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Unmet need for family planning and associated factors, among women of child-bearing age working in Hawassa industrial park, Southern Ethiopia 2021: An institution based cross-sectional study

Open AccessPublished:August 06, 2022DOI:https://doi.org/10.1016/j.cegh.2022.101122

      Abstract

      Background

      Despite the negative consequence of the unmet need for family planning no study has been conducted on women working in the industrial parks. Therefore this study aimed to determine the prevalence of unmet need for family planning and its associated factors among women in reproductive age working in Hawassa industrial park.

      Methods

      An institution-based cross-sectional study was conducted from July 1 to 30/2021 among randomly selected 405 women working in Hawassa industrial park. Data was collected using face-to-face interviews using a pre-tested structured questionnaire. The data was entered into Epi-data 3.1 and exported to SPSS Version 24 for statistical analysis. Bivariable and multivariable logistic regression analyses were used to identify factors associated with the unmet needs for family planning. Independent factors associated with the unmet need for family planning were assessed using AOR with their corresponding 95% CIs at P-value < 0.05 cut of point.

      Result

      In this study, the prevalence of unmet need for family planning was 27.7% (95% CI 23.2 to 32.3). Educational status [AOR = 4.53; CI (1.62, −12.61)], marital status (AOR = 7.2; 95% CI: (3.77, 13.73)], residence [AOR = 0.56; 95% CI: (0.31, 0.99)], and knowledge of family planning [AOR = 0.36; 95% CI: (0.20, 0.63)] were independent predictors of unmet need for family planning.

      Conclusion

      This study found that the prevalence of unmet needs for family planning was high. Educational status, marital status, residence, and knowledge of family planning were significantly associated with unmet needs of family planning.

      Keywords

      1. Introduction

      Globally, many women and couples want to postpone or avoid unwanted pregnancies.
      • Bearak J.
      • Popinchalk A.
      • Alkema L.
      • Sedgh G.
      Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model.
      ,
      United Nations Department of Economic and Social Affairs Population Division
      World FamilyPlanning.
      In 2020, among 1.9 billion women of reproductive age (15–49 years), 1.1 billion women were considered to require family planning, of these women, 851 million are using a modern method of contraception and 85 million are using a traditional method. An additional 172 million women are using no method at all, despite their desire to avoid pregnancy.
      United Nations Department of Economic and Social Affairs Population Division
      World FamilyPlanning.
      In Ethiopia despite Health Extension Program has significantly improved access to FP services,
      • Kora A.
      Situation analysis of family planning services in Ethiopia.
      22% of currently married women have an unmet need for family planning according to the Ethiopian demographic health survey (EDHS) 2016.
      Central Statistical Agency Addis Ababa EI
      Demographic Health Survy Ethiopia.
      The SDG plans to ensure universal access to sexual and reproductive healthcare services including family planning will enable more women with a need for family planning to make an informed choice about a method of contraception that is acceptable and appropriate in their circumstances.
      United Nations Department of Economic and Social Affairs Population Division
      World FamilyPlanning.
      The Government of Ethiopia committed itself to the achievement of Sustainable Development Goals (SDGs) and strongly believed family planning was one of the key strategies to improve maternal health and bring about development. In this regard, several policies and strategies have been developed to strengthen the demand and service for the provision of family planning services.
      • Commitments G.
      • Ownership N.
      Federal Democratic Republic of Ethiopia the 2017 Voluntary National Reviews on SDGs of Ethiopia : Government Commitments.
      The unmet need for family planning is projected to remain above 10% worldwide between now and 2030, despite the reductions anticipated for some regions. The largest declines are expected in Eastern Africa, where unmet need is projected to fall from 22% in 2017 to 16% in 2030, similar reports from Ethiopia Unmet need for family planning among married women has declined over time, from 37% in 2000 to 22% in 2016.
      Central Statistical Agency Addis Ababa EI
      Demographic Health Survy Ethiopia.
      Globally, 43% of unintended pregnancies occurred in low and middle-income countries of which 74% of them were related to unmet need for family planning. In addition to this, in East Africa, unmet need for family planning is responsible for 86% of unintended pregnancies.
      • Singh S.
      • et al.
      Adding it up: The Cost and Benefits of Investing in Family Planning Maternal Health and New Born.
      Abortion is a frequent consequence of unintended pregnancy. An estimated 18 million unsafe abortions take place each year in the low-income countries which in turn result in serious, long-term negative health effects including infertility and maternal death.
      • Stover J.
      • Winfrey W.
      The effects of family planning and other factors on fertility, abortion, miscarriage, and stillbirths in the Spectrum model.
      Different kinds of the literature identified that different factors influencing unmet need for family planning were Age of the respondent, Marital status, Women's education, Partner education, women's employment, Multiparty, Husband attitude towards family planning, respondents' information about family planning, perceived risks of pregnancy, Knowledge of contraceptive method and discussion with partner and health professional were among the factors associated with the unmet need to limit fertility.
      • Bhusal C.K.
      Factors affecting unmet need of family planning among married tharu women of dang district , Nepal.
      • Dejenu G.
      • Ayichiluhm M.
      • Abajobir A.A.
      Prevalence and associated factors of unmet need for family planning among married women in enemay district, northwest Ethiopia: a comparative cross-sectional study.
      • Gebresilassie Y.H.
      • Woldu G.T.
      Explaining unmet need for family planning in rural tigrai , Ethiopia.
      • Wolde A.
      • Haile D.
      • Anjulo U.
      • Wolde J.
      Unmet need for modern contraceptive methods and associated factors among currently married women in Damot Woyde district , SNNPR.
      • Worku S.A.
      • Ahmed S.M.
      • Mulushewa T.F.
      Unmet need for family planning and its associated factor among women of reproductive age in Debre Berhan Town.
      • Letamo G.
      • Navaneetham K.
      Levels, trends and reasons for unmet need for family planning among married women in Botswana: a cross-sectional study.
      • Adebowale S.A.
      • Palamuleni M.E.
      Determinants of unmet need for modern contraception and reasons for non-use among married women in rural areas of Burkina Faso.
      Despite its magnitude and negative health effects, the majority of the previous studies were focused on married reproductive-age women in the community. But this study focused on women working in the industrial park, most of them are adolescents and unmarried and their working conditions and socio-demographic conditions might reduce their access to family planning services. As a result, this study may guide health care providers to initiate intervention regarding family planning, particularly for unmarried girls who work in different industrial parks. Therefore, this study aimed to determine the level of unmet need for family planning and associated factors among women of the reproductive age working in Hawassa industrial park, Southern Ethiopia.

