Utilization of Long Acting Reversible Contraceptive Methods. Associated Factors among Women of Reproductive Age

Table of Contents

Acknowledgement

Acronyms/Abbreviations

List of Tables

List of Figures

SUMMARY

1. Introduction
1.1. Background
1.2. Statement of the problem

2. Literature Review
2.1 Magnitude of utilization of modern contraceptive and long acting and Reversible contraceptive methods (LARCMs)
2.2 Factors affecting utilization of Long Acting and Reversible contraceptive methods

3. Significant of the study
3.1. Justification of the study

4. Objectives
4.1 General objective
4.2 Specific Objectives

5. Materials and Methods
5.1 Study area
5.2 Study period
5.3 Study design
5.4 Source population
5.5 Study population
5.6 Inclusion and Exclusion Criteria
5.7 Sample size Determination
5.8. Sampling procedure
5.10 Operational definition
5.11 Data Collection tools and procedures
5.12 Data processing and analysis
5.13 Data quality control
5.14 Ethical considerations
5.15 Data dissemination plan

6. Results
6.1 Socio-demographic characteristics of the respondents
6.2 Reproductive history of the respondent
6.3 Knowledge of respondents on modern contraceptive and LARMs
Figure 3. Prevalence rate of LARMs
6.4 Methods preferred and reasons for not using LARMs among women in the reproductive age group
6.5 Factors affecting utilization of Long Acting and reversible contraceptive methods
6.6. Predictors of utilization of LARMs

7. DISCUSSION

8. STRENGTH AND LIMITATION
8.1 Strength
8.2 Limitation

9. CONCLUSION AND RECOMMENDATION
9.1 Conclusion
9.2 Recommendation

Reference

Annex I. Questioner for data collection in English version

Annex II. Questionnaire in Afan Oromo version

Annex III. የአማሪኛ መጠይቅ

Acknowledgement

First of all, I would like to thank the Almighty God. Ensuing, I would like to express our deepest gratitude to my advisor Mr. Girum Sebsibie (Ass. Prof, PhD fellow) for his valuable advice, guidance and support when I conduct this study and provision of encouragement, he offered me. Last but not least I would like to express my heartfelt to Rift Valley University for the opportunity conducting this research as requirement for graduation in masters of General Public Health department, for material support, and assigning advisor for free.

Acronyms/Abbreviations

CBD Community Based Distribution

CI Confidence Interval

CPR Contraceptive Prevalence Rate

DHS Demographic and Health Survey

FGAE Family Guidance Association of Ethiopia

FP Family Planning

FGD Focus Group Discussion

IEC Information, Education and Communication

IUDs Intra Uterine Devices

ICPD International Conference on Population and Development

INV Investigator

IMR Infant Mortality Rate

MCH Maternal and Child Health

MOH Ministry of Health

MOE Ministry of Education

MC Modern Contraception

OR Odds Ratio

OCP Oral Contraceptive Pill

RLAFP Reversible Long Acting Family Planning

RHB Regional Education Bureau

REB Regional Health Bureau

List of Tables

Table 1. Socio-demographic characteristics among women in reproductive age group (15-49) living in Bishoftu town, Oromia region, 2018.

Table 2. Reproductive history among women in reproductive age group (15-49) living in Bishoftu town, Oromia region, 2017 (n=227)

Table 3. Knowledge of modern contraceptive and LARMs, source of information, discussion made among women in reproductive age group (15-49) in Bishoftu town, Oromia region 2017(n=227)

Table 4. Methods preferred and reasons for not using LARMs among women in the reproductive age group (15-49)

Table 5. Association of utilization of LARMs and its correlates among women in the reproductive age group (15-49) in Bishoftu town, Oromia region, Ethiopia 2018 (Bivariate table)

Table 6. Association of utilization of LARMs and its correlation among women of reproductive age group (15-49) in Bishoftu town, Oromia region, Ethiopia 2018 (multivariate table)

List of Figures

Figure 1. Conceptual framework

Figure 2 . Schematic presentation of sampling procedure and selection

Figure 3. Prevalence rate of LARMs

Figure 4: Source of information of long acting reversible contraceptive of reproductive age women in Bishoftu city, 2020

Figure 5. Types of Contraceptive method used

SUMMARY

BACKGROUND: - World health organization report indicated that, in 2017 alone, over 295,000 maternal deaths that resulted from pregnancy and delivery related complication were reported worldwide indicating a decline of 45% from 1990. The sub-Saharan Africa region accounted for 62% of maternal death followed by southern Asian country (24%). Provision of family planning is one of the effective interventions that prevent unwanted and ill spaced pregnancy there by reducing maternal mortality and morbidity. Given that its effectiveness and, associated fewer visits to health facilities, LARC are very important in tackling maternal mortality and morbidity. However, little is known regarding its prevalence in Bishoftu eastern Ethiopia.

