Individual-level and community-level factors associated with the family planning use among pastoralist community of Ethiopia: a community-based cross-sectional study

Mussie Alemayehu, Araya Abrha Medhanyie, Elizabeth Reed, Afework Mulugeta, Mussie Alemayehu, Araya Abrha Medhanyie, Elizabeth Reed, Afework Mulugeta

Abstract

Objective: The study aimed to identify the effects of the individual-level and community-level factors on the use of family planning (FP) among married women in the pastoralist community of Ethiopia.

Design: A community-based cross-sectional study was conducted in September 2018. Data were analysed using R software. To determine the fixed effect of individual-level and community-level factors of FP use, a two-level mixed-effects logistic regression was used. The result was described using the Adjusted OR (AOR), and the variance partition coefficient.

Setting and participants: Afar, Ethiopia (2018; n=891) married women of reproductive age (15-49) years.

Primary outcome measures: FP use or non-use.

Results: The current use of FP was 18.7% (16.31%-21.43%). Women who need to walk 1 hour and more to the nearest health facility (AOR 0.14, 95% CI 0.05 to 0.3), have ANC visit of 4 and above (AOR 6.02, 95% CI 1.74 to 20.8), had their last birth at a health facility (AOR 2.71 95% CI 1.27 to 5.81), have five and more children (AOR 4.71, 95% CI 1.86 to 11.9), have high knowledge on FP (AOR 2.74, 95% CI 1.11 to 6.74) and had high intentions to use FP (AOR 10.3, 95% CI 3.85 to 27.6) were more likely to report FP use. The magnitude of the effect of for FP use was smaller than that of 9 of the 13 individual factors. Apart from this 19.4% of the total variance in the odds of using FP attributed to between community difference (intraclass correlation coefficient=0.194). Regarding the community-level characteristics, clusters of having higher electronic media possession (AOR 2.84, 95% CI 1.2 to 6.72) and higher women decision making on FP (AOR 8.35, 95% CI 2.7 to 27.1) were significantly associated with increased FP use compared with clusters with lower reports of these aspects.

Conclusion: FP use among the pastoralist community is influenced by both individual cluster/community-level characteristics or factors. Even though the effect of clustering in FP use was large in comparison with the unexplained between-cluster variation, it was lower than the individual-level factors.

Trail registrtion number: NCT03450564.

Keywords: epidemiology; public health; reproductive medicine.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