      2. Methods and materials

      2.1 Study area, design, and period

      An institution-based cross-sectional study was done at Hawassa industrial parks, from July 1 to 30/2021. Hawassa is found 273 km south of Addis Ababa. The Hawassa Industrial Park, which opened in July 2016, has been described as the Ethiopian government's “flagship” industrial park. Currently, a total of 28,721 individuals working in the 22 companies of the park, among them 3957 were male and 24,764 were women of reproductive age. There is one clinic for the park and one 1st aid corner for each company.
      • Hardy M.
      Hawassa Industrial Park administrative data collection support.

      2.2 Study participants, inclusion and exclusion criteria

      The source population was all women in the reproductive age group who were working in Hawassa Industry Park. All women in the reproductive age group who were working in Hawassa industry parks and who were available during the data collection period were included in this study. Those women who were sick at the time of data collection were excluded from this study.

      2.3 Sample size determination and sampling procedure

      The sample size for this study was computed based on single population proportion formula, using the prevalence of unmet need for family planning among women in the reproductive-age women from previous study done in Tigray region of 41.8%,
      • Gebrecherkos K.
      • Gebremariam B.
      • Gebeyehu A.
      • Siyum H.
      • Kahsay G.
      Unmet need for modern contraception and associated factors among reproductive age group women in Eritrean refugee camps , Tigray , north Ethiopia : a cross - sectional study.
      Z-value of 1.96 at 95% confidence level, the margin of error of 5%, and 10% non-response rate. The final sample size was 412.
      All the company of the Hawassa Industrial parks was covered by the study. From a total of all companies,
      • Hailemariam A.
      • Haddis F.
      Factors affecting unmet need for family planning in southern nations, nationalities and peoples region, Ethiopia.
      seven of them were selected through simple random sampling using the lottery method. After selecting the company sample size was proportionally allocated to the selected company based on the number of women working on them. Finally, a simple random sampling technique was employed from the list of women working in the selected company.

