Effective Coverage of Modern Contraceptive Use in Ethiopia: An Ecological Linking Analysis of Service Provision Assessment and National Health Equity Surveys

Abstract

The increase in contraceptive prevalence rate (crude coverage) in Ethiopia over the past two decades does not necessarily reflect service quality, and although the proportion of women with unmet needs has decreased, it remains unacceptably high. Hence, this study aimed to estimate the effective coverage (EC) of modern contraceptive methods in Ethiopia, considering the quality of care. We used nationally representative surveys, such as health facility surveys (Ethiopia Service Provision Assessment, 2021/22) and household surveys (National Health Equity Survey, 2022/2023). The descriptive analysis and ecological linking of the two surveys were used to assess the relationship between service quality and utilization among married/in union women in need of limiting or spacing children. In 2022, about 78% of health facilities in Ethiopia were ready to provide Family Planning (FP) services using modern contraceptive methods. Met FP need was 48%, with the quality of services assessed at 36%. After accounting for both service quality and readiness, Ethiopia's effective coverage of family planning services using modern methods was estimated at 16%, with the highest coverage in the Sidama region (21%) and the lowest in the Somali region (2%). The EC of FP services in Ethiopia was low, largely attributed to the poor overall quality of the FP services provided. It is therefore important to ameliorate the quality of FP services in the country.