OBJECTIVES: To assess utilization of long acting reversible contraceptive methods and its associated factor among women of reproductive age group in Bishoftu public Health facilities, Oromia, Ethiopia.

METHODS: Health Facility Based cross-sectional study was conducted from March 16 to 30 2020. Systematic random sampling technique was applied, in a total of 227 randomly selected reproductive age group women from who attend Bishoftu town public health facilities. Structured questionnaire is developed using questionnaire that were applied in different studies related to family planning previously. The data was entered to computer by using EPI-Info 7 version and cleaned then exported to SPSS version 20. Bivariate and multivariate logistic regression was employed to determine independent predictors of long acting and Reversible contraceptive utilization.

Result: Utilization of LARMs was 28.6%, the most common is Implant 45(19.8%), and followed by Intra Uterine Contraceptive Device (IUCD) 20(8.8%). The result of multivariate analysis revealed that, the significant association of attitude of husband on LARMs [AOR 3.33, 95%CI (2.81, 6.58)], discussion with service providers on use of LARMs [AOR 4.18, 95% CI (1.11, 8.81)], and reproductive age group women those who need any more additional children was found to be associated [AOR 3.17, 95%CI (1.19, 5.11)].

Conclusion and recommendations: Utilization of LARMs among contraceptive methods users in a town was 28.6% and higher than the LARMs use rate reported other studies and Ethiopia Demographic and Health Survey (EDHS) 2014, but still lead by short acting methods that was inject-able followed by Implant and the least IUCD. So better collaboration with stake holders for those working on family planning should strengthen, continuous education on the use of LARMs using model. LARMs users and advocacy, ensure availability of printed materials like leaflets that help family planning users to understand the benefits of LARMs and Service providers should provide counseling on LARMs during consultation, clients should be provided with complete information on the advantage and disadvantage of LARMs methods including their side effects.

Key words: long acting methods, utilizations, reproductive health, Bishoftu, Ethiopia

1. Introduction

1.1. Background

Improving women’s health and reducing maternal mortality has been a global public health priority for the United Nations international development agenda [1, 2]. Maternal death during pregnancy, after pregnancy and child birth were estimated 295,000 in 2017. This figure shows that a cut in 45% of the same case which has been assessed in 1990. In Africa the highest maternal death was seen in sub-Saharan region which is about 179,000 deaths or (62%) of the total global maternal death followed by Southern Asia of 69,000 or 24% of the Global. The global MMR in 2017 were 211 per 100,000 live births, down from 342 maternal deaths per 100 000 live births in 20003.

The MMR in developing regions (230) was 14 times higher than in developed regions. Fortunately, the vast majority of maternal and newborn deaths can be prevented with proven interventions to ensure that every pregnancy is wanted using modern contraceptive and every birth is safe 4. In Ethiopia despite family planning (FP) interventions of the Ethiopian federal ministry of health (EFMOH), including the Health Extension Program have significantly improved access to FP services 5, 22% of currently married women have an unmet need for family planning according to Ethiopian demographic health survey (EDHS) 2016 6. A disparity exists between contraceptive use rates in rural and urban areas, with less than half as many women in rural areas as in urban areas using modern methods (22% vs nearly 50%).