      2.4 Study variables

      Dependent variable- The unmet need for family planning and dichotomized as the presence of unmet need (1 = yes) and absence of unmet need (0 = no)
      Independent variables- Socioeconomic and demographic factors (age, marital status, ethnicity, religion, educational status (women and partner), mothers and partner occupation, household monthly income, family size, number of live children; Reproductive history (age at marriage, age at pregnancy, history of pregnancy, parity, desired number of children); Awareness and information related characteristics:(Women Knowledge, and Media exposure)

      2.5 Operational definitions

      Unmet need for family planning: women who desire to either delay the next pregnancy or limit future pregnancies but are not using any method of contraception.
      Good knowledge- 9 questions were used to measure the level of knowledge regarding family planning. Those respondents who score mean and above on knowledge questions were categorized as having good knowledge.

      2.6 Data collection instrument and procedures

      Data was collected using interviewer-administered structured questionnaires that were prepared after reviewing different published literature (9–14) The questionnaire was designed in English and was translated into Amharic and Sidaamu Afoo for common understanding, and then translated back to English by a language expert to check for consistency.
      The first part of the questionnaire contains information about sociodemographic and socioeconomic characteristics and the second part includes reproductive characteristics and the third deals with awareness and information-related characteristics. Data collectors were four nurses and supervisors were two health officers.

      2.7 Data quality assurance

      Data collectors were trained on how to collect and handle data. A questionnaire was pretested on 5% of the sample in Yirgalem Industrial Park two weeks before the actual data collection period. After data collection, each questionnaire was given a unique code by the investigators. The researcher checked the filled questionnaires at the end of data collection every day for completeness, consistency and to take corrective measures. Before entering epi-data data completeness was checked manually.

      2.8 Data processing and analysis

      Data were entered into Epi data version 3.1 and was exported to the SPSS version 24 for analysis. Data exploration was conducted to examine different characteristics of the data and descriptive statistics were used to describe the data depending on its nature. Descriptive statistics such as frequencies, proportions, and percentages were done for the categorical variables while measures of central tendency and dispersion were summarized for continuous data.
      Bivariable variable logistic regression was carried out to select a candidate for multivariate logistic regression analysis with a p-value <0.25 at a 95% confidence level. Then, a candidate variable was entered into a multivariable logistic regressions model to identify the statistically significant factors for the unmet need for family planning. The degree of association between dependent and independent variables was assessed using an adjusted odds ratio and statistically significant factors were declared at 95% of a confidence interval and a p-value of less than 0.05.

      3. Result

      3.1 Socio-demographic characteristics of the respondents

      A total of four hundred five (405) women of childbearing age participated in the study, making a response rate of 98.54%. The mean (SD) age of the respondents was 23.96 (3.531) years. The minimum and the maximum age of the respondents were 18 and 35 years respectively. More than half of the respondents 253 (62.5%) had college and above level of educational status and more than half of them were 282 (69.6%%) lived in rural areas. Two hundred twenty-five (55.6%) of the respondents were single. About 101 (24.9%%) of the participants had a monthly income of the 4501–6000 Ethiopian birr. Regarding ethnicity, the majority 321 (79.3%) were Sidama (Table 1).
      Table 1Socio-demographic characteristics of women are of child bearing age working in Hawassa industrial parks, southern Ethiopia 2021.
      Variables (n = 405)FrequencyPercentage
      Age≤25 years27968.9
      26–35years12631.1
      Educational statusRead and write266.4
      Primary education235.7
      Secondary education10325.4
      college and above25362.5
      ResidenceRural12330.4
      Urban28269.6
      Marital statusMarried18044.4
      Single22555.6
      ReligionOrthodox7518.5
      Protestant28971.4
      Muslim174.2
      Others245.9
      EthnicitySidama32179.3
      Oromo194.7
      Amara317.7
      Other348.4
      Monthly income>1500 ETB7217.8
      1500-3000 ETB9022.2
      3001-4500 ETB7719.0
      4501-6000 ETB10124.9
      >6000 ETB6516.0

