Geographic distribution and demographic factors associated with use of a long-acting reversible contraceptive (LARC) in Ethiopia.

Background: Increasing access to and utilization of long-acting reversible contraceptives (LARC) can prevent unintended pregnancies and reduce unmet need for family planning in Ethiopia However, LARC uptake lags behind less effective contraceptive methods. This study aimed to analyze the geographical distribution and demographic factors associated to LARC uptake.

Methods: The 2019 Performance Monitoring For Action Ethiopia (PMA Ethiopia) survey data was used. Spatial autocorrelation was examined using Global Moran's I and Local Indicators of Spatial Association (LISA). Bivariate Moran's I and bivariate LISA (BiLISA), Spatial lag, and spatial error regression analyses were performed to assess the spatial correlation and association between LARC uptake and demographic factors.

Results: LARC uptake was 8% among the study population, with Afar and Somali regions having the lowest uptake. There was a statistically significant positive spatial autocorrelation for LARC uptake (Moran's I= 0.308, p<0.001). Additionally, an inverse correlation was observed between LARC uptake and the percentage of Muslims, rural population, no formal education, and low wealth quantile. The spatial lag model indicated that zones with higher Muslim populations and those with higher percentages of population with no formal education had lower LARC uptake.

Conclusions: To expand access to LARC, the Ethiopian government, policymakers, and non-governmental organizations might implement programs targeting low-uptake areas (Afar and Somali regions). Muslim religious leaders could play an important role in promoting acceptance of LARC among their members. Tailored health education programs should be developed for Muslim populations and those with no formal education to enhance awareness and acceptance of LARC.