Variation in the influence of concerns about contraceptive-induced fertility impairment on hormonal contraceptive use by parity and residence; evidence from PMA Ethiopia 2020 cross- sectional survey

Abstract

Background Fear of contraceptive-induced fertility impairment is a major deterrent to contraceptive use, however, few studies have explored whether and how this fear varies by life course or residence. Objectives We use cross-sectional nationally representative data from the 2020 PMA Ethiopia survey to describe patterns of concerns about contraceptive-induced infertility, assess the relationship between these concerns and current contraceptive use and assess whether these relationships vary by parity and residence. Methods We use descriptive statistics among a sample of 7,491 women, age 15-49, to assess agreement with the statement “If I use family planning, I may have trouble getting pregnant next time I want to”, a proxy for concerns about contraceptive-induced fertility impairment. We use multilevel hierarchical models to assess how agreement is associated with the use of a hormonal method of contraception among 3,882 sexually active, fecund women who wish to prevent pregnancy. We include interaction terms for parity and residence. Results About six in ten women disagreed (42.3%) or strongly disagreed (20.7%) with the statement. Relative to women who strongly disagreed, women who disagreed and women who agreed had significantly lower odds of using a hormonal method of contraception (aOR: 0.65, 95% CI: 0.44-0.97 and 0.46, 95% CI: 0.46, 95% CI: 0.30-0.70). This effect was strongest among high parity women (aOR: 0.54, 95% CI: 0.30-0.95). Greater agreement with the statement at the community-level use was associated with a reduction in the odds of using hormonal contraception, but only among rural women. Discussion While the majority of women in Ethiopia either disagree or strongly disagree that use of hormonal contraception may influence fertility, efforts to address this concern, particularly amongst high-parity women and in rural communities, through the provision of comprehensive counseling and through community education or other mass media campaigns are necessary. Incorporation of comprehensive counseling, particularly as a part of postpartum care, is an opportunity to address concerns about contraceptive-induced infertility.