Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan 21;19(1):15.
doi: 10.1186/s12978-022-01324-x.

Unmet need for family planning among rural married women in Ethiopia: What is the role of the health extension program in reducing unmet need?

Daniel Tadesse  1 , Girmay Medhin  2   3 , Getnet M Kassie  4 , Tegene Legese Dadi  5 , Setegn Tigabu  2 , Mekdes Demissie  6   7 , Mussie Alemayehu  8 , Mulusew J Gerbaba  9 , Bisrat F Denberu  10 , Alula M Teklu  2
Affiliations

Unmet need for family planning among rural married women in Ethiopia: What is the role of the health extension program in reducing unmet need?

Daniel Tadesse et al. Reprod Health. .

Abstract

Background: Ethiopia is striving to reduce unmet need for family planning (FP) and implementation of the health extension program (HEP) is one of the major actions that the country took to address health issues of rural communities including FP. However, there is limited published evidence demonstrating the role of HEP in reducing the unmet need of married rural women for FP. The aim of this study is to estimate the role of HEP in reducing unmet need for FP in rural Ethiopia.

Methods: This paper is based on data extracted from a national rural HEP assessment that covered all regions of Ethiopia. We identified 4991 eligible married women both from agrarian and pastoralist settings. The role of HEP was measured by the exposure of eligible women to FP services through the implementation of HEP packages. We used descriptive statistics to summarize different variables and used logistic regression to model the unmet need for FP.

Results: The overall prevalence of unmet need for FP among married rural Ethiopian women was 22.41%, contraceptive prevalence rate (CPR) was 44.60%, and the total demand for FP was 60.86%. Women exposed to HEP had a lower level of unmet need (4.82%), a higher demand for FP (37.78%) and a higher CPR (24.93%) compared to women unexposed to HEP. Having exposure to FP services (adjusted odds ratio (AOR) = 0.46, 95% confidence interval (CI) 0.37-0.59), having level IV Health Extension Workers (HEWs) in the catchment health post (AOR = 0.80, 95% CI 0.67-0.95) and older age are significantly associated with lower levels of unmet need for FP. Having more children (AOR = 2.11, 95% CI 1.67-2.65) and better awareness of the husband about the availability of FP services (AOR = 1.22, 95% CI 1.01-1.48) were associated with a higher likelihood of an unmet need for FP.

Conclusion: The unmet need for family planning is high in rural Ethiopia in general and among women who do not have exposure to HEP packages in particular. Assigning a better-qualified health worker at the health post, reaching out to pastoralist women, maximizing opportunities to counsel rural women about FP during any contact with HEWs, and increasing positive attitudes of husbands towards FP use are likely to have positive impacts in reducing the unmet need for FP of rural women.

Keywords: Family planning; Health extension program; Rural Ethiopia; Unmet need; Women.

Plain language summary

Family planning is a method that couples can use to limit the number of child or space the gap. Unmet need for family planning is defined as the percentage of reproductive age women who wants to space or limit the number of children but not currently using any family planning method. There is a huge proportion of eligible women have an unmet need for family planning in Ethiopia. The health extension program is one of the strategies to reach rural women to improve the health of the community. Although, family planning service is one of the packages in a health extension program and this study aimed to estimate the role of health extension program in reducing unmet need for family planning. About 4991 married women were asked about the family planning use, need and the place where they get the services. During the assessment the role of health extension program was assessed by different question. Some of the major assessment areas were women exposer to service, service availability, awareness and mode of service delivery. One fourth of the women have unmet need for family planning. The family planning utilization is still low. The contribution of the health extension program in family planning service is significant. Women exposed to HEP through level 4 health extension worker and older age are significantly associated with low level of unmet need FP. The unmet need for family planning is high in rural Ethiopia. This will inform the improvement and sustainability of the program.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Unmet needs for family planning (FP), contraceptive prevalence rate (CPR) and demand for FP of married rural women aged 15–49 years by livelihood in Ethiopia, 2020
Fig. 2
Fig. 2
Unmet need for family planning, married women aged 15–49 by region in Ethiopia, 2020
Fig. 3
Fig. 3
Percentage of married rural women aged 15–49 years exposed to Health Extension Plan services (HEP) with unmet needs for family planning (FP), demand for FP, and contraceptive prevalence rate, Ethiopia, 2020. WDA Woreda Development Army, SMC Social Mobilization Committee, TV Television, HEW Health Extension Worker
Fig. 4
Fig. 4
Primary sources of family planning information for married rural women in Ethiopia, 2020. FS Female sterilization
Fig. 5
Fig. 5
Methods of modern contraceptive used by married rural women in Ethiopia, 2020
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. United Nations. The sustainable development goals report 2016. Sustain Dev Goals Rep 2016. 2016.
    1. Federal Minster of Health (FMOH). National strategy for newborn and child survival in Ethiopia, Addis Ababa, Ethiopia. 2015;(June 2015).
    1. Federal Minister of Health (FMOH) Health sector transformation plan (HSTP) Addis Ababa: Federal Minister of Health; 2014.
    1. Wang H, Tesfaye R, Ramana NVG, Chekagn CT. Ethiopia Health extension program: an institutionalized community approach for Universal Health Coverage. Washington, DC: World Bank; 2016.
    1. United Nations. World contraceptive use, 2014. United Nations, Dep Econ Soc Aff Popul Div (POP/DB/CP/Rev2014). 2014;1–3. http://measuredhs.com/Topics/Unmet-Need.cfm.