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Social-Ecological Predictors of Contraceptive Use in Ethiopia Mekonen Fisseha Gebrekidan Walden University

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Social-Ecological Predictors of Contraceptive Use in Ethiopia Mekonen Fisseha Gebrekidan Walden University Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2019 Social-Ecological Predictors of Contraceptive Use in Ethiopia Mekonen Fisseha Gebrekidan Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Public Health Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral study by Mekonen Gebrekidan has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Aimee Ferraro, Committee Chairperson, Public Health Faculty Dr. Gwendolyn Francavillo, Committee Member, Public Health Faculty Dr. Namgyal Kyulo, University Reviewer, Public Health Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2019 Abstract Social-Ecological Predictors of Contraceptive Use in Ethiopia by Mekonen F. Gebrekidan MPH, Walden University, 2015 BS, University of Texas Medical Branch at Galveston, 2010 BA, Addis Ababa University, 2001 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Public Health Walden University May 2019 Abstract Unintended pregnancy is a global public health threat that affects the lives of women, families, communities, and society. In 2008, the rate of unintended pregnancy in Ethiopia was 101 per 1,000 women aged 14 to 44 years. Although Ethiopia has experienced a steady increase in modern contraceptive use since 2004, this increase did not result in a proportional decline in unintended pregnancy, total fertility rates, or rapid population growth. In this cross-sectional study, associations between individual, interpersonal, community, and societal factors and contraceptive uptake were tested using a sample of 3,863 women aged 15 to 49 years who participated in the 2016 Ethiopian Demographic and Health Surveys. Statistically significant predictors of contraceptive use were included in the logistic regression model. Findings showed that age, education, marital status, type of residence, and wealth index reliably predicted contraceptive use. Increase in age, highest level of education, and wealth index were associated with 13%, 15%, and 65% increase in the odds of contraceptive use, respectively. Being married was associated with 85% decrease in the odds of contraceptive use and being from an urban residence was associated with 56% increase in the odds of contraceptive use. Results of the study can be used to develop targeted family planning interventions to increase contraceptive use and reduce unintended pregnancy, child and maternal mortality, total fertility rates, and rapid population growth in Ethiopia. Social-Ecological Predictors of Contraceptive Use in Ethiopia by Mekonen F. Gebrekidan MPH, Walden University, 2015 BS, University of Texas Medical Branch at Galveston, 2010 BA, Addis Ababa University, 2001 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Public Health Walden University May 2019 Dedication This research is dedicated to my father, Fisseha Gebrekidan (1956-2012). The death of my father was my inspiration for returning to school to finish my long-term goal of completing a doctoral degree. Dad, you will always be remembered for your positive effect on my life. This research is also dedicated to my children, Ezra, Eldana, Sipara, and Maekot for their unconditional love and support throughout the doctoral study process. Also, this research is dedicated to my wife, Selome Berehe, for her compassion, love, financial, and moral support. Finally, this research is dedicated to my mother Nigsti Tewele, brothers Negassi, Tsegay, and Adisu, and sisters Werknesh and Tirhas Fisseha. Acknowledgments I would like to thank my committee chair, Dr. Aimee Ferraro for her frank coaching and providing the guidance that I needed to complete my dissertation and for her considerable patience, sincerity, motivation, and knowledge. In addition to my advisor, I would like to thank my second committee member Dr. Gwendolyn Francavillo, my URR, Dr. Namgyal Kyulo, and my Program Director, Dr. Nancy Rea for their support and guidance throughout the doctoral study process. I also would like to thank my wife Selome Berehe for all her dedication, support, and space that she provided me while I completed my dissertation. My close friends also played a significant role in the completion of my dissertation. I would like to thank my friends, Habtamu Hailu for his motivation, Lauren Hailu and Dr. Nichole Cottrill for editing my dissertation and Timothy Allison-Aipa for assisting in statistical analysis. Lastly, I would like to thank my coworkers and leadership at Children’s Medical Center of Dallas Respiratory Care for their patience and support throughout my doctoral study process. Table of Contents List of Tables .......................................................................................................................v Section 1: Foundation of the Study and Literature Review .................................................1 Introduction ....................................................................................................................1 Problem Statement .........................................................................................................4 Purpose of the Study ......................................................................................................7 Research Questions and Hypotheses .............................................................................8 Theoretical Foundation ................................................................................................10 Nature of the Study ......................................................................................................13 Literature Review Search Strategy ..............................................................................14 Literature Review of the Historical Development of Contraception ...........................15 Literature Review of Key Concepts .............................................................................20 Conclusion ...................................................................................................................42 Definition of Key Terms ..............................................................................................48 Assumptions .................................................................................................................51 Scope and Delimitations ..............................................................................................52 Significance and Potential for Social Change ....................................................................54 Significance of Study ...................................................................................................54 Social Change ..............................................................................................................55 Summary ......................................................................................................................56 Section 2: Research Design and Data Collection ..............................................................57 Introduction ..................................................................................................................57 i Research Design and Rationale ...................................................................................57 Methodology ................................................................................................................59 Study Population ................................................................................................... 60 Sampling and Sampling Procedures ..................................................................... 61 Access to Secondary Data ..................................................................................... 62 Instrumentation and Operationalization of Constructs ................................................63 Instrumentation ..................................................................................................... 63 Operationalization ................................................................................................. 63 Data Analysis Plan .......................................................................................................64 Threats to Validity .......................................................................................................69 Ethical Considerations .................................................................................................70 Human Subjects .................................................................................................... 70 Ethical Issues ........................................................................................................ 70 Summary ......................................................................................................................71 Section 3: Presentation of the Results and Findings ..........................................................72 Introduction
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