Barriers to Contraceptive Use Among Child Bearing Women in Ambo Town, West Shewa Zone, Oromia Regional State, Ethiopia

Background: Contraception is a technique to prevent a conception; its usage is a central element of quality care in the provision of family planning services and an important dimension of women’s reproductive rights. Barriers to use contraceptive is the factor that increase the likely hood of adverse mothers’ sexual and reproductive health consequence such as unwanted pregnancy or poorly timed pregnancy, unsafe abortion, maternal death and others. The objective of this study was to determine the barriers of contraceptive use among child bearing women living in Ambo town, West Shewa zone, Oromia Regional state, Ethiopia. Methodology: The study was conducted in Ambo town from February to March, 2015 G.C. Cross sectional study design was used& Participants were selected using systematic random sampling method. Data was collected by using structured questionnaires through face to face interviews & coded, entered and analyzed using EPIINFO Version 3.5.1. The analyzed data was presented by using tables and graphs. Result: Forty percent of the respondents were using at least one contraceptive methods; injectable (58.8%) was the most used ones. Fear of side effect (25.8%) and desire to have a children were the most mentioned barrier for non-use. Multiple logistic regression model revealed that Educational status of mother (AOR 7.3, 95% CI: 3.22-16.6), and husband educational status (AOR 4.9, 95% CI: 1.4-16.9), religious influence (AOR 9.15, 95% CI: 1.75-46.9) and marital status (AOR: 1.95, 95% CI: 1.12-3.42) were positively associated with the use of contraceptives. Conclusion and recommendation: Contraceptive use rate was low. Therefore, the community should be encouraged to continue and use contraceptive so as to space family size and also leaders of religions to be involved in the education of the community to use contraceptive. Gy ne col ogy & Obetrics ISSN: 2161-0932 Gynecology & Obstetrics


Data quality assurance
To assure data quality, pre-tested collection tools was prepared in English and translated into Afan Oromo, data collectors and the supervisor were trained on the data collection techniques. In addition, the completeness, accuracy and consistency of the collected data were checked on daily basis during the data collection time, by the principal investigator and trained supervisor. Supervisors and principal investigator closely follow the data collection process.

Ethical considerations
Ethical clearance was obtained from Ethical Review Committee (ERC) of Ambo University. A formal letter of support was written to Ambo town Administration to get permission. After explaining the purpose of the study; verbal consent was obtained to proceed interview and confidentiality of the information was also maintained by omitting their names and personal identification.

Result Socio demographic characteristics of study population
The mean age of the respondents was 29.84. Majority (27.27%) of our respondents were found in the age group of 25-29. Eighty five percent of respondents were Oromo by ethnicity and majority (70.4%) of them were married. Most of (44%) respondents were protestant followed by orthodox 137 (40.2%). Concerning the educational status, more than three fourth of the respondents and 203 (84.6%) their partner were literate. Among the respondents, 94 (27.6%) were government employee followed by student 84 (24.6%) and housewife 80 (23.5%) ( Table 1).
Majority (84.2%) of the respondents possessed radios/TV. Almost all (99.1%) of the respondents had access to health care services and most of them get health service from health center 152 (45.16%) followed by government Hospital 134 (39.56%) ( Table 2).

Contraceptive use
More than two fifth of (42.3%) the respondents were using modern contraceptive currently. Among contraceptive users, majority of them use injectable 80 (58.8%) (Figure 1).

Factors associated with contraceptive utilization
In a multivariate logistic regression analysis, and by controlling

Study area and period
The study was conducted in Ambo town which was located 114 Kms to Southwest of Addis Ababa, the capital of Ethiopia from February to March 2015. The town has 3 kebele and 13,147 households and total population of 86, 949 from which 40, 476 (46.5%) are females. Child bearing age women (CBAW) make up about 17, 322 (42.8%) of the total women population. In the town there is one Zonal hospital, two Health centers, one Maternal and child health (MCH) clinic, twenty private clinics and two health posts.
Study design: A Community based cross-sectional study design was used.
Source of population: All women of reproductive age group who live in Ambo town. Exclusion criteria: women of two months postpartum, critically sick and non-responded women were excluded from the study.

Sample size and sampling procedure
The sample size was calculated using a single proportion formula. Assuming the proportion to be 29% (6), margin of error (d) 5%, level of significance at 95% confidence interval (Z) and adding non-response rate of 10% the final sample size after using correction formulas was 348.
Systematic random sampling method was employed to select the households. One house from one edge of the road was selected as reference house hold and proceeded every other house hold. After completing households found in one row (direction) the next household was selected by going in a clockwise direction. In cases of selected household with more than one eligible respondent, only one respondent was chosen by lottery method.

Data collection
First, a structured and pre-tested questionnaire was prepared in English and then translated into Oromic (Oromiffa), the Local language which was used for data collection. Information about sociodemographic and economic, reproductive history and contraceptive were gathered. The data were collected by six female BSc health officer students. The data collectors were supervised daily by two supervisors. The filled questionnaires were checked daily by the supervisors and principal investigator.
Data collectors approached and interviewed the selected respondents after informed consent had been obtained. The women, who were not available in the first visit, were revisited for two more times. During the revisit, the women in the next household were interviewed in place of those women who were not found.

