Contraceptive use to delay first birth and its associated factors among married young women in rural parts of central Oromia,Ethiopia: A community-based cross-sectional study

Abstract

Background

In Ethiopia, young women’s pregnancy is a serious public health issue that hurts the health outcomes of both the mother and child. However, no research has been done on the use of contraceptives to delay first birth and associated factors among married young women aged 15-24 in Ethiopia.

Objectives

This study aimed to assess the contraceptive use to delay first birth and its associated factors among married young women in rural parts of central Oromia, Ethiopia, in 2024.

Design

A community-based cross-sectional study design was employed.

Methods

The sample size for the study was 422 married young women. A census was conducted to obtain a sample frame, and a simple random sampling method was used to select the study participants. Data were collected using interviewer-administered structured questionnaires. The collected data were entered into EpiData version 4.6 and exported to SPSS version 23 for further analysis. Binary logistic regression analyses were performed to identify variables associated with contraceptive use to delay first birth, with a p-value of less than 0.05 considered significant.

Results

The overall contraceptive use to delay first birth among married young women was 16.3%, with a 95% CI (12.8, 20.3). The following were found to be factors associated with the use of contraceptives to delay first birth among married young women: exposure to contraceptive information. [AOR=4.36; [95% CI: (2.14, 8.86)], p=0.001], a favorable attitude toward contraceptive methods (95% CI: (1.72, 7.31)), and p=0.001]; intention to use contraceptives [AOR=4.16; (95% CI: (1.96, 8.84); p < 0.001)]; perceived social approval [AOR=3.48; (95% CI: (1.65, 7.35)); p=0.001]; beliefs about contraceptive myths at the community level) [AOR=3.74; 95% CI: (1.82, 7.66); p < 0.001); and family planning counseling [AOR=5.19; 95% CI: (2.43, 11.08); p < 0.001) were among the significant variables associated with contraceptive use to delay first birth among young married women.

Conclusions

The contraceptive use to delay first birth among married young women was low. Healthcare providers, policymakers, and program designers should intensify their efforts to create awareness about the importance of contraceptive utilization among young married women to delay their first birth.

Plain language summary

Why was this study needed? Young women’s pregnancy is a serious public health issue that negatively impacts the health outcomes of both the mother and child. Therefore, this focuses on the use of contraceptives to delay first birth and associated factors among married young women aged 15-24 in rural parts of central Oromia, Ethiopia. Understanding the prevalence of contraceptives to delay first birth and associated factors among married young women in rural parts can help to create more pregnancy delay strategies.

What did the researcher aim for? This study aimed to investigate the contraceptive use to delay first birth and its associated factors among married young women in rural parts of central Oromia, Ethiopia, in 2024.

What did the researcher do? A community-based one-time data collection was used as a design for the study. We included 422 married young women aged 15-24 years from nine kebeles of rural central Oromia, Ethiopia, for the study. On starting a mass registration of all young married women in the selected rural kebeles to obtain a sample frame, multistage sampling was used for proportional allocation of the sample. A simple random sampling method was used to select the study participants. Data were collected using interviewer-administered structured questionnaires on sociodemographic and economic factors; knowledge, attitude, and intention to use contraceptive methods; perceived social approval; and community-level beliefs and enhance about modern contraceptive use and counseling services. Then, the collected data were entered into EpiData version 4.6 and exported to SPSS version 23 for further analysis. Binary logistic regression analyses were performed to identify variables associated with contraceptive use to delay first birth, with a p-value of less than 0.05 considered to declare the statistical significant association between the exposure and outcome variables.

What did the study find? Out of 405 study participants, the overall contraceptive use to delay first birth among married young women was only 66 (16.3%). 162 (40%) of the women were married at ages younger than 18 years, and 340 (84%) study participants were housewives by occupation. Nearly 160 (39.5%) of the respondents’ spouses had completed secondary school. 221 (54.6%) had a monthly income of 10-30 USD.