The Total Fertility Rate in Ethiopia declined from 5.36 in 2005 to 4.08 in 2017. Despite these positive trends, the gap between demand for and uptake of FP is large. While nearly 75% of currently married women of reproductive age report a desire to delay childbirth for at least two years or stop bearing children altogether, only 27.3% of them are currently using a modern contraceptive method to prevent pregnancy. Use of FP in Ethiopia has traditionally been limited to short-acting methods such as injectable and pills due to limited access to Long-Acting FP (LAFP) methods, commodity shortages and lack of skilled health care providers to offer services at the community level 7. An estimated 80 million unintended pregnancies occur each year worldwide, resulting in 42 million induced abortions and 34 million unintended births. These unintended pregnancies have grave consequences for the health and well-being of women and families, particularly in low and middle-income countries where maternal mortality is high and abortions are often unsafe. Three hundred and fifty-eight thousand women die of pregnancy-related causes every year, many resulting from unintended pregnancies that were unsafely aborted 8. The rate of unintended pregnancy is high across the world. Unintended pregnancy is not only resulted in substantial costs to health services, it can lead to personal distress for women experiencing it.

Whilst a large number of unintended pregnancies occur in those women who are not using any method of contraceptive, it can also occur in women using a contraceptive method incorrectly or inconsistently 9. Unintended pregnancy remains a significant global public health problem; its rate is greater in less developed regions (57 per 1000 women aged 15-44 years) than in more developed regions (42 per 1000). In real-world tests LARC methods were over 20 times more effective at preventing unintended pregnancy compared to the contraceptive pill, patch or ring. Although LARC use and continuation has been proven to effectively reduce unintended pregnancy thereby reducing abortion, not more than 15% of women use LARC method worldwide 10. The most effective methods of contraceptive are frequently the least available 11. In spite of their effectiveness, LARC are under-utilized by women. Educating women and health professionals and dispelling myths about these methods may improve their acceptability. Furthermore, facilitating uptake by ensuring that a range of contraceptive providers are trained and able to provide to women without undue delay may also be effective strategies to improve uptake and prevent more unintended pregnancies 12. Repeat pregnancy within 2 years of a previous birth or abortion occurs in approximately 35% of recently pregnant female adolescents. Rapid repeat pregnancy (RRP) is associated with increased maternal and neonatal morbidity and continues a cycle of economic deprivation for young women and their families. Adolescents who do not initiate a LARC method have up to a 35 times increased risk of RRP compared with their peers using LARC 13.

A decrease in unmet need for family planning accompanied this rapid increase in the use of contraceptives, such that 12 per cent of married or in-union women globally had an unmet need for family planning in 2015. However, wide disparities in the level of unmet need for family planning are still evident among countries, and a benchmark set by Governments in 1999 to close the gap in meeting demand for family planning by 2015 is out of reach for most countries 14.

Overall modern contraceptive prevalence has increased in Sub-Saharan Africa (SSA). The ongoing increase in the contraceptive use is due to changes in behavior consistent with the ongoing family planning promotion over the past 30 years. By contrast, an increase in the proportion of women with secondary education does not explain the change in modern contraceptive prevalence in most SSA countries 15. Ethiopia is one of the Sub-Saharan African countries with highest MMR which is 273 maternal deaths per 100,000 live births. The vast majority of maternal and new born deaths can be prevented with proven interventions to ensure that every pregnancy is wanted by using the most effective modern Family planning methods and every birth is safe. Holistic, client-centered approaches to FP programming create effective and successful programs that ultimately support health systems to meet the RH intentions of women and men. Although LARC decreases unintended pregnancies by eliminating user compliance issues, its uptake is low. Strategies that promote LARC uptake by targeting specific barriers may effectively reduce high unintended pregnancy rate 16.

Long acting reversible methods of contraceptives are the most effective methods of contraceptives. In spite of this, they are under-utilized by women in developed countries. Educating women and health professionals and dispelling myths about these methods may improve their acceptability. Furthermore, facilitating uptake by ensuring that a range of contraceptive providers are trained and able to provide to women without undue delay, particularly in the immediate post abortion and postpartum period, may also be effective strategies to improve uptake and prevent more unintended pregnancies 17. For fecund, sexually active women, LARC offers an effective way to postpone childbearing for relatively long periods of time. Women in Ethiopia could benefit significantly from greater knowledge and availability of these methods and family planning programs and policies targeted at serving women should emphasize these methods more strongly 18.