      3.2 Reproductive characteristics of women of childbearing age

      The majority, 364(89.9%) of respondents had access to health facilities and from this 182 (44.9%) of them live at a medium distance from the health facility. More than half, 253(62.5%) of respondents took <30 min to the health facility, and 178(44.0%) of study participants had a previous history of using FP services. Regarding the current use of contraceptives, 82(20.2%) of them use FP and 40(48.8%) of them use the injectable types of FP. Concerning the pregnancy status of non-users, 245(75.9%) of women were non-pregnant and 232(57.3%) women had no child. Of a total of women who have children, 135(78%) had fewer than two children and 247(61%) desire to have less than five children and 77(19%) of respondents had a history of abortion. Concerning discussion with health professionals, the majority 214(52.8%) of women discuss family planning with health care professionals (Table 2).
      Table 2Reproductive characteristics of women's of child bearing age working in Hawassa industrial parks, southern Ethiopia 2021.
      VariableFrequencyPercentage
      Availability of health facilityYes36489.9
      No4110.1
      Distance of facilitylong10525.9
      medium18244.9
      short8420.7
      i dont know348.4
      time taken to health facility<30 min25362.5
      >30 min10525.9
      I don't know4711.6
      Past contraceptive useYes17844.0
      No22756.0
      Current use of contraceptiveYes8220.2
      No32379.8
      Type of contraceptiveoral pill1315.9
      injectable4048.8
      implant2226.8
      IUCD78.5
      Pregnancy status among non-usernon pregnant24575.9
      pregnant7824.1
      ChildrenYes17342.7
      No23257.3
      Number of children1–213578
      ≥23822
      Desire number of children< Five24761.0
      > five15839.0
      History of abortionYes7719.0
      No32881.0
      Discussion with health professionalyes21452.8
      No19147.2

      3.3 Knowledge of women working in industrial park about family planning

      Two hundred eighty-five, (70.4%) of respondents had good knowledge about family planning. Most of the respondents 218 (67.9%) knew about pills and 191(59.5%) knew about the injectable type of FP. In the past 6 months before the initiation of data collection, 120 (29.6%) women never discussed contraceptive methods with their family at least once and 188(46.4%) of women rarely discuss family planning with friends (Table 3).
      Table 3Knowledge about family planning among women's of child bearing age working in Hawassa industrial parks, southern Ethiopia 2021.
      Knowledge on FPGood28570.4
      Poor12029.6
      Knowledge on condomyes9529.6
      No22670.4
      Pillsyes21867.9
      No10332.1
      Injectableyes19159.5
      No13040.5
      IUCDyes278.4
      No29491.6
      Implantyes10833.6
      No21366.4
      Tubal lagationyes103.1
      No31196.9
      Emergencyyes31598.1
      No61.9
      Rhythemyes1.3
      No32099.7
      Lactational_aminorrheayes175.3
      No30494.7
      Discussion with familyfrequently9523.5
      sometime10024.7
      rarely9022.2
      never12029.6
      Discussion with friendsfrequently4210.4
      some time10225.2
      rarely18846.4
      never7318.0
      Use of contraceptiveyes30876.0
      No7217.8
      unknown256.2

      3.4 The magnitude of unmet need

      In this study, the overall unmet need for FP among women in the reproductive age (15–49yrs) group working in the industry park was 27.7% (95% CI 23.2 to 32.3) of which 81(72.3%) were to delay and 31(27.7) to limit pregnancy.

