Trend and multivariate decomposition analysis of modern contraceptive utilization among women in Ethiopia

Analyzing the trend and identifying the factors influencing the utilization of modern contraceptives is essential for designing effective measures to improve reproductive health and economic development to ensure universal access to family planning services. This study aimed to investigate the trends in modern contraceptive use among women of reproductive age in Ethiopia and the factors influencing these trends. Data from the 2014 to 2019 Performance Monitoring and Accountability/Action Survey datasets were analyzed, with 4422 women in 2014, 5113 in 2015, 5071 in 2016, 4927 in 2017, 4981 in 2018, and 6117 in 2019 included. Data analysis was conducted using Stata version 16.0 statistical software. Given the sample disproportionality, survey design considerations were taken into account by applying probability weights. The sample weight was utilized with weighting factors provided in the PMA data to address the complex survey design. The 'svy' Stata command was applied to consider the clustering effect before descriptive statistical analysis. The trend was examined based on selected characteristics, with the primary statistical parameter being the trend of modern contraceptive utilization. The trends of modern contraceptive utilization for each year from 2014 to 2019 were calculated. Then, logit-based decomposition analysis was used to identify the factors driving changes in modern contraceptive utilization. Statistical significance was determined at a P value of less than 0.05, and results were presented as decomposition coefficients and percentages. Additionally, we conducted data smoothing to predict the future trend of modern contraceptive utilization and did not visually observe a distinct trend. We explored different time-series models such as linear, quadratic, exponential, and exponential smoothing. The results showed that the exponential smoothing trend model provided the most accurate fit, with the lowest standard error of estimate, sum square error, and highest adjusted R² value. The modern contraceptive utilization trend increased from 32.5% in 2014 to 37% in 2019, with 5.94% and 94.06% attributed to changes in composition and behavior, respectively. Changes in composition were influenced by factors such as women's age, marital status, education level, community lifestyle, and number of children. Meanwhile, changes in behavior among educated women, those aged 35-49, with a certain number of children, and living an agrarian lifestyle contributed to the change in modern contraceptive use. The most significant increase in modern contraceptive methods mix during this timeframe was noted in the adoption of implants. The future trend in modern contraceptive use can be described by the formula: modern contraceptive utilization = 32.5 + 1.3 (coded year) - 0.099 (squared coded year), with an adjusted R² value of 0.99 and a P value of 0.027. It suggests that the exponential smoothing trend can explain nearly 99% of the variation in modern contraceptive utilization. Over the past 6 years, population composition and behavior changes have driven a noticeable increase in modern contraceptive utilization. In Ethiopia, it is essential to target interventions toward advancing-age women, those women with no children, and women belonging to pastoralist communities to enhance contraceptive utilization rates further. Further, focusing on behavioral interventions and education to increase modern contraceptive use rather than solely targeting demographic changes is imperative.