1.2. Statement of the problem

Different report indicates that the utilization of Long Acting Reversible Contraceptive method is low. The prevalence of Long Acting Reversible Contraceptive use is 13% in the world and Long Acting Reversible Contraceptive use coverage is 2%, for sub-Saharan Africa 19. For Ethiopia, Long Acting Reversible Contraceptive use coverage is 3.7%.20. The prevalence of implant in Oromia region was lower than the rate in different parts of Ethiopia in 201521. Similarly, in the Amhara region, the EDHS 2016 report shows that the utilization of LARMs is 15.1%, which is low, whereas the utilization of injectable contraceptive method is 63% with unclear reason [22, 23].

A study conducted in Goba indicates 8.7% of married women used Long Acting Reversible Contraceptive 24. Among family planning users only 16% were use long acting reversible contraceptive in Jimma and Addis Ababa. Studies done in Ethiopia indicate awareness of LARCM is low 25.

A community-based study from Jinka and Butajira indicates that 18% and 25% participants were aware of LARC and permanent methods [26, 27]. Ministry of Health (MOH) made effort to expand method mix special attention given to expansion of services for LARCM aim provide of 20% of family planning with LARCM 28.

Therefore, the general understanding that utilization of long acting reversible contraceptive methods in particular is low in Oromia, there is little or no study done to identify the magnitude and factors associated with utilization of long acting reversible contraceptive methods in Bishoftu town. Thus, it is difficult for local health authorities and partner organization to implement a focused and tailored intervention in the area. So, this study was intended to assess utilization of long acting reversible contraceptive methods and its associated factors.

2. Literature Review

2.1 Magnitude of utilization of modern contraceptive and long acting and Reversible contraceptive methods (LARCMs)

Intrauterine contraceptive device (IUCD) is one of the most widely used long acting reversible contraceptive method which accounts for (26%) of all contraceptive method. More than half of the 150 million women in the world using an Intrauterine Contraceptive Device (IUCD) are in China. A more accurate picture emerges when focusing on regional data: the percentage of women using IUCD who are married or in union is (7%) in Lat in America, (6%) in Asia (excluding China) and just (1%) in Africa 29.

A study conducted in Karachi, Pakistan, on factors affecting hormonal and non-hormonal contraceptive method uses in women presenting to Reproductive Health Services revealed that most commonly used contraceptive method was long acting reversible contraceptive and it accounts 41% were Norplant and followed by 35% were IUCD users.30

The cohort study undertaken on knowledge and use of family planning methods and services in Kenya revealed that the most popular methods among the informants were Pills and injection, mentioned by (66.2 %) and (64.4%) respectively. It also showed that (69%) of women used of modern contraception while the use IUCD and implant were 14.4% and 17.9% respectively 31.

Southern Ethiopia, In Jinka town, a cross sectional study done on prevalence and factors affecting use of long acting and permanent contraceptive showed that (31.6%) of the women preferred to user modern contraceptive other than long acting and permanent contraceptive methods. In married women used long acting methods such as implant (50%) and intra uterine contraceptive device (12.5%) 26.

Systematic review and meta-analysis done on five studies conducted in different areas Jinka, Debremarkos, Goba, Mekele, and Wolayita town in Ethiopia. Based on meta-analysis studies finding utilization of long acting and Reversible contraceptive methods among reproductive age group in five areas in average was 13.5%. The highest was in Debremarkos town 19.5% and the lowest prevalence from five towns was Jinka town 7.3 % 32.

Study conducted in Debre Markos showed that, 78.2% respondents were ever used contraceptive methods, and from total contraceptive methods 19.5% were LARMs users, 76.4% of implant and IUCD users need to continue with the methods and the rest 23.6% of respondents need to remove before the date because of desire of pregnancy 32. Other study in Addis Ababa showed that modern contraceptives and LARCMs utilization among study participants were inject able 51.2%, implants 21.9%, pills 14%, IUCD 12.9 % 33.

Study conducted on LARMs in different time and different areas of localities in Arbaminch, Mekkele, Jimma, Addis Ababa, Shashemene and Goba town found that the prevalence of the utilization of LARMs were 22.9%, 16.4%, 16%, 34.8%, 28.4% and 8.7% respectively [24,25,33,34, 35,36].