Young married people with exposure to contraceptive information were four times more likely to be contraceptive users than those with no exposure to contraceptive information. Furthermore, having a favorable attitude toward contraceptive methods, intention to use contraceptives, perceived social approval, good beliefs about contraceptive myths at the community level, and family planning counseling by healthcare providers were among factors that enhanced contraceptive use to delay first birth among young married women.

What do the findings mean? The contraceptive use to delay first birth among married young women was low. Thus, this study highlights the need for targeted interventions to enhance contraceptive use to delay birth among young married women in rural Ethiopia. These interventions should focus on information, a favorableattitude, social behavioral change, and counseling on modern contraceptive methods for the better health of young married women. Healthcare providers, policymakers, and program designers should intensify their efforts on modern contraceptive methods and services for young married women to delay their first birth.

Keywords

Contraceptive Young married Delayed first birth Central Oromia Ethiopia

Introduction

Globally, it has been estimated that 16 million females aged 15–24 give birth each year, with 90% occurring within marriage. 95% of these births occur in low- and middle-income countries (LMICs), including Sub-Saharan Africa (SSA).¹ The use of modern contraceptives is crucial for individuals and couples to realize their fundamental right to choose freely and responsibly whether to have children, when to have children, and how many children to have.² In addition to improving health-related outcomes, including lower maternal and neonatal mortality, monitoring rapid population growth, gender inequity, improvements in schooling, and opportunities for economic empowerment.³ However, global gender disparities place young women at a disadvantaged social position, and sexual and reproductive health and rights issues disproportionately affect women.⁴ Their lower social status within their families and communities often undermines young women’s decisions about whether, when, and how many children to have, leading to early and unwanted pregnancies.⁵

Approximately 14 million young women in low- and middle-income countries would like to prevent, delay, or avoid pregnancy by utilizing modern contraceptives.⁶ Furthermore, studies have indicated that young women who have never been married are more likely to use modern contraceptives to prevent unintended pregnancies, while married women are often confronted with pressure to have a child soon after marriage.^7,8

As a result, approximately 21 million young women in LMICs become pregnant every year, of which 50% are unintended, leading to an increased risk of eclampsia, puerperal endometritis, systemic infections, neonatal morbidities, and maternal death, particularly among those aged 15-19 years.⁹ Furthermore, most girls leave school following marriage and focus on domestic duties, pregnancy, and raising children.^10,11 Nowadays, more young women exist in the world, with approximately one in every five people, mostly in developing countries.¹²

In Ethiopia, about 63.5% of women ages 15-24 who are currently married are not using contraception.¹³ As a result, unwanted pregnancies among young married women are more than double that of married women over 25 years old.^14,15 A mixed-method study conducted on contraceptive prevalence rate and associated factors among married young women in four emerging regions of Ethiopia showed that 11.7%, 38.6%, 25.5%, and 8.8% for Afar, Benshangul Gumuz, Gambela, and Somali regions, respectively.¹⁶

According to a report by Population Services International (PSI), four out of five girls in Ethiopia become mothers by age 20 without considering the financial consequences.¹⁷ Additionally, three out of four Ethiopian females between the ages of 15 - 24 years use their first contraceptive after giving birth to two or more children.^18,19 As a result, it hurts maternal and neonatal mortality, school attainment, productivity, and poverty.²⁰ Thus, contraceptive use to delay first birth among married young women is crucial to reducing maternal and child mortality, preventing married young women from falling into poverty, and achieving sustainable development goals. However, most research conducted in Ethiopia has been limited to contraception use for spacing of births among women of reproductive age, not among married young women. Therefore, this study aims to assess the contraceptive use to delay first birth and its associated factors among married young women in rural parts of central Oromia, Ethiopia.

Methods

Study area and period

The study was conducted in Goro woreda of Southwest Shewa Zone, Oromia Regional State, 135 km away from Addis Ababa, the capital city of the country. The woreda has 19 rural kebeles with four primary health centers, 19 health posts, and 5 private clinics providing primary health care services, including family planning services. The total population is 66,815, of which 32,739 are male, and 34,076 are female. The estimated number of women aged 15-24 was 8,280 in rural kebeles. The study was conducted from August 1 to September 30, 2024.

