.pone.0209602. eCollection 2019.
Long acting reversible and permanent contraception (LARPs) offer promising opportunities for addressing the high and growing unmet need for modern contraception and helps to reduce unintended pregnancies and abortion rates in sub-Saharan Africa (SSA). This study examines the contextual factors that influence the use of long acting reversible and permanent contraception among married and fecund women in Ethiopia.
We use data from the 2016 Ethiopian Demographic and Health Survey to examine the contextual factors that influence choice of long acting reversible and permanent contraception among married, non-pregnant and fecund women. The DHS collects detailed information on individual and household characteristics, contraception, and related reproductive behaviors from women of reproductive age. In addition, we created cluster level variables by aggregating individual level data to the cluster level. Analysis was done using a two-level multilevel logistic regression with data from 6994 married (weighted = 7352) women residing in 642 clusters (communities).
In 2016, 12% of married, non-pregnant and 'fecund' women were using long-acting reversible and permanent methods of contraception in Ethiopia. A higher proportion of women with secondary and above education (17.6%), urban residents (19.7%), in the richest wealth quintile (18.3%) and in paid employment (18.3%) were using LARP methods compared to their counterparts. Regression analysis showed that community level variables such as women's empowerment, access to family planning information and services, region of residence and knowledge of methods were significantly associated with use of LARP methods. Age, wealth status, employment status and women's fertility preferences were among the individual and household level variables associated with choice of LARP methods. With regards to age, the odds of using LARP methods was significantly lower among adolescents (OR, 0.53; 95% CI, 0.32-0.85) and women over the age of 40 (OR, 0.63; 95% CI, 0.44-0.90) compared to women in their 20's.
The findings of this study indicate that the demand for long-acting reversible and permanent contraception is influenced not only by women's individual and household characteristics but also by the community's level of women's empowerment, socio-economic development, as well as access and exposure to family planning information and services. Thus, improving knowledge of long-acting reversible and permanent methods, improving women's decision making autonomy and upgrading the capacity and skills of health workers particularly the midlevel providers and community health extension workers on the provision of LARP methods and rights-based approach is important to improve the uptake of LARP methods.
长效可逆和永久性避孕（LARPs）为解决撒哈拉以南非洲（SSA）不断增长的现代避孕需求提供了有希望的机会，并有助于降低意外怀孕和堕胎率。本研究考察了影响埃塞俄比亚已婚和生育妇女使用长效可逆和永久性避孕的背景因素。
我们使用 2016 年埃塞俄比亚人口与健康调查的数据，考察了影响已婚、未怀孕和生育妇女选择长效可逆和永久性避孕的背景因素。DHS 从育龄妇女那里收集了关于个人和家庭特征、避孕和相关生殖行为的详细信息。此外，我们通过将个人数据汇总到集群级别来创建集群级别的变量。使用来自 6994 名已婚（加权=7352）妇女和 642 个集群（社区）的数据，使用两级多水平逻辑回归进行分析。
2016 年，埃塞俄比亚 12%的已婚、未怀孕和“生育”妇女使用长效可逆和永久性避孕方法。与对照组相比，受过中等教育及以上（17.6%）、城市居民（19.7%）、最富有五分之一（18.3%）和有薪就业（18.3%）的妇女使用 LARP 方法的比例更高。回归分析表明，妇女赋权、计划生育信息和服务获取、居住地和方法知识等社区层面变量与 LARP 方法的使用显著相关。年龄、财富状况、就业状况和妇女的生育偏好是与 LARP 方法选择相关的个人和家庭层面变量。就年龄而言，与 20 多岁的妇女相比，青少年（OR，0.53；95%CI，0.32-0.85）和 40 岁以上的妇女（OR，0.63；95%CI，0.44-0.90）使用 LARP 方法的可能性显著降低。
本研究结果表明，长效可逆和永久性避孕的需求不仅受妇女个人和家庭特征的影响，还受社区妇女赋权、社会经济发展以及获取和接触计划生育信息和服务的影响。因此，提高对长效可逆和永久性方法的认识，提高妇女的决策自主权，提高中层次提供者和社区卫生推广人员提供 LARP 方法和基于权利的方法的能力和技能，对于提高 LARP 方法的使用率非常重要。
