Literature Review of Attitudes toward Family Planning and Reasons for Nonuse among Women with Unmet Need for Family Planning in Ethiopia

Since 1990, researchers around the world have used DHS data to investigate unmet need for family planning. This review focuses on studies that assess factors influencing the use of family planning methods. In most parts of the world, women want to have smaller families; hence rapid population growth will not be an ongoing phenomenon. Worldwide, nearly 100 million married women would prefer to avoid pregnancy but are not using any method of family planning, which means that they have an unmet need for family planning (Robey, et al., 1996).

Viable family planning programs could be devised through reliable and accurate estimates of the magnitude of unmet need for family planning. In most cases, women in the unmet need category are targets of family planning programs since there is a discrepancy between their fertility goals and contraceptive practice (Westoff and Bankole, 1998).

According to data generated from 27 DHS surveys between 1990 and 1994, unmet need for family planning ranges from 11 percent in Turkey to 37 percent in Rwanda (Casterline et al., 1997). In the same period, it was found that unmet need is most prevalent in sub-Saharan Africa. On average, the fertility level in sub-Saharan Africa could be reduced by about one birth per woman if it were possible to meet the unmet need for family planning (Robey et al., 1996).

Likewise, the majority of currently married Ethiopian women want to control their future fertility. According to the 2000 Ethiopia Demographic and Health Survey report, nearly one third of Ethiopian women do not want to have any more children, a figure that rose from one quarter in the 1990 National Family and Fertility Survey (NFFS). In the 1990 NFFS, unmet need for family planning to limit childbearing was less than 1 percent among currently married women, whereas this figure was 14 percent in the 2000 Ethiopia DHS survey. This implies that there is an increasing demand for fertility control (CSA, 1993; CSA and ORC Macro, 2001).

Thus, meeting the unmet need for family planning may play an important role in slowing the pace of population growth, improving maternal and child health, and minimizing problems with natural resources and the environment that prevail in Ethiopia. In many countries, the stated targets of population policies, i.e., increasing contraceptive use and decreasing fertility levels, could be achieved by eliminating the unmet need for family planning (Ross and Mauldin, 1994; Westoff and Bankole, 1995).

Although unmet need has considerable demographic and social significance, its root causes are still largely unknown (Dixon-Mueller and Germain, 1992). Analysis of data from 13 DHS surveys by Bongaarts and Bruce (1995) showed that lack of knowledge, fear of side effects, and husband’s disapproval were the principal reasons for nonuse among women who were otherwise motivated to use family planning. A study by Westoff and Bankole (1995) using DHS-II data indicated that lack of information about family planning, opposition to family planning, and ambivalence about future childbearing were the principal factors responsible for unmet need for family planning.

Using the 1990 NFFS, Sahelyesus (1995) studied determinants of contraceptive nonuse and unmet need among married women in urban Ethiopia. His findings showed that the number of surviving children and ideal family size are the most important determinants of unmet need for family planning in urban Ethiopia.

Similarly, reasons for not using a contraceptive method among Ghanaian women were assessed by Govindasamy and Boadi (2000) using data collected in the Ghana Demographic and Health Surveys that were conducted in 1988 and 1998. According to their results, a significant number of women mentioned fertility-related reasons (infrequent sex, menopausal/subfecund, postpartum/breastfeeding, and wanting more children) as principal reasons for nonuse. Methodrelated reasons, particularly fear of side effects for method use, were also cited as reasons for nonuse. In Uganda, community mobilization in family planning programs has also been difficult and has been hindered by opposition to family planning on the part of some religious and community leaders (Okwero et al., 1994).

Another report presented a review of literature on male attitudes and behaviors concerning family planning and male initiatives in Africa. The results indicated that men often have positive attitudes toward family planning, but women believe that their husband disapproves of family planning. The report further noted that spousal communication was positively associated with family planning method use (Toure, 1996). However, another study conducted by Ezeh (1993) in Ghana showed that spousal influence, rather than being mutual or reciprocal, is an exclusiveright of the husband. According to the Demographic and Health Surveys, many married womenwho want to avoid pregnancy are not using contraception because their husband objects. Nearly one in ten married women with unmet need cited husband’s disapproval as the principal reason for nonuse of contraception (Drennan, 1998).

A similar study of family planning programs in India’s rural Bihar state indicated that improved access to services, expanded choice of available methods, and increased knowledge of family planning were important for the acceptance of contraception. However, opposition from husbands and in-laws, the desire for at least two sons, and lack of trust of voluntary health workers from a different caste or religion were obstacles to the acceptance of contraception (Rudranand et al., 1995)
As indicated in the previous subsections of this analysis, the unmet need for family planning is high (about 36 percent) in Ethiopia. Therefore, this study looks at whether the factors that have been mentioned are associated with the prevailing high level of unmet need for family planning in Ethiopia.

There have been numerous research endeavors on factors associated with the use of family planning methods in most parts of Africa and Asia. However, such studies are limited in Ethiopia, but there are a few fragmented descriptive studies that have been carried out by scholars, mainly dealing with the reasons for nonuse of contraceptive methods. To fill these gaps, this study assesses the socioeconomic and demographic factors, as well as individual attitudes and perceptions, influencing use of family planning in Ethiopia. It is hoped that this study will contribute to the improvement of family planning services in the country through appropriate service delivery approaches and strategies.

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