Data processing and analysis
The completed and checked data were entered and analyzed using Epi Info 3.5.1, 2008 (CDC, Atlanta, Georgia). Tables and graphs were used to present the data. Descriptive statistics was used to see the frequency and percentage of the characteristics. Logistic regression (binary and multiple) analyses to determine the effect of factor(s) on the outcome variable(s) and to control possible confounders. P-value < 0.05 was considered to declare statistical significance. Variables with for all other variables, educational status of the respondent, marital status, religion of respondents, and husband's educational status were significant predictors of utilization of contraceptive methods (p<0.05) (

Discussion
This study tried to identify barriers to utilization of contraceptive use among child bearing age women of Ambo town, Ethiopia in 2015.
In the study, majority of the respondent were knowledgeable about at least one contraceptive method. Injectable were largely known by respondents (90.1%) followed by Pills (89.5%), and condom (72.2%). Similar, other studies done in Ethiopia and Kenya [10][11][12] support this idea. This shows that modern contraceptives were well known and popular among childbearing age group of women due to the commitment of government and non-government organization to address the unmet need of contraceptive in the world. The other possible reason for this might be, the study was conducted at urban setting where majority of the people have access to Medias such as TV and Radio.
The prevalence of modern contraceptive use among respondents was 42.3%, which is slightly lower than a study conducted in other parts of Ethiopia in North Shoa Zone, Amhara Region [5]. This may be due to the difference in method acceptance among the two society, health care service weakness, and nature of study area. Our study showed that 43.1% of the respondents are not used contraceptive due to fear of side effect, this showed that fear of side effect almost similar with cross-sectional study done in Baringo North District, kenya and Jimma Zone, Agaro town, which reveals fear of side effect was 25.4% [12][13][14][15].    According to our study, 23.5% respondents were not used contraceptive due to desire to have a child which is similar with a cross-sectional study done on Awareness and determinants of family planning practice in Jimma, Ethiopia, reveals that desire to have more children have major effect on modern contraceptive usage [13].
In our study, religious influence is the 3 rd major predictor for not to use contraceptive accounted about 17.6% which is higher than cross-sectional study done in Mojo town on family planning service utilization reveals that religious influence 7.6%. This may be due to the fact that religious background in the study area where there were certain beliefs discouraging the use of contraceptives usually observed among Catholics, and protestant hence the women ended up using the contraceptives without the knowledge and approval of their spouses. The husband influence is one the factor that not to use contraceptive accounted 9.4% which is almost similar with cross-sectional study done in Mojo town on family planning service utilization reveals husband influence accounts 10.9% [16].
Lack of health education about contraceptive used in our study was 4.7% which was lower than the similar cross-sectional community based research done in Agaro town 7 (9.9%). In our study, the distance from health institution showed that 2.1 percent were not get health facility due to far distance which is less than the result, 11.1 percent in Agaro town. A Cross-sectional community based study was conducted on modern contraceptive methods and determinant factors among women's of child bearing age  in Agaro town showed that 28.2% are not used contraceptive due to cultural influence which is very high compared with the result of this study 5% [14].
Our result shows that socio-demographic variables has positive effect on practice of contraceptive methods. 47.8 percent of literate respondents use contraceptive compared with 11.3 percent of those illiterate which is similar with a cross-sectional study done in Agaro town (23) shows that percentage of contraceptive users' increases with educational level. Educational status of the husband has positive effect on contraceptive methods use in which the literate husbands are four times that of the illiterate one. Being married and divorced women were found to be significantly associated with use of modern contraceptive than unmarried women. The reason for this may be due to the fact that, these groups of women use contraceptive for spacing pregnancy prevent unintended pregnancy and sexually transmitted infections including HIV/AIDS. One of the limitations of this study was lack of qualitative method which helps to explore in-depth view about the barriers to use of contraceptive methods. The other possible limitations could be not including the study participants from the rural parts and the cross-sectional nature of this study precluded drawing causal inferences between explanatory factors and contraceptive behavior.

Conclusion and Recommendation
The use of modern contraceptive was low in the study area. Respondents' educational status, marital status, religion and husband's educational status were the major predictors of uptake of modern contraceptive methods. Fear of side effects as a major consideration when choosing a method and as barrier to use among those who have never used. The study recommends that reproductive health programs need to intensify efforts in improving women's awareness about modern contraceptive methods. Further research into the male partner views on family planning; cultural determinants of non-use; and barriers to the use of modern contraceptive methods between men and women is proposed in the study area.

Acknowledgment
We are grateful to colleagues of Ambo University, College of Medicine and Health Sciences and to the supervisor and data collectors who committed themselves throughout the study period. And Ambo University for funding the study. Finally, we would like to express our gratitude to all participants who voluntarily participated in the study.

Variables
Contraceptive