References

    1. WHO Family planning/contraception, 2018. Available: [Accessed 8 Feb 2018].
    1. Swallow B. The role of mobility within the risk management strategies of pastoralists and Agro-Pastoralists. International Institute for Environment and Development Sustainable Agriculture and Rural Livelihoods Programme Kenya, 1997.
    1. AU "Farmer-Herder Conflicts on the Rise in Africa", 2018. Available: [Accessed 8 Aug 2018].
    1. Ethiopian Public Health Institute (EPHI) [Ethiopia], ICF . Ethiopia mini demographic and health survey 2019: key indicators. Rockville, Maryland, USA: EPHI and ICF, 2019.
    1. Central Statistical Authority [Ethiopia], ORC Macro . Ethiopia demographic and health survey 2000. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Authority and ORC Macro, 2001.
    1. Alemayehu M, Araya AM, Kibrom B, et al. . The levels of utilization of reproductive, maternal and neonatal health services among women from pastoralist communities in afar, Ethiopia: across-sectional survey. Ethiop J Health Dev 2018;32:34–42.
    1. Afework B, Alemayehu M, Znabu H, et al. . Factors influencing contraceptive use among women of reproductive age from the pastoralist communities of afar, Ethiopia: a community-based cross-sectional study. Ethiop J Health Dev 2018;32:28–33.
    1. Wudneh A, Nigatu D, Dendir Z, et al. . Comparative analysis of the cost-effectiveness of natural resource management actions with and without family planning interventions as a means of achieving sustainable resource use in the bale Eco-Region.SHARE bale Eco-Region project. Ethiopia, 2017.
    1. Alemayehu M, Medhanyie AA, Bezabih AM, et al. . Use of community-based intervention to promote family planning use among Pastoralist women in Ethiopia: cluster randomized controlled trial. medRxiv 2020:20117093.
    1. Central Statistical Agency (CSA) [Ethiopia], ICF . Ethiopia demographic and health survey 2016: key indicators report. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA and ICF, 2016.
    1. Alemayehu M, Lemma H, Abrha K, et al. . Family planning use and associated factors among pastoralist community of afar region, eastern Ethiopia. BMC Womens Health 2016;16:39. 10.1186/s12905-016-0321-7
    1. Fishbein M. The role of theory in HIV prevention. AIDS Care 2000;12:273–8. 10.1080/09540120050042918
    1. Austin PC, Merlo J. Intermediate and advanced topics in multilevel logistic regression analysis. Stat Med 2017;36:3257–77. 10.1002/sim.7336
    1. Neuhaus JM, McCulloch CE. Separating between- and within-cluster covariate effects by using conditional and partitioning methods. J Royal Statistical Soc B 2006;68:859–72. 10.1111/j.1467-9868.2006.00570.x
    1. Larsen K, Merlo J. Appropriate assessment of neighborhood effects on individual health: integrating random and fixed effects in multilevel logistic regression. Am J Epidemiol 2005;161:81–8. 10.1093/aje/kwi017
    1. Diehr P, Cain K, Connell F, et al. . What is too much variation? the null hypothesis in small-area analysis. Health Serv Res 1990;24:741–71.
    1. Belda SS, Haile MT, Melku AT, et al. . Modern contraceptive utilization and associated factors among married pastoralist women in bale eco-region, bale zone, South East Ethiopia. BMC Health Serv Res 2017;17:194. 10.1186/s12913-017-2115-5
    1. Bogale A, Mekonnen W. Family planning use and its determinants among Pastoralist communities of Ethiopia. Soc Sci 2017;6:57–62. 10.11648/j.ss.20170602.13
    1. Medhanyie AA, Desta A, Alemayehu M, et al. . Factors associated with contraceptive use in Tigray, North Ethiopia. Reprod Health 2017;14 10.1186/s12978-017-0281-x
    1. Gonie A, Wudneh A, Nigatu D, et al. . Determinants of family planning use among married women in bale eco-region, Southeast Ethiopia: a community based study. BMC Womens Health 2018;18:50. 10.1186/s12905-018-0539-7
    1. Subhi R, Ahmed H, Mawlood Z. Spacing effects on maternal-child health. Tikrit Med J 2011;17:1–6.
    1. Abera Y, Mengesha ZB, Tessema GA. Postpartum contraceptive use in Gondar town, Northwest Ethiopia: a community based cross-sectional study. BMC Womens Health 2015;15:19. 10.1186/s12905-015-0178-1
    1. Achyut P, Mishra A, Montana L, et al. . Integration of family planning with maternal health services: an opportunity to increase postpartum modern contraceptive use in urban Uttar Pradesh, India. J Fam Plann Reprod Health Care 2016;42:107–15. 10.1136/jfprhc-2015-101271
    1. WHO Sexual and reproductive health:New guidelines on antenatal care for a positive pregnancy experience. Geneva, 2016.
    1. Alemayehu M, Belachew T, Tilahun T. Factors associated with utilization of long acting and permanent contraceptive methods among married women of reproductive age in Mekelle town, Tigray region, North Ethiopia. BMC Pregnancy Childbirth 2012;12:6. 10.1186/1471-2393-12-6
    1. Mayaki F, Kouabenan DR. Social norms in promoting family planning: a study in niger. S Afr J Psychol 2015;45:249–59. 10.1177/0081246315570356
    1. Key CW, Araya AM, Mark S, et al. . Best practices for addressing socio-cultural barriers to reproductive, maternal and neonatal health service utilization among women from pastoralist communities of afar, Ethiopia: a qualitative study. Ethiop J Health Dev 2018;32:4–12.
    1. Peyman N, Oakley D. Effective contraceptive use: an exploration of theory-based influences. Health Educ Res 2009;24:575–85. 10.1093/her/cyn058
    1. Hanson JD, Nothwehr F, Yang JG, et al. . Indirect and direct perceived behavioral control and the role of intention in the context of birth control behavior. Matern Child Health J 2015;19:1535–42. 10.1007/s10995-014-1658-x
    1. Mboane R, Bhatta MP. Influence of a husband’s healthcare decision making role on a woman’s intention to use contraceptives among Mozambican women. Reprod Health 2015;12:8 10.1186/s12978-015-0010-2
    1. FMOH Health sector transformation plan 2015/16 - 2019/20, 2015.
    1. Ross JA, Winfrey WL. Contraceptive use, intention to use and unmet need during the extended postpartum period. Int Fam Plan Perspect 2001;27:20–7. 10.2307/2673801

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