Studies from different localities were reported that utilization of LARMs was ranging from 8.7-34.4%. According to different study conducted in different part of Ethiopia namely Addis Ababa, Goba and Arbaminch the type of contraceptive used reveals that, types and their utilization are different. For instance, utilization of LARMs in Addis Ababa is four times than that of Goba. While Depo provera followed by implant and OCP. According to health based cross sectional study conducted in Arbaminch utilization of LARMs which is 13.1% a year before increased by 10% and it is 22.9% 37.

2.2 Factors affecting utilization of Long Acting and Reversible contraceptive methods.

2.2.1 Socio-demographic factors

Age

Demographic growth in the developing world was continue to exert upward pressure on the population base of women of reproductive age. In many countries, where contraceptive utilization is low and 40% to 50% of the population is under age 15 years, this may result in higher probability of having unintended pregnancies 38. The Guttmacher Institute estimates a pregnancy rate of 137 per 1,000 women aged 15–44 years in the developing world and an unintended pregnancy rate of 57 per 1,000 which is either mistimed or unwanted pregnancies.

Marital status

According to the DHS Ethiopia 2016 report, 63.9% of currently married women in Ethiopia know any methods and 85.3% know at least one modern method. Currently married women, who are urban dwellers and who know at least one modern method were found to be 98%, while for rural residence it will 84.5% 39.

Address

Urban fertility is 26% lower than rural fertility for all the four Ethiopia regions combined. Most women give birth while they are in their teens, as a consequence of the early age of marriage. Among women currently pregnant, a significant proportion (about 40% in Tigray, a little over 40% in Amhara, 31% in Oromia and 37% in SNNPR) reported that the pregnancy was unwanted or mistimed suggesting that these pregnancies could have been prevented if women had access to family planning services 40.

Income

Almost everywhere, poor women are less likely to use modern contraceptive than richer women. The disparities in use between rich and poor are most common in countries with low contraceptive use overall, like Uganda 41.

According to Ethiopia demographic and health survey 2016, women of educated and higher family monthly incomes have a much higher chance of contraceptive user when compare to women with less education and low monthly incomes 42.

Educational status

Using LARMs makes women become infertile and unable to have children for everlasting. Inadequate information on LARMs leads women to miss perception. When women educational status or knowledge is increased, uptake of LARMs also increased 43.

2.2.2 Knowledge related and Attitude

Study conducted in Jimma town, 86.4% women of reproductive age group knows about LARMs, from these interviewed women on the study 54% on implant and IUCD 39.5% have knowledge 30. The other study done in Goba town, 66.9% reproductive age group heard about LARMs, from these interviewed women 87.3% were heard contraceptive of implant 32. On the other hand, study done in shashemene town showed 85% of respondent know about LARMs, the majority of respondents from 85%, 98.9% knows implant 36.

Health facility based cross-sectional study done in Addis Ababa, interviewed reproductive age group respondent for LARMs 64%, 40.6% have knowledge on implant prevent pregnancy for 3-5 years and IUCD for 12 years respectively 33.

Study conducted in Debre Markos Town, 96.7% were heard at least one methods of modern family planning. Among methods injectable 96.5%, pills 80.3%, implanon and IUCD collectively 81.5% 26. Study conducted in Mekelle city, 66.1% respondents had gotten information from health institution, and 72.8% responded LARMs limit family size, where as 63.7% of them shows the use of LARMs to prevent unwanted pregnancy.

Regarding to attitude 50% of reproductive age group those who using LARMs before, they were never use again in the future. From client intention to use LARMs in future 82.1% implant and the rest is IUCD 35.

2.2.3. Method related factors

Most women are heard about the side effects of LARMs such as (excessive weight gain, bleeding, pain etc) from their friends and peers that influence them to not use this method and also a common to discontinue with methods. Study done in Addis Ababa 2015, 225 respondent 36.7% were not used LARMs due to fear of side effects and 33.3% high number of women of reproductive age un users of LARMs is due to miss conception on it 33. Study conducted in Mekelle city, 36.5% respondents believe that irregular bleeding due to implant insertion and 41.2% pain with insertion and removal of implants at risk 35. Study conducted in Nekemte, the reason not to use LARMs (implant and IUCD) was due to rumors and fear of side effect 49%, 38.9% respectively 43.

Study done in Mekelle city, 13.2%of participants had agreed that irregular bleeding were occurred due to implant usage, 10.5% respondents were believe that implant had severe pain during insertion and removal, 47.1% participants thought insertion of IUCD as shamed and 36.3% of respondents thought that IUCD obstacle to women to conduct different routine activities 35.