      3.5 Factors associated with unmet need for family planning

      In the multivariate analysis, the partner's education level, marital status, knowledge about family planning, and residence were significantly associated with the unmet need for FP.
      Women who attained Primary education were 4.53 times more likely of having an unmet need for FP as compared to those respondents with college and above education[AOR = 4.53; CI (1.625,12.615)]. Furthermore, the odds of unmet need for FP were 7.20 times (AOR = 7.2; 95% CI: (3.777, 13.733)] higher among those who reported being married as compared to their counterparts. Women from rural residence were 0.56 times less likely to have unmet need for FP than their counterparts [AOR = 0.56; 95% CI: (0.312, 0.991)]. The unmet need for FP was 0.36 times less likely among knowledgeable respondents as compared to their counterparts. [AOR = 0.36; 95% CI: (0.202, 0.633)] (Table 4).
      Table 4Bivariable and Multivariable logistic regression analysis of factors associated with unmet need for FP among women of child bearing age working in Hawassa industrial parks, southern Ethiopia 2021.
      VariableUnmet needCOR(95%CI)AOR(95%CI)P·V
      YesNo
      Age
      ≤25 years692100.63(0.401, 1.002)1.57(0.867, 2.846)0.136
      26–35years438311
      Educational status
      Read and write9171.50(0.638, 3.528)1.99(0.748, 5.296)0.168
      Primary education12113.09(1.302, 7.340)4.53(1.625,12.615)0.004
      Significant at p-value <0.05.
      Secondary education25780.908(0.534,1.544)1.09(0.589, 2.043)0.77
      College and above6618711
      Residence
      Rural29940.74(0.454, 1.206)0.56(0.312, 0.991)0.047
      Significant at p-value <0.05.
      Urban8319911
      Current marital status
      Married801004.82(2.998, 7.765)7.20(3.777,13.733)<0.001
      Significant at p-value <0.001.
      Single3219311
      Knowledge about family planning
      Good662190.48(0.306, 0.768)0.36(0.202, 0.633)<0.001
      Significant at p-value <0.001.
      Poor467411
      Availability of health facility
      Yes992650.80(0.401, 1.616)0.73(0.322, 1.666)0.457
      No132811
      Past contraceptive use
      Yes651061.99(1.281, 3.093)1.05(0.587, 1.879)0.68
      No4718711
      Desire number of child
      < Five621111.78(1.116, 2.843)1.28(0.708, 2.305)0.416
      > five5018211
      Discussion with health professional
      Yes551590.81(0.526, 1.258)0.72(0.414, 1.246)0.239
      No5713411
      a Significant at p-value <0.05.
      b Significant at p-value <0.001.

      4. Discussion

      In this study, the prevalence of unmet needs for family planning was 27.7%. Factors associated with the unmet need for family planning were Educational status, marital status, knowledge of family planning, and residence.
      This study showed that the prevalence of unmet needs for FP was 27.7%. This finding is in line with the study conducted in Debre Brehan town,
      • Worku S.A.
      • Ahmed S.M.
      • Mulushewa T.F.
      Unmet need for family planning and its associated factor among women of reproductive age in Debre Berhan Town.
      and Tiro Afeta district in South-West Ethiopia.
      • Solomon T.
      • Nigatu M.
      • Gebrehiwot T.T.
      • Getachew B.
      Unmet need for family planning and associated factors among currently married reproductive age women in Tiro Afeta District , South West Ethiopia , 2017 : cross- sectional study.
      Higher than, EDHS 2016.
      Central Statistical Agency Addis Ababa EI
      Demographic Health Survy Ethiopia.
      This variation is due to the EDHS included only married women. But ours include married and unmarried women. In study subjects in which those studies include only married reproductive age groups but, this study included all reproductive age groups.
      This study revealed that women who attained Primary education were 4.53 times more likely of having an unmet need for FP as compared to those respondents with college and above education. This is in line with a systematic review and meta-analysis done in Ethiopia,
      • Getaneh T.
      • Negesse A.
      • Dessie G.
      • Desta M.
      • Moltot T.
      Predictors of unmet need for family planning in Ethiopia 2019 : a systematic review and meta analysis.
      which revealed that women and their partner with no formal education were significantly associated with the unmet need for family planning. In addition, other studies done were in Toke Kutaye District, Oromia,
      • Desta H.O.
      • Bala E.T.
      Factors associated with unmet need for family planning among married reproductive age women in Toke Kutaye district, Oromia, Ethiopia.
      Rural Ethiopia,
      • Alem A.Z.
      • Agegnehu C.D.
      Magnitude and associated factors of unmet need for family planning among rural women in Ethiopia: a multilevel cross-sectional analysis.
      Damot Woyde district, southern region,
      • Wolde A.
      • Haile D.
      • Anjulo U.
      • Wolde J.
      Unmet need for modern contraceptive methods and associated factors among currently married women in Damot Woyde district , SNNPR.
      enemay district, Northwest Ethiopia,
      • Dejenu G.
      • Ayichiluhm M.
      • Abajobir A.A.
      Prevalence and associated factors of unmet need for family planning among married women in enemay district, northwest Ethiopia: a comparative cross-sectional study.
      also revealed that women's educational status associated with the unmet need of family planning. This implies that the higher the education attained, the likeliness of meeting the FP needs increases. The possible explanation for this could be that women empowered through education have good knowledge of contraceptives and have better access to health facilities compared to uneducated women.
      The odds of unmet need for family planning were 7.20 times higher among those who reported married as compared to their counterparts. This finding is in line with the study done in Burkina Faso
      • Letamo G.
      • Navaneetham K.
      Levels, trends and reasons for unmet need for family planning among married women in Botswana: a cross-sectional study.
      and Rural Tigray.
      • Gebresilassie Y.H.
      • Woldu G.T.
      Explaining unmet need for family planning in rural tigrai , Ethiopia.
      The possible reason for this significance might be the increased frequency of sexual activity among married women irrespective of low access to family planning.
      Women from rural parts were 0.56 times less likely to report having an unmet need for FP as compared with women from urban residences. This is in line with studies conducted in southern Ethiopia and Gambia, Mozambique.
      • Hailemariam A.
      • Haddis F.
      Factors affecting unmet need for family planning in southern nations, nationalities and peoples region, Ethiopia.
      ,
      • Yaya S.
      • Wheeler D.I.
      • Uthman O.A.
      • Bishwajit G.
      Determinants of unmet need for family planning in Gambia & Mozambique : implications for women ’ s health.
      The possible justification for this might be, In most parts of Ethiopia, rural residents have usually low health services coverage and decreased awareness of FP due to low education, low socioeconomic status, and have limited access to FP services, this may lead to a higher prevalence of unmet need in rural areas.
      The unmet needs of FP were 0.36 times less likely among knowledgeable women as compared to their counterparts. Poor knowledge about FP has increased the risk of having an unmet needs for FP. This finding is supported by a study done in Debre Berhan Town, Ethiopia.
      • Worku S.A.
      • Ahmed S.M.
      • Mulushewa T.F.
      Unmet need for family planning and its associated factor among women of reproductive age in Debre Berhan Town.
      This might be due to those women who had good knowledge about family planning could have decision-making ability regarding family planning utilization.
      The limitation of this study is that since it was an institution-based cross-sectional study the finding of this study is difficult to generalize to reproductive-age women in the community.

