Application of individual behavioral models to predict willingness to use modern contraceptives among pastoralist women in Afar region, Northern Ethiopia.

Background: Use of modern contraceptive methods reduces the risk of unwanted pregnancy, and is influenced by individual-level factors. Willingness to use modern contraceptive methods maybe a useful metric when considering health outcomes as it could predict health behaviors. Therefore, the current study aimed to assess the willingness of women to use modern contraceptives in Afar pastoralist communities.

Methods: A community-based cross-sectional study was conducted from May 1 to 30, 2016. Three hundred forty-five women of childbearing age (15-49 years) were systematically sampled with proportionate allocation from seven randomly selected kebeles (neighborhoods) in Aballa District of Afar Region, Ethiopia. All women meeting the inclusion criteria in each selected household were interviewed at home using a semi-structured questionnaire. Construct validity was assured using factor analysis. A combination of individual behavioral models were applied in order to measure willingness to use modern contraceptive methods. Multiple logistic regressions were utilized to identify factors associated with willingness to use contraceptive at P-value of less than 0.05.

Results: Three hundred twenty-two women participated in the study, for a response rate of 93.3%. The mean age of respondents was 27 (±6) years. About one-third (N = 106, 32.9%) of the participants reported that they were willing to use modern contraceptives. Orthodox Christians (AOR = 4.22, 95% CI 1.94-8.92), women aged 19 or older at first marriage (AOR = 2.89, 95% CI 1.16-7.23), and women who had never experienced a stillbirth (AOR = 3.85, 95%CI 1.37-10.78) were more likely to report being willing to use modern contraceptives. Additionally, perceived severity of an unwanted pregnancy (AOR = 1.71, 95% CI 1.57-1.93) and perceived self-efficacy to use contraceptives (AOR = 1.26, 95% CI 1.17-1.65) were positively associated with the willingness. Women who had never had an abortion were less likely to express willingness to use modern contraceptives (AOR = 0.41, 95% CI 0.19-0.92) and perceived importance of cultural and religious norms (AOR = 0.85, 95% CI 0.62-0.90) was also negatively associated with willingness.

Conclusions: The majority of women in this study were not willing to use modern contraceptive methods. A previous pregnancy outcome of stillbirth was associated with reduced willingness, while a prior abortion was associated with increased willingness. Perceived severity of unwanted pregnancy and higher self-efficacy surrounding contraceptive use were strong predictors of increased willingness to use contraceptives. Religious and cultural norms also appear to influence perception towards modern contraception. Thus, involvement of cultural and religious leaders and consideration of a woman's reproductive history are recommended when designing health education messages on contraception for Afar pastoralist women.