Umeå International School of Public Health, Umeå University, Umeå, Sweden.
Department of Epidemiology and Global Health, Umeå University, Umeå, SE-901 87, Sweden.
BMC Womens Health. 2023 Apr 4;23(1):158. doi: 10.1186/s12905-023-02304-4.
Unmet need for family planning (FP) is a global public health concern, particularly in low- and middle-income countries. In Ethiopia, although several studies have assessed unmet needs for FP, there have only been few empirical investigations into regional inequalities and their contributory factors. This study assessed urban-rural inequalities in unmet FP needs among reproductive-aged women in Ethiopia and particularly examined the contribution of material, cultural-behavioral, and psychosocial factors therein.
A cross sectional study was conducted among 8811 reproductive-aged women derived from the nationally representative 2019 Ethiopian Performance Monitoring for Action (PMA) data. The outcome variable was unmet need for FP. The exposure variable was place of residence (urban or rural). Contributing factors were categorized into material, psychosocial and cultural-behavioral factors. Blinder-Oaxaca decomposition analysis was used to assess urban-rural inequalities in unmet need for FP as well as to disentangle the contributory factors in percentage points.
In our study, 13.8% of reproductive-aged women in Ethiopia reported unmet FP needs. Urban-rural inequalities therein accounted for 6.8% points. Disparities in FP needs between urban and rural areas were mostly explained by psychosocial factors (81.0%) followed by material (21.0%), and cultural-behavioral (3.2%) factors. While women who were living with a partner (39.1%, p < 0.01) and multiparas (51%, p < 0.01) contributed to increasing inequalities, attending family planning counseling services with a healthcare provider (-1.7%, p = 0.03) reduced the gap in unmet need for FP between urban and rural areas. Women from the poorest and poor category contributed 14.1% (p = 0.02) and 11.1% (p = 0.04), respectively. Being from a Muslim religion also contributed to the disparity by 7.3% (p < 0.01).
This study showed that among reproductive-aged women in Ethiopia, inequalities in unmet FP needs show distinct urban-rural patterning. Most inequalities could be attributed to psychosocial factors, mainly parity and marital status, followed by material and cultural-behavioral factors. Policymakers should target these modifiable psychosocial factors to reduce urban-rural inequalities in unmet need for FP in Ethiopia.
计划生育未满足的需求是一个全球性的公共卫生问题，尤其是在低收入和中等收入国家。在埃塞俄比亚，尽管已经有几项研究评估了计划生育未满足的需求，但对区域不平等及其促成因素的实证研究很少。本研究评估了埃塞俄比亚育龄妇女计划生育未满足需求的城乡不平等，并特别研究了物质、文化行为和心理社会因素的贡献。
这是一项横断面研究，对象是来自全国代表性的 2019 年埃塞俄比亚绩效监测行动（PMA）数据的 8811 名育龄妇女。结果变量是计划生育未满足的需求。暴露变量是居住地（城市或农村）。促成因素分为物质、心理社会和文化行为因素。使用 Blinder-Oaxaca 分解分析评估计划生育未满足需求的城乡不平等，并按百分比分解促成因素。
在本研究中，埃塞俄比亚 13.8%的育龄妇女报告计划生育未满足需求。城乡之间的不平等占 6.8%。城乡地区计划生育需求差异主要由心理社会因素（81.0%）解释，其次是物质因素（21.0%）和文化行为因素（3.2%）。虽然与伴侣生活在一起的妇女（39.1%，p<0.01）和多产妇（51%，p<0.01）导致不平等加剧，但与医疗保健提供者一起接受计划生育咨询服务（-1.7%，p=0.03）减少了城乡地区计划生育未满足需求的差距。来自最贫穷和贫穷类别的妇女分别贡献了 14.1%（p=0.02）和 11.1%（p=0.04）。属于穆斯林宗教也导致了 7.3%的差异（p<0.01）。
本研究表明，在埃塞俄比亚的育龄妇女中，计划生育未满足需求的不平等表现出明显的城乡格局。大多数不平等可以归因于心理社会因素，主要是生育和婚姻状况，其次是物质和文化行为因素。决策者应针对这些可改变的心理社会因素，以减少埃塞俄比亚计划生育未满足需求的城乡不平等。
