This report presents findings from one of four further analysis projects undertaken as part of the followup to the 2000 Ethiopia Demographic and Health Survey (DHS). ORC Macro coordinated this activity and provided technical assistance. Funding was provided by the U.S. Agency for International Development (USAID) through its mission in Ethiopia.
The 2000 Ethiopia DHS survey is part of the MEASURE DHS+ project designed to collect, analyze and disseminate data on fertility, family planning, and maternal and child health. Additional information about the MEASURE DHS+ project may be obtained from MEASURE DHS+, ORC Macro, 11785 Beltsville Drive, Calverton, MD 20705 (telephone: 301-572-0200; fax: 301-572-0999; email: reports@macroint.com; internet: www.measuredhs.com).
Acknowledgements:
The author thanks Professor Charles F. Westoff, Dr. Pav Govindasamy, Lakachew Walie, Girma Kassie, Dr. Abdulahi Hassan, Amare Isaias and Kierstan Johnson, for their review of this paper, Albert Themme for data processing assistance, Dr. Sidney Moore for editorial assistance, and Kaye Mitchell for word processing.
Suggested citation:
Korra, Antenane. 2002. Attitudes toward Family Planning, and Reasons for Nonuse amongWomen with Unmet Need for Family Planning in Ethiopia. Calverton, Maryland USA: ORC Macro.
Introduction
Effective family planning programs make the rapid spread of voluntary modern family planning methods possible in any country. Such programs help people achieve their personal reproductive goals (Robey et al., 1994). Many women in developing countries use family planning methods to prevent unwanted and unplanned pregnancies. Contraceptive use levels have increased from 10 percent in the 1960s to more than 50 percent in the 1990s in developing countries (Robey et al., 1994), including some sub-Saharan countries.
Effective family planning programs make the rapid spread of voluntary modern family planning methods possible in any country. Such programs help people achieve their personal reproductive goals (Robey et al., 1994). Many women in developing countries use family planning methods to prevent unwanted and unplanned pregnancies. Contraceptive use levels have increased from 10 percent in the 1960s to more than 50 percent in the 1990s in developing countries (Robey et al., 1994), including some sub-Saharan countries.
Despite the recent increase in contraceptive use in sub-Saharan Africa, the region is still characterized by high levels of fertility and considerable unmet need for contraception (Babalola et al., 2001). For instance, in Malawi, use of modern contraceptive methods has dramatically increased from 7 percent in 1992 to 26 percent in 2000, while the fertility level has slightly decreased from 6.7 children per woman to 6.3 during the same period. However, nearly one in three currently married women has an unmet need for family planning and the demand for family planning is satisfied for only half these women (CSA and ORC Macro, 2001).
Ethiopia has also experienced a fairly slow decline in fertility over the past decade. The reported total fertility rate (TFR) was 6.4 children per woman in 1990 (CSA, 1993), and by the year 2000, it had decreased to 5.9 children per woman (CSA and ORC Macro, 2001). Although the contraceptive prevalence rate among women of reproductive age (15-49 years) has doubled during the last ten years, it still remains very low. This may indicate the existence of some barriers that prohibit couples from using family planning even if they desire to limit or delay births.
In the developing world, a substantial gap exists between women’s stated reproductive preferences and their use of contraception. This discrepancy is referred to as the unmet need for family planning (Bongaarts and Bruce, 1995). Unmet need is important for the design of family planning programs because it affects the potential demand for family planning services and has important implications for future population growth. Its definition, however, has changed over time.
Currently married women have an unmet need for family planning if they say that they want no more children (unmet need for limiting) or want to wait at least two years before having another child (unmet need for spacing) but are not using contraception. Pregnant married women whose pregnancy is unwanted or mistimed and who became pregnant because they were not using contraception also have an unmet need. Amenorrheic women whose pregnancy was unintended are also considered to have an unmet need (CSA and ORC Macro, 2001).
Many married women and women living in a union in developing countries have unmet need for spacing or limiting (Robey et al., 1996). On average, the level of total unmet need for contraception in sub-Saharan Africa is more than 20 percent. In some countries this is even higher with one in three women having an unmet need (30 percent in Malawi and 37 percent in Rwanda). Ethiopia is one of the countries with a high level of unmet need. The 2000 Ethiopia Demographic and Health Survey (DHS) indicates that the unmet need for family planning among currently married Ethiopian women is 36 percent, with 22 percent having a need for spacing and 14 percent having a need for limiting (CSA and ORC Macro, 2001). In contrast, the met need for family planning is only 8 percent. The unmet and met need together constitute the total demand for family planning, which is 44 percent at the national level. Because of the low level of contraceptive use, the proportion of demand that is satisfied is only 18 percent (15 percent for spacing and 24 percent for limiting) (see Table 1). This proportion is much lower than in Ghana (40 percent) and sub-Saharan Africa in general (41 percent) (Govindasamy and Boadi, 2000; Bongaarts and Bruce, 1995).
Given the prevailing low level of contraceptive use in Ethiopia, an analysis of unmet need and a critical assessment of the underlying factors are relevant. An understanding of the underlying causes of unmet need is important for designing effective programs to reduce the prevailing high level of unmet need. Therefore, a major concern is which factors are contributing to the observed high level of unmet need for family planning in Ethiopia and which strategies can best bring about changes to the current situation. Many factors may contribute to the observed discrepancy in unmet need and met need; however, this study focuses on demographic and socioeconomic factors and individual perceptions and attitudes. The broad objective of this analysis is to examine the underlying factors of unmet need for family planning among Ethiopian women. Specifically, this study seeks to accomplish the following:
- Analyze the characteristics of women with unmet need
- Examine attitudes toward family planning among women with unmet need
- Assess the major reasons for nonuse among women with unmet need
- Identify the main factors responsible for nonuse among women with unmet need for family planning.