Kebede Natnael, Anteneh Rahel Mulatie, Moges Natnael, Tsega Sintayehu Simie, Zemene Melkamu Aderajew, Gebeyehu Asaye Alamneh, Belete Melaku Ashagrie, Anley Denekew Tenaw, Alemayehu Ermiyas, Chanie Ermias Sisay, Dessie Anteneh Mengist
Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
Department of Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia.
Contracept Reprod Med. 2025 Mar 31;10(1):22. doi: 10.1186/s40834-025-00356-5.
While studies in Ethiopia have explored family planning use and contraceptive determinants, limited research examines the spatial variation and predictors of satisfaction with family planning methods. This study addresses this gap using geographically weighted regression (GWR) analysis to assess spatial patterns and determinants of satisfaction with family planning methods among reproductive-age women. Utilizing nationally representative 2021 Performance Monitoring for Action Ethiopia (PMA-ET) data, the study aims to provide targeted insights for improving family planning services.
A weighted sample of 1,456 reproductive-age women was analyzed. Spatial analysis was conducted using ArcGIS 10.7 and SaTScan 9.6. Hotspot detection, ordinary least squares (OLS) regression, and geographically weighted regression (GWR) were applied. The Bernoulli model was used to identify spatial clusters of satisfaction. Associations between satisfaction and explanatory variables were assessed using OLS and GWR, with statistical significance set at P < 0.05.
The overall satisfaction rate with current family planning methods was 84.1% (95% CI: 82.12, 85.97). Satisfaction levels exhibited a clustered spatial distribution. High-satisfaction hotspots were detected in Addis Ababa, most parts of Amhara, and some areas of Benishangul-Gumuz. SaTScan identified a primary spatial cluster (RR = 1.19, P < 0.001) in Addis Ababa, northern southwestern Ethiopia, and eastern Gambela, and a secondary cluster (RR = 1.18, P < 0.001) in northern Addis Ababa and southern Amhara. GWR analysis revealed that younger women (15-24 years), those with poor wealth status, and urban residents were significant spatial predictors of satisfaction.
The study revealed that satisfaction with the current use of family planning methods among reproductive-age women in Ethiopia exhibits regional variations. Statistically significant clusters of higher satisfaction were identified in Addis Ababa, most parts of Amhara, and some parts of Benishangul-Gumuz. Geographically Weighted Regression (GWR) analysis indicated that women aged 15-24, those with poor wealth status, and urban residents were significant spatial predictors of satisfaction at the local level. These findings suggest the need for targeted regional strategies to improve satisfaction with family planning services. Interventions should prioritize high-satisfaction areas to sustain progress while addressing disparities in underserved regions. Policymakers should focus on enhancing equitable access, strengthening awareness campaigns, and mitigating socioeconomic barriers to improve satisfaction with family planning.
虽然埃塞俄比亚的研究探讨了计划生育的使用情况和避孕决定因素，但对计划生育方法满意度的空间差异和预测因素的研究有限。本研究利用地理加权回归（GWR）分析来填补这一空白，以评估育龄妇女对计划生育方法满意度的空间模式和决定因素。该研究利用具有全国代表性的2021年埃塞俄比亚行动绩效监测（PMA-ET）数据，旨在为改善计划生育服务提供有针对性的见解。
对1456名育龄妇女的加权样本进行了分析。使用ArcGIS 10.7和SaTScan 9.6进行空间分析。应用了热点检测、普通最小二乘法（OLS）回归和地理加权回归（GWR）。使用伯努利模型来识别满意度的空间聚类。使用OLS和GWR评估满意度与解释变量之间的关联，统计学显著性设定为P < 0.05。
目前对计划生育方法的总体满意度为84.1%（95%置信区间：82.12, 85.97）。满意度水平呈现出聚类的空间分布。在亚的斯亚贝巴、阿姆哈拉的大部分地区以及贝尼尚古尔-古穆兹的一些地区检测到高满意度热点。SaTScan在埃塞俄比亚西南部北部的亚的斯亚贝巴和甘贝拉东部确定了一个主要空间聚类（相对风险RR = 1.19，P < 0.001），在亚的斯亚贝巴北部和阿姆哈拉南部确定了一个次要聚类（RR = 1.18，P < 0.001）。GWR分析显示，年轻女性（15 - 24岁）、财富状况较差的女性和城市居民是满意度的重要空间预测因素。
该研究表明，埃塞俄比亚育龄妇女对当前计划生育方法的满意度存在地区差异。在亚的斯亚贝巴、阿姆哈拉的大部分地区以及贝尼尚古尔-古穆兹的一些地区确定了具有统计学显著性的较高满意度聚类。地理加权回归（GWR）分析表明，15 - 24岁的女性、财富状况较差的女性和城市居民是地方层面满意度的重要空间预测因素。这些发现表明需要有针对性的区域战略来提高对计划生育服务的满意度。干预措施应优先考虑高满意度地区以维持进展，同时解决服务不足地区的差距。政策制定者应专注于加强公平获取、强化宣传活动以及减轻社会经济障碍，以提高对计划生育的满意度。
