Reasons and multilevel factors associated with unscheduled contraceptive use discontinuation in Ethiopia: evidence from Ethiopian demographic and health survey 2016

摘要

IntroductionDiscontinuation of contraception method is an abandonment of contraceptive method utilization among women who ever use contraception for any reason [1]. Women with unmet need are defined as those who want to stop or delay childbearing but are not using modern contraceptive methods [2]. Unscheduled contraceptive use discontinuation is an abandonment of contraceptive utilization despite the desire to avoid pregnancy.Although there is an increase in contraceptive prevalence rate (CPR), worldwide 38% women using family planning discontinue their contraceptive method without switching to another method, despite their desire to avoid pregnancy [3]. 64% women discontinued their contraceptive use by the 36th month [4]. Greater than a half of women who start using a modern contraceptive method stop using it before two years of continual utilization [1].Discontinuation for reasons other than wanting to become pregnant has a big contribution to unplanned pregnancies, unwanted births, unwanted fertility and termination of pregnancies that may be done through unsafe abortion [2, 5].Tackling discontinuation has been highlighted as a key global health issue [6]. However; a main obstacle to reduce unwanted fertility is the discontinuation of modern contraception [1]. One-third of unintended pregnancies are due to method failure or discontinuation [7, 8]. In countries with moderate to high contraceptive prevalence, the majority of unintended pregnancies are the result of contraceptive discontinuation or failure [9].Investing in family planning accelerates achievement across the five Sustainable Development Goal (SDG) themes which are the five P’s (People, Planet, Prosperity, Peace, and Partnership) [2]. So if FP2020 is to reach an additional 120 million women with an unmet need for family planning by 2020, family planning programs need to escape their selves from becoming a “leaking bucket” [10] in order to effectively addressed contraceptive discontinuation.Therefore; promotion of continuation rates and re adoption among past users is better than promotion of new acceptance rates, because unwanted and mistimed pregnancies would increasingly result from discontinuation of methods rather than not ever using contraceptive at all [11]. Contraceptive discontinuation for reasons other than the desire for pregnancy is a public health concern due to its negative reproductive health outcomes consequences [12].In sub-Saharan Africa countries, even though contraceptive use is rising, contraceptive discontinuation rates are also highly increasing [13]. According to the World Bank collection of development indicators, compiled from officially recognized sources, contraceptive prevalence among women ages 15–49 in Ethiopia was reported at 35.9% in 2016. So this indicates a moderate contraceptive prevalence rate during the year of 2016.In the study done in 2015, 25% of reproductive age women had discontinued their contraceptive utilization [14], whereas the study done in 2017 stated that 27.4% of women discontinued their contraceptive utilization within 24?months [15]. In EDHS 2016, the overall discontinuation rate, including for the reason of wanting to become pregnant, was 35%. So, discontinuation rate of modern contraceptive, in Ethiopia, is increasing. Despite a high level of knowledge majority of male and female showed negative attitude toward the contraceptive practicing [16].In Ethiopia, almost all studies done on contraceptive use discontinuation were based on a single level analysis, however; the multilevel factors that could affect the contraceptive use discontinuation, using multilevel analysis, are not well addressed. For data with a hierarchical nature, unlike single level analysis, using multilevel models that allow one to account for the clustering of subjects within clusters of higher-level units when estimating the effect of subject and cluster characteristics on subject outcomes, would give us appropriate parameter estimation [17]. Limited evidences are available regarding multilevel predictors of contraceptive use discontinuation in Ethiopia at nationally representative sample.Moreover; the studies that have been done on factors associated with contraceptive discontinuation was done on all women including those discontinued for the reason of wanting to get pregnant and on all episodes of discontinuation; so this could lead to complex results. For example, one could conclude that the odds of discontinuation is higher in the age group of 25–34 than of 15–24, but this might be due to higher need of to be pregnant in the 25–34 age group. Using data from overlapping contraceptive calendars, more than one-third of women were discordant in their reports for the reference month in the two surveys; and women using with more complex reproductive histories, including more births and more episodes of contraceptive use, were least likely to report reliably [18]. Therefore; this study uses the last method discontinued in