Study design

A community-based cross-sectional study design was employed.

Source population

All married females aged 15-24 years residing in the Goro woreda.

Study population

All selected married females aged 15-24 residing in the Goro woreda.

Sample size calculation

The sample size was determined using the single population proportion formula, with the following assumptions: Z = 95% confidence interval (1.96), d = margin of error (5%), and proportion of participants (p = 50%) because no study had been done before on this concept.

n $= \frac{{(z_{\frac{α}{2}})}^{2} p (1 - P)}{d^{2}}$ $n = \frac{{(1.96)}^{2} 0.5 (1 - 0.5)}{{(0.05)}^{2}}$ = 384; after considering a non-response rate of 10%, the final sample size was 422.

Sampling techniques

Initially, a simple random sampling technique was used to select 9 kebeles, assuming the kebeles were homogeneous. Then, married women aged 15-24 were identified by conducting a house-to-house listing by selected community health workers to have a sampling frame. The calculated sample size was proportionally allocated to select kebeles based on the number of married women aged 15-24 identified and the calculated sample size for the study. Due to inadequate resources or the absence of funding, study samples were selected using a simple random sampling technique from a sampling frame. Three times, a repeat visit was made for women who were not at home during data collection to reduce the non-response rate (Figure 1).

Figure 1.

The schematic diagram representation of sampling procedures to identify the prevalence of delaying first birth and associated factors among young married women in Goro Woreda, central Oromia, Ethiopia, in September 2024.

For proportional allocation of a sample:

n p = \frac{n u m b e r o f h o u s e h o l d s i n e a c h k e b e l e s * t o t a l s a m p l e s i z e}{t o t a l n u m b e r o f h o u s e h o l d s i n t h e s e l e c t e d k e b e l e s}

Study variables

Dependent variable

Contraceptive use to delay the first birth

Independent variables

Sociodemographic and economic status, Knowledge, Attitude, intention to use, exposure to information, perceived social approval, and community-level factors (belief and support).

Inclusion and exclusion criteria

Inclusion

Women aged 15 to 24 years, of marital status, residing in the study area for at least six months, who consented to participate, were included in this study.

Exclusion

Women with serious health conditions in previous births and non-consent were excluded from this study.

Operational definition

Contraceptive use to delay first birth was assessed using binary outcomes: whether married women aged between 15 to 24 years had been using one modern contraceptive method for at least two years to delay first birth and had never given birth (coded 1), or if she did not start using any modern contraceptive and/or was pregnant and/or had a child/child (coded 0).²¹

Monthly Household Income: This is the participants’ household average monthly income. Participants were asked to estimate and tell their household’s monthly income in USD, and then, for analysis purposes, it was categorized into three categories.²²

Exposure to family planning information in the last 12 months: Whether the women heard or saw about modern contraceptive methods on the radio or television, or read about them in a newspaper or magazine. In the last 12 months (coded 1), if not (coded 0).²³

Knowledge about contraceptive methods among young married women refers to women having information about modern contraception. Seven knowledge-assessing questions were used. It was graded as high knowledge, moderate knowledge, and low knowledge, with scores of 75-100%, 50-74%, and <50%, respectively.²⁴

Attitude towards modern contraceptive methods: Married young women’s attitudes towards modern contraceptive methods included in this study include women’s general feelings, emotions, and opinions towards modern contraceptive methods. Categorized as a favorable (positive) attitude (those who could answer ≥ 70% of the attitude questions correctly are regarded as having a favorable attitude) or unfavorable (negative) attitude: Those who could answer fewer than 70% of the attitude questions were regarded as having an unfavorable attitude.²⁵

Women’s decision-making autonomy: Whether the women had the independent right to make choices and control resources. The scale score calculated as the median and above is considered as high-level decision-making autonomy and below median score is considered as low-level decision-making autonomy, the scale score calculated as the median and above is considered as high-level decision-making autonomy and below the median score is considered as low-level decision-making autonomy.²⁶

Interspousal communication: Refers to how often she discusses with her husband things that happened during the day, her worries or feelings, how many children to have, and whether to use contraceptive methods. The overall inter-spousal communication scale was constructed depending on the median score. Median and above are considered a higher spousal communication scale, and below the median score indicates a lower level of interspousal communication.

