Spatial distribution and determinant factors of unmet need for family planning among all reproductive-age women in Ethiopia: a multi-level logistic regression modelling approach.

Background: Unmet need for family planning has been remaining high in developing countries than developed countries, notably in sub-Saharan Africa. Data on unmet needs can help countries set service priorities. This study aimed to explore the geographical disparities of unmet need among reproductive-age women in Ethiopia using a 2016 national population-based survey.

Methods: This study was based on the nationally representative 2016 Ethiopian Demographic and Health Survey data. We used a total weighted sample of 15,683 reproductive-aged women. A multi-level logistic regression analysis was used to account for the Demographic Health Survey data's hierarchal nature. In the multivariable multi-level analysis, those variables with a p-value < 0.05 were significantly associated with unmet needs. Spatial autocorrelation techniques were used to explore the clustering tendencies of unmet needss using Getis-Ord Gi* statistics.

Results: Overall, 15.2% (95% Confidence Interval (CI): 14.63, 15.76) of women of the reproductive age group in Ethiopia had an unmet need for family planning in 2016. In multivariable multilevel logistic regression analysis; individual-level variables such as being married (Adjusted odds ratio (AOR) = 25.7,95% CI: 11.50,60.42), lowest wealth status (AOR = 1.43,95% CI:1.14,1.79), having five or more children (AOR = 1.98, 95% CI:1.62,2.41), being a follower of Muslim religion (AOR = 1.35,95% CI:1.03,1.76) and protestant religion (AOR = 0.73,95% CI: 0.53,0.99) than orthodox Christian followers were statistically associated factors with unmet need. Among community-level variables; being in rural residency (AOR = 1.37, 95% CI: 1.01, 1.93), belong to the Oromia region (AOR = 1.53, 95%CI: 1.10, 2.11) and Somali region (AOR = 0.37, 95% CI: 0.22, 0.61) were significantly associated unmet need. The spatial analysis of unmet need among all women revealed that Oromia, Southern Nations, and Nationality of People and Gambela regions had high hotspots than other parts of the country.

Conclusions: In this study, the prevalence of unmet needs was high. Significant regional unmet need variation was indicated among reproductive-age women in Ethiopia, specifically in western parts of the country. Wealth status, number of children, marital status, residence, and religion were the most important associated factors with unmet needs. Addressing unmet needs targeted rural residents with low socioeconomic status, and western regions should be given top priority.