2.2.4. Provider related

According to Study conducted in Debre Markos Town, 52.6% of respondents discussed with health personnel about LARMs at least once and the most discussed ones on implant (45.5%). But mostly, during counseling the health providers told to women about complication rather than taking time to counseling them 32.

2.2.5. Reproductive related

Study conducted in Debre Markos town, from the pregnant women 65% were intended pregnancy, 23.9% were mistimed and 10.9% were unintended pregnancy 32. Other study done in Addis Ababa on long acting Reversible methods (LARMs) users 96.3% were married early at age of 18 and 94.9% were gave birth at age of 20 and above. From LARMs users 75.3% had 3 to 4 children and among study participants 17.9% currently users of LARMs had abortion previously 27. Study conducted in Mekelle city, 10.5% of respondents had faced one and more than one abortion, and 55.3% study participants had a family size of 3 to 4, 28.1% had five above children 35. Study conducted in Nekemte, majority of participants (81.5%) making decision with their husband on having children 44.

Partners view

Partners’ views on LARMs were mixed, a few husbands are support using of LARMS but majorities are opposed to use. And study done in Goba Town showed 67.6% of respondent discussed with their husband to decide using LARMs contraceptive 24. Study conducted in Ambo, 65.3% using LARMs, 57.3 implants, 6.2% IUCD and 3.6% are not allowed by their husband to use LARMs. Study conducted in Debre Markos Town, 71.5% couples approved using LARMs and the rest of them did not approve. 45.9% of women respondents had intention to use LARMs in the future but large number of married women (54.1%) husband approved using LARMs 32. Another study conducted in shashemene, 54.1% respondents’ husbands did not let them to use or oppose LARMs and 41.8% need decision of husbands to use LARMs 36.

Abbildung in dieser Leseprobe nicht enthalten

2.3. Conceptual frame work

Figure 1. Conceptual framework

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Source: Conceptual framework Adopted and modified from Abebe. B, 2017 45.

3. Significant of the study

From the perspectives of unmet need for family planning; long acting contraceptives are more useful for spacing and limiting than short acting. However, different studies were conducted on the use of long acting reversible contraceptive method utilizations; none of them doesn’t explain or touch why the perception of utilizers towards LARCMS. This study was try to address this gap and try to analyze the perception rate of users, factors associated with the use of LARCMS and the myth that non-users tell or believe not to use long acting contraceptive methods.

The study was boost recognition of health professionals about socio demographic, reproductive, source of information/awareness, knowledge, attitude and practice variables that influence utilization of long acting reversible contraceptive. It also helps health managers at a higher level and in particular those looking after the health institutions in the region to understand the extent of the problem and to use it for evidence-based practice. It also helps health managers at a higher level and in particular those looking after the health institutions in the Oromia region to understand the extent of the problem and to use it for future implementations in different health facilities to alleviate the problem. Besides, the findings of this study was provide input to policy makers to design appropriate policy, programs and strategies to address factors leading to low utilization of long acting reversible contraceptive.

3.1. Justification of the study

No matter how different researches has been conducted on utilization of long acting reversible contraceptive methods, none of them addressed what makes LARCM to be used in low amount in the rural and semi-rural regions of the country, the knowledge gap towards LARCM, information flow between the users and health facilities, and factors associated with using LARCMs are not addressed well. Addressing this gap in turn helps in the improvement of awareness on the family planning clients and helps to see where the gap is and makes us to see where and how to work to improve the lower utilization of LARMS.

This study is designed to find out the knowledge gap which is seen in LARM users and non-users, information flow gap, myths believed by non-users not to use LARMS and factors associated with using LARMS was addressed. This study helps to see the knowledge gap in terms of what factors are affecting utilization of LARCM among women in reproductive age, group, and family planning users. The findings of the study play a greater role towards improving effective use of contraceptives and family planning services, to develop new approaches for increasing utilization of LARCM among women in reproductive age and help to generate ideas for reducing women’s negative perceptions and attitudes towards use of contraceptives. In addition, the paper can be useful for other researchers as reference material while conducting further studies on similar problems.

