Shimels Derso Kebede ^1* Daniel Niguse Mamo ² Jibril Bashir Adem ³ Agmasie Damtew Walle ⁴ Yawkal Tsega ¹ Elsabeth Addisu ¹ Zinabu Bekele Tadese ⁵ Ermias Bekele Enyew ¹

• ¹ Wollo University, Dessie, Ethiopia
• ² Arba Minch University, Arba Minch, SNNPR, Ethiopia
• ³ Arsi University, Asella, Oromia, Ethiopia
• ⁴ Debre Berhan University, Debre Berhan, Amhara, Ethiopia
• ⁵ Samara University, Semera, Ethiopia

Background: High unmet need for family planning combined with other factors such as high early marriage and teenage pregnancy increases the risk of developing obstetric fistula and other complications. This study aimed to assess spatial distribution and urban-rural disparities of unmet need for family planning among married/in-union women in Ethiopia.The study was conducted on secondary data from a cross-sectional survey which conducted nationally from September to December 2019 using a two-stage cluster design on a total of 265 enumeration areas. Total weighted sample of 5349 married/in-union women were included in the analysis. ArcGIS Pro and SaTScan software were used to handle spatial analysis.Finally, multivariable decomposition analysis with logit model was used to decompose the observed difference in unmet need by the compositional difference and the difference in effects of explanatory variables between places of residence.Results: Spatial distribution of unmet need for family planning was clustered in Ethiopia with a global Moran's I index value of 0.25(p-value: 0.004). Accordingly, enumeration areas in West Hararge, Arsi, Bale, Gujji, Borena, Jimma, and East Wellega zones of Oromia region, and Gurage, Hadiya, Silte, Gedio, Sidama, Wolaita, Alaba, and Dawro zones of South Nation and Nationality People region, and southern part of Zone 3 in Afar region were detected as hotspot areas. The decomposition result revealed that there is a significant disparity in unmet need between urban and rural resident women (0.074, p-value < 0.001). Endowment and coefficient factors explained the urban-rural disparity by 68.32% and 31.68%, respectively. Household size, husband feeling on family planning use, community acceptance to use family planning, age of woman at first sexual intercourse, and women's age were determinants of the urban-rural disparity.The results highlighted a significant disparity of unmet need for family planning in place of residence and the spatial distribution was clustered across the study area with significant hotspot areas. Thus, interventions should be taken to eliminate the observed variation by mobilizing resources to high-risk areas and targeted high risk groups.