Spatial Disparities and Determinants of Modern Contraceptive Use among Reproductive Age Women in Ethiopia: Application of Multilevel Spatial Analysis

Bisrategebrial Tesfaye Muchie ¹ Ashenafi Abate Woya ² Awoke Seyoum Tegegne ² Maru Zewdu Kassie ^3* Muluhabt Alene ¹ WONDAYA FENTA ZEWDIA ^1*

• ¹ Bahir Dar University, Bahir Dar, Amhara Region, Ethiopia
• ² Department of Statistics, Bahir Dar University, Bahir Dar, Ethiopia
• ³ Assosa University, Assosa, Benishangul-Gumuz, Ethiopia

Background: Contraception aims to prevent unintended pregnancies, significantly impacting maternal and infant mortality in Sub-Saharan Africa, especially Ethiopia. This study investigates factors influencing modern contraceptive use among reproductive-age women in Ethiopia.Methods: We analyzed the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) dataset, which includes 8,196 weighted samples of women aged 15-49. Data management utilized STATA version 17, R version 4.2.2, and Arc GIS 10.8 for mapping. We employed multilevel and spatial analyses to identify determinants.Results: Only 26% of women used modern contraceptives, with notable spatial clustering (Global Moran’s Index = 0.237776, p <0.001). Hotspots were identified in Benishangul Gumuz, Gambela, SNNP, and eastern Oromia. Age group (25-34) (AHR=1.346, 95% CI: 1.143, 1.585), education level: higher (AOR=1.919, 95% CI: 1.380, 2.669), Secondary (AOR=1.554, 95% CI: 1.261, 1.914), and primary (AOR: 1.3514, 95% CI: 1.1624, 1.5712), Married (AOR=25.953, 95% CI: 20.397, 32.942), Higher Community Wealth (AOR=1.497, 95% CI: 1.114, 2.011) were positively associated with contraceptive usage, whereas women aged 35-49 (AOR=0.538, 95% CI: 0.446, 0.649), having three or more children (AOR=0.634, 95% CI: 0.460, 0.872), and Somali region (AOR=0.114, 95% CI: 0.045, 0.2882) were negatively associated with contraceptive usage. The best-fitting model included individual, community, and spatial variables, with an intra-class correlation coefficient (ICC) indicating that 15.57% of variability in contraceptive use was due to cluster differences. Conclusions: Modern contraceptive use among Ethiopian women is low and varies by cluster. Factors positively associated include age (25-34), education, marital status, and community wealth. Conversely, women aged 35-49, those with three or more children, and those in the Somali region showed lower usage. Community-level interventions are necessary to improve modern contraceptive adoption.