Intention to use modern contraception: Refers to young married women who report intending to use any form of contraceptive method in the future but who are not currently utilizing any form of modern contraceptive method. The overall intention scale was constructed depending on the median score. A median and above indicates having the intention to use modern contraception, and a lower score indicates no intention to use it.²⁷

Perceived social approval: Refers to how their referents accept (approve) their contraceptive use. The answers were classified as perceiving their referents approve more of their contraceptive use (median value and above) and not perceiving their referents approve of their contraceptive use (below median score).²³

Belief in contraceptive myths: Refer to misinformation and widely held but false beliefs about contraception that differ from women’s concerns regarding documented or experienced method-related side effects. The answers were classified as a strong belief in the myths or misconceptions regarding contraceptive methods (below median score) and no belief in the myths or misconceptions regarding contraceptive methods (median value and above of contraceptive myth-assessing question 23).

Community support for contraceptive use to delay the first birth: According to this study, “community support for smart start contraception” refers to respondents’ feelings about whether cultures within the community are favorable to using modern contraceptives to delay the first birth. The overall community support for the smart start contraception scale was constructed depending on the median score.^28–30

Counseling on modern contraceptive methods: This was measured using four questions, and the answers were changed to binary (yes if counseled on general contraceptive methods in the last three months by a health care professional, no if not). Finally recorded based on the median score.²⁴

Data collection tools and procedures

The collection tools were adapted from different literature after being modified to the local context, and content validity was checked by the Delphi method^{23,24,26,28,31,32} (Supplementary tools). The tools contain socio-demographic and economic status factors associated with contraceptive use, such as knowledge, attitude, intention, perceived social approval, beliefs, myths about contraception, and community support. Data were collected using an interviewer-administered structured questionnaire. Unique identification number for an eligible household used to locate young married women. Finally, data were collected by three midwifery professionals trained on the objectives and methods of the study and one supervisor.

Data quality

The questionnaire was prepared in English and then translated into local languages (Afan Oromo and Amharic) and then back-translated to English by independent language experts to ensure clarity and consistency of the tools. To ensure the quality of data, a day of training was given for data collectors on the objective and methods of the study, data collection procedures, the content of the questionnaires, and ethical issues. A pretest was conducted on 5% of the total sample to assess the tool’s simplicity and flow outside the study area to prevent information contamination. Based on the findings from the pretest and mock interview, necessary modifications have been made to the tool whenever needed. The data were checked for completeness and consistency before leaving the household, and necessary checks were done before data entry, cleaning, and analysis. The supervisors made ongoing checkups during the data collection.

Ethical considerations

This study was conducted in accordance with the declarations of Helsinki and was approved by the Institutional ethical review board of the Jimma University Institute of Health, Institutional Review Board with ethical approval reference number JUIHIRB 75/24. The study participants were informed on the study's objectives, procedures, potential risks, benefits, and voluntary participation,n and confidentiality was maintained. This study included participants with poor literacy levels, as a result, written consent was waived, and verbal informed consent was secured from the study participants before data collection. For participants under 18, consent from parents or guardians was waived, as the Ethiopian National Research Ethics Review Guidelines allow married or parenting minors to give consent themselves.