4. Objectives

4.1 General objective

- To assess the utilization of Reversible long acting contraceptive method and factors among women of reproductive age in Bishoftu town public Health facilities, Oromia region, Ethiopia.

4.2 Specific Objectives

- To determine the magnitude of utilization of Reversible long acting contraceptive method among women of reproductive age in Bishoftu town public Health facilities, Oromia region, Ethiopia.
- To identify factors associated with utilization of long acting and reversible contraceptive method among women of reproductive age in Bishoftu town public Health facilities, Oromia region, Ethiopia.

5. Materials and Methods

5.1 Study area

The Study was conduct at Bishoftu town in Oromia which is found at 53 K.M from Adama. Bishoftu town is found in Ada’a woreda and has 9 kebeles. Lying 47 K.M South-East of Addis Ababa. It was formerly know as Debre zeit. How ever since the late 1990s it has been officially known by the Oromo name, Bishoftu, which was its name until 1955. The town is located in the Misraq shoa zone of the Oromia Region, and has an elevation of 1,920 meters (6,300 ft). Bishoftu is located 47.9 KM (29.8 mile) south east of Addis Ababa along its route 4 high way. Nearby point of interest includes mount Yerer, Green Crater Lake and lake hora kiloli. It is a Resort town, known for five crater lakes: lake bishoftu, lake Hora (a base for water sports, many water birds and an annually festival), lake bishoftu Guda, lake kuriftu and the seasonal lake chalaleka. Bishoftu is also home for the Ethiopia Air force and the Harar meda Airport, as well as a station on the Addis Ababa-Djibouti Rail way.

A total population for Bishoftu is 99,928, of whom 47,860 were men and 52,068 were women. The majority of the inhabitants said they practiced Ethiopian Orthodox Christianity. With 79.75% of the population reporting they observed these beliefs, while 13.82% of populations were protestant, and 4.98% of the population were Muslim. And also, three largest ethnic groups reported for this town were the Amhara (42.86%), the Oromo (39.4%), and the Gurage (8.3%); all other ethnic group made up 9.44% of the population. Amharic is spoken as a 1st language by 71.95%, and 20.12% spoken afan oromo, the remaining 7.93% spoke al other primary languages. Know a day Bishoftu town is five governmental Health Centers, 18 private clinics and also one governmental Hospital and one private hospital, ten primary school, two high school and also one military engineering college, one animal science university and two private college in the town 37.

5.2 Study period

The study was conduct from March 16 to 30 2020.

5.3 Study design

Health facility based cross-sectional study was conduct.

5.4 Source population

All women of reproductive age group visiting health facilities in Bishoftu city for contraceptive service was a source population.

5.5 Study population

All selected women of reproductive age group (15-49 years) who got contraceptive service at selected public health institutions was included in the study.

5.6 Inclusion and Exclusion Criteria

5.6.1 Inclusion criteria

All women of reproductive age group (15-49 years) who got contraceptive service at selected public health institutions was included in the study.

5.6.2 Exclusion criteria

Women who were sick and cannot respond to the interview questionnaire was excluded.

5.7 Sample size Determination

The sample size was calculated by using single population proportion formula by considering the following assumptions:

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5.8. Sampling procedure

The Bishoftu city has one public Hospitals (Bishoftu General hospital), and five health centers (Bishoftu HC, Keta HC, Cheleleka HC, kurkura HC and Babogaya HC), and eighteen private clinics.

Both public and private health facilities are providing family planning services in the city. For this study only government health facilities will be considered, i.e. one hospital and three health centers of these government health facilities will be included in the study (Bishoftu Hospital, Bishoftu H/C, Chalalake H/C and Keta H/C). The calculated sample size will proportionally be allocated to each health facility based on the previous consecutive three months average daily client flow of the units which was obtained by referring client registration log books. The average monthly client flow of women in all selected health facilities will found to be 120 in a month. Health institutions were selected using simple random sampling technique. The study participants was selected by using systematic random sampling method from family planning service users who visited the health facilities for the use of contraceptive during the data collection period. The first client in each health facility will selected by lottery method then subsequent respondents was selected every Kth where N/n (N is the total population and n is sample size) of from the daily FP clients flow until the required respondents was selected depends on voluntarily consenting reproductive ages women who visit health facilities for Family Planning methods within four weeks of working days.

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