      5. Conclusion

      This study found that the prevalence of the unmet need for family planning was high. Educational status, marital status, knowledge of family planning, and residence were significantly associated with the unmet needs for family planning. A comprehensive education program should be introduced to focus on informing about family planning and strengthening family planning services.

      Ethics approval and consent to participate

      Ethical clearance for the proposed study was obtained from the Institutional Review Board of Pharma College and a supporting letter was obtained from Sidama regional administration and Hawassa municipality. Verbal consent was obtained from the study subjects and the right of the respondents to withdraw or not to participate was respected. Anonymity and confidentiality of the data provided were strictly maintained. Participants were assured that their participation is voluntary.

      Funding

      No fund was obtained for conducting this research.

      Authors' contributions

      EA and TA conceptualized the paper, led the data collection process, and investigated the data. EA and TA wrote the draft of the manuscript. EA and TA revised and amended the manuscript draft. Both authors read and approved the final manuscript.

      Participant consent

      Attained.

      Consent for publication

      Not applicable.

      Availability of data and material

      For those who are concerned; the datasets of this study could be accessed from the corresponding author on rational request.

      Declaration of Competing interest

      The authors state that they have no competing interests.

      Acknowledgments

      We would like to acknowledge PHARMA College, Public Health Department , for providing opportunity. Our heart full thanks also go to Hawassa industry park administrative staffs for providing necessary information for this study. Finally, would like to acknowledge my data collectors, supervisor and participants of the study for their cooperation.

      Acronyms

      CSA
      Central Statistical Agency
      DHS
      Demographic and Health Survey
      ICPD
      International Conference on Population and Development
      FP
      Family planning
      HSDP
      Health Sector Development Plan
      SDG
      Sustainable Development Goal
      SPSS
      Statistical Package for Social Sciences
      TFR
      Total Fertility Rate
      UN
      United nation
      WHO
      World Health Organization

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