Statistical analysis

The STROBE checklist was used to report findings from this study (Supplementary file: STROBE checklist).³³ The data were checked, coded, and entered into EpiData version 4.6 and then exported to SPSS version 23 for further analysis. Descriptive analysis was used for the presentation of socio-demographic data and the prevalence of contraceptive use to delay first birth. A binary logistic regression analysis was conducted to identify variables that were candidates for multiple logistic regressions, having a p-value ≤ 0.25, to control for confounding factors.¹⁶ All candidate variables were entered together into a multivariable logistic regression using the enter method to determine the factors associated with contraceptive use to delay first birth by controlling for potential confounders. The independent variables were checked for multicollinearity by using the variance inflation factor. (VIF) and tolerance test (TT). All variables yield a variance inflation factor <10 (VIF < 1.323) and tolerance>0.1(TT>0.756), and they were not removed from multivariable analyses. Hosmer and Lemeshow’s test was used to determine the model’s fitness (p = 0.445). Finally, independent variables’ AOR with a 95% confidence interval at a p-value < 0.05 were used to declare the statistical significance.

Results

A total of 405 out of 422 participants were interviewed, resulting in a response rate of 95.97%. Of the total, 178 (44%) were in the 15-17 age group. Around 162 (40%) of the women were married at ages less than 18 years. Around 61 (15.1%) had no formal education, and 340 (84%) study participants were housewives by occupation. Nearly 160 (39.5%) of the respondents’ spouses had completed secondary school, and 172 (42.5%) were farmers. More than half of the respondents, 221 (54.6%), had a monthly income of 10-30 USD (Table 1).

Table 1.

Shows the sociodemographic and economic status of study participants in rural kebeles of Goro District, central Oromia, Ethiopia, 2024.

Variables		Frequency	Percent
Age of the mothers [year]	15-19	178	44.0
Age of the mothers [year]	20-24	227	56.0
Age at first marriage	15-17	162	40.0
Age at first marriage	18-24	243	60.0
Women’s educational status	No formal education	61	15.1
	Primary education	225	55.6
	Secondary and above	119	29.4
Husband’s educational status	No formal education	36	8.9
	Primary education	146	36.0
	Secondary education	160	39.5
	Diploma and above	63	15.6
Women’s occupational status	Housewife	340	84.0
	Farmer	26	6.4
	Government employee	19	4.7
	Merchant	18	4.4
	Other*	2	0.5
Husband’s occupational status	Not working	27	6.7
	Government employee	74	18.3
	Merchant	104	25.7
	Farmer	172	42.5
	Other*	28	6.9
Monthly income	<10 USD	16	4.0
	10-30 USD	221	54.6
	>30 USD	168	41.5

*Daily laborer/car driver, USD, United States Dollar.

Prevalence of contraceptive use to delay first birth among married young women

Only 66 (16.3%) of the respondents, with a 95% CI (12.8-20.3), were using modern contraceptives to delay their first birth. Among them, Depo-Provera was the most commonly used method, 39 (9.4%), followed by implants, 16 (4%), and contraceptive pills, 11 (2.7%).

Knowledge status of participants

Most of the participants had heard about family planning methods 335 (82.7%). Around 346 (82%) of respondents were able to name at least one modern contraceptive method, and the major sources of information were health workers, 276 (68.1%); neighbors, 106 (26.2%); radio, 67 (16.5%); and schools, 43 (10.6%). The most commonly mentioned methods by respondents were Depo-Provera 272 (67.2%), contraceptive pills 198 (48.9%), and implants 132 (32.6%), respectively. The majority of the respondents, 288 (71.1%), know about modern contraceptives used to prevent unwanted pregnancy; 221 (54.6%) know about modern contraceptives used to delay first birth; and 166 (41%) of respondents know that early initiation of modern contraceptives in marriage is important, respectively. Regarding the overall knowledge of study participants, 196 (48.4%) had good knowledge, 146 (36%) had moderate knowledge, and the remaining 63 (15.6%) had poor knowledge of family planning. (Table 2).

Table 2.

Knowledge level of study participants about modern contraceptive methods in Goro Woreda, central Oromia, Ethiopia, September 2024.

Variables			Frequency	Percentage (%)
Have you ever heard about modern contraceptive methods	No		70	17.3
Have you ever heard about modern contraceptive methods	Yes		335	82.7
Source of information on the modern contraceptive method	Health workers	No	129	31.9
	Health workers	Yes	276	68.1
	Husband	No	388	95.8
	Husband	Yes	17	4.2
	Neighbors	No	299	73.8
	Neighbors	Yes	106	26.2
	School	No	362	89.4
	School	Yes	43	10.6
	Radio	No	338	83.5
	Radio	Yes	67	16.5
Types of modern contraceptive methods known	Contraceptive pills	No	207	51.1
	Contraceptive pills	Yes	198	48.9
	Depo Provera	No	133	32.8
	Depo Provera	Yes	272	67.2
	Implants	No	273	67.4
	Implants	Yes	132	32.6
	IUCD	No	375	92.6
	IUCD	Yes	30	7.4
	Condom	No	369	91.1
	Condom	Yes	36	8.9
Sources of modern contraceptive methods are known	Government HFs	No	76	18.8
	Government HFs	Yes	329	81.2
	Private clinic	No	388	95.8
	Private clinic	Yes	17	4.2
	Pharmacy	No	339	83.7
	Pharmacy	Yes	66	16.3
Modern contraceptives are used to prevent unwanted pregnancy	No		117	28.9
	Yes		288	71.1
Modern contraceptives are used to delay the first birth	No		184	45.4
Modern contraceptives are used to delay the first birth	Yes		221	54.6
Early initiation of modern contraceptives in marriage is important	No		239	59
	Yes		166	41

Attitude status of participants

The majority, 216 (53.3%) of the respondents had agreed to discuss family planning issues with their partner, and 133 (32.8%) agreed to use it in the future. Around 15 (3.7%) and 142 (35.1%) of study participants strongly agreed and agreed that using family planning contradicts their religion and culture, respectively. Around 120 (29.6%) of respondents had a favorable attitude, while 285 (70.4%) of the participants had an unfavorable attitude towards contraception (Table 3).

Table 3.

Attitude of study participants about modern contraceptive methods in Goro Woreda, central Oromia, Ethiopia, September 2024.

S.N	Statement	Frequency (%)
S.N	Statement	SA	A	N	D	SD
1.	Discussing the issue of family planning with a partner is a must.	136 (33.6%)	216(53.3%)	17(4.2%)	34(8.4%)	2(0.5%)
2.	Family planning exposes to infertility	43 (10.6%)	181(44.7%)	106(26.2%)	70(17.3%)	5(1.2%)
3.	Using family planning in the future is a must	43 (10.6%)	133(32.8%)	103(25.4%)	118(29.1%)	8(2%)
4.	Family planning contradicts your culture and religion	15 (3.7%)	142 (35.1%)	64(15.8%)	169(41.7%)	15(3.7%)
5.	Overall Attitude	Favorable	120 (29.6%)
5.	Overall Attitude	Unfavorable	285(70.4%)

SA: Strongly agree, A: Agree, U: Unknown, D: Disagree, SD: Strongly disagree.

Intention to use contraception status

This study revealed that around 168 (41.5%) of respondents say getting further along in their life, like finishing school, getting a job, or making more money, before they have a child or their next child, is important for them. 136 (33.6%) of respondents said that their partner was against using contraception. Around 155 (38.3%) of the respondents said it is important to avoid getting pregnant now, and using birth control is important (Table 4).

Table 4.

Shows the respondents’ level of intention to use modern Contraceptives in Goro Woreda, Oromia, Ethiopia, September 2024.

S.N	Statement	Frequency (%)
S.N	Statement	VI(DY)	I(PY)	SI(PN)	NI(DN)
1.	How important is it for you to get further along in your life, like finish school, get a job, or make more money, before you have a child or your next child?	124(30.6)	168(41.5)	43(10.6)	4(1.0)
2.	Do you think the person you have sex with is against you using birth control?	85(21)	136(33.6)	65(16)	53(13.1)
3.	How important is it for you to avoid getting pregnant now?	49 (15.6)	155 (38.3)	73(18)	48(11.9)
4.	How important is it for you to use birth control now?	63(15.6)	155 (38.3)	73(18)	48(11.9)

VI-Very important, DY-Definitely not, I-Important, PY-Probable yes, somewhat important. NI-Not at all important, DN-definitely yes, PN-probably not, DY-definitely yes.

Perceived social approval

Around 141 (34.8%) of the study participants’ parents and 148 (39.5%) of their friends agreed on using contraception, respectively. Additionally, 139 (34.3%) of the study participants’ husbands used contraception, and 138 (34.1%) of the study participants believed that society disagreed with using contraception to delay the first birth (Table 5).

Table 5.

Shows the level of perceived social approval regarding contraceptive use of the respondents on modern contraceptive methods in Goro woreda, Oromia, Ethiopia, September 2024.

Variables	SA (%)	A (%)	U (%)	D (%)	SD (%)
Parents believe in using contraceptives	56(13.8)	141(34.8)	102(25.2)	104 (25.7)	2(0.5)
Friends believe in using contraceptives	11(2.7)	148(39.5)	130(32.1)	113 (27.9)	3(0.7)
Husband believes in using contraceptives	23(5.7)	116(28.6)	107 (26.4)	139(34.3)	20(4.9)
Society believes in using contraceptives	18(4.4)	108(26.7)	119 (29.4)	138(34.1)	22(5.4)

SA: Strongly agree, A: Agree, U: Unknown, D: Disagree, SD: Strongly Disagree.

An individual believes in contraception myths

This study shows that 41 (10.1%) and 168 (41.5%) respondents strongly agreed and agreed on statements that contraceptives can harm women’s wombs, respectively. While 132 (32.6%) and 181 (44.7%) of the study participants agreed that contraception ruins sexual mood, 51.6% believe contraceptives can harm women’s wombs. Around 41.2%, 55.3%, 20.7%, and 19.5% responded as the community believes contraception would ruin the sexual mood and lead to infertility, respectively. Furthermore, around 172 (42.5%) and 209 (51.6%) respondents disagreed with the statement that using contraception leads to having deformed babies and that women who use contraceptive methods may become promiscuous, respectively (Table 6).

Table 6.

Shows community-level beliefs in contraception myths on modern contraceptive methods in Goro Woreda, Oromia, Ethiopia, September 2024.

Variables	SA (%)	A (%)	U (%)	D (%)	SD (%)
Contraceptives are dangerous to women	48(11.9)	150(37)	69(17)	131(32.3)	7(1.7)
Contraceptives can harm a woman’s womb	41(10.1)	168(41.5)	76 (18.8)	105(25.9)	15(3.7)
Contraception would ruin the sexual mood	35(8.6)	132(32.6)	126(31.1)	112(27.7)	0
Use of a contraceptive makes one infertile	43 (10.6)	181(44.7)	106(26.2)	70 (17.3)	5(1.2)
Contraceptives give you deformed babies	3(0.7)	81(20)	136(33.6)	172(42.5)	13(3.2)
Use a contraceptive because of promiscuity	14(3.5)	65(16)	96 (23.7)	209(51.6)	21(5.2)

SA: Strongly agree, A: Agree, U: Unknown, D: Disagree, SD: Strongly disagree.

Community-level enhancing factor to use of modern contraceptives to delay the first birth

The findings from this study indicated that 108 (26.7%) young married women received community support for contraceptive use. Additionally, 47 (11.6%) were encouraged to use contraceptives, and 42 (10.4%) participants received support for their intention to delay their first birth after marriage (Table 7).

Table 7.

Shows community level support to use modern contraceptives to delay first birth in Goro woreda, Central Oromia, Ethiopia, September 2024.

Variables		Frequency	Percentage (%)
Community supports contraceptive use	No	297	73.3
Community supports contraceptive use	Yes	108	26.7
Community encourages contraceptive use	No	358	88.4
Community encourages contraceptive use	Yes	47	11.6
Community supports delaying your first birth	No	363	89.6
Community supports delaying your first birth	Yes	42	10.4

Counseling on modern contraceptive methods.

