Contraceptive utilization is one of indicators that can inform status of family planning programs. More than half (53.3%) of the study subjects were using any type of contraceptive methods. Although contraception utilization was higher than previously reported in study area [15, 17], it was lower than ministry of health plan that targeted to reach 66% in the year 2015 [19].
Nearly three fourth (73.9%) of current users were using short term contraceptive methods mainly injectable. This finding was consistent with other previous studies in Ethiopia [8, 15, 17, 20–22], Kenya [23] and Ghana [24]. FGD participants also agreed that due to the simplicity of the procedure, popularity by promotion and availability in health facilities, injectable was the most chosen contraceptive method. In addition, in-depth interview with providers also indicated that when clients come to health facility for the first time, some providers simply give injectable without informing choices and women continue using it.
Women in the age range of 35 to 39, 40 to 44 and 45 to 49 years were 52% [AOR 95% CI 0.31–0.89], 29% [AOR 95% CI 0.15–0.54] and 29% [AOR 95% CI 0.09–0.86] less likely to use contraceptive methods as compared those in age range of 15 to 19 years. Previous studies also showed that older age negatively influenced contraceptive use [13, 25].
Avoiding barriers to the use of contraceptive methods could avert globally 54 million unintended pregnancies, 79,000 maternal deaths and one million infant deaths each year [5]. Due to different factors, in 2012, unintended pregnancy in Africa was the highest (80 per 1,000 women aged 15–44) [4]. Women sexually active and living alone are also at risk of unintended pregnancy. Researches from Ethiopia reported that younger age groups (20–24 years) were at risk of unwanted pregnancy [26, 27] while single women were more likely to have induced abortion [27] which is major cause of maternal mortality. In this study, those who were single or not with partner were less likely to utilize contraceptive methods as compared to those women with partner. Those who ever married but not living with partner (divorced, widowed or separated) at time of data collection were 24% less likely to use contraceptive than married and living with partner with AOR at 95% CI 0.24 [0.16–0.37]. In-depth interview with community level health care workers also showed that in some communities, there was community taboo of using contraceptives unless living with partner.
Majority, 88%, of participants heard at least one contraceptive method and awareness of contraception was also high. Having overall good knowledge of and attitude to contraceptives were positively associated with contraceptive use with AOR 15.51 [95% CI 9.75–24.68] and 1.97 [95% CI 1.57–2.47] respectively. Even though the benefits of contraceptive were acknowledged by majority of study participants, lack of knowledge, desire to have many children and fear of perceived side effects of contraceptives were mentioned as reasons for non-use as also reported by other researches [13, 15, 28–32].
Though good level of contraceptive awareness was noted by quantitative interview, FGDs with women showed that contraceptive utilization was affected by various misconceptions. The misconceptions ranged from fear of side effects to association of death of a woman with contraceptive use. Some women believed menstruation as a sign of being healthy and added if menstruation decreases or disappears, the dirty blood would accumulate and can cause cancer. They also believed that young women should not use contraceptive before their first pregnancy; because if they use, their uterus may become dirty and as a result they may not get pregnant. The in-depth interviews findings also indicated that long acting methods particularly implants and IUCD were not preferred by community due to fear of procedure and side effects. Such myths and misconception were also reported in Nigeria [11]. Even though these type of thoughts were from minor groups, they need attention as they have potential to get majorities concern especially in rural communities.
Rural FGDs participants reported that people in the rural areas prefer many children because children are sources of labor for families. But in general sample, women having 1–2 children were 3.07 times more likely to use contraceptives than those who had no children [AOR 95% CI 2.06–4.58] and women having 3–4 and more than five children were 3.74 times more likely [AOR 95% CI 2.41–5.82] and 4.67 times more likely [AOR 95% CI 2.91–7.49] than women who had no children respectively. This was in line with other findings that reported as the number of living children increases, use of contraceptives increases [12, 33]. Pastoralist FGD participants preferred having as many children rather than using contraception. This was enforced by in-depth interview findings; women in pastoralist area have no or limited power to decide and use contraceptive. Women from pastoralist were 33% less likely to use contraceptives than agrarian with AOR 0.33 [95% CI 0.14–0.84].
Improvement of the status of women in the family and in society can contribute to smaller family size, the opportunity for women to plan births and also improves their individual status. Countries are recommended to respect and ensure, regardless of their overall demographic goals, the right of persons to determine, in a free, informed and responsible manner, the number and spacing of their children [34]. But in this study only about half, 52.8%, decided number of children to have. Women who had decided number of children were 58% more likely to utilize contraceptives than those who had not decided with AOR at 95% CI 1.58 [1.29–1.93]. Child death also matters on deciding family size. Women who had experienced child death were 62% less likely to utilize contraceptive than who had not experienced child death. 0.62 [0.48–0.81]. This might be due to an attempt to replace the lost ones and want to have more children.
This study was limited in assessing male partner involvement and support, gender myths and specific roles and power inequalities which can function as a barrier to contraceptive utilization. Results might have been affected by social desirability bias since questionnaires were collected by interviewers. In addition, risk for pregnancy or sexual activity was not assessed which could be reason for non-use of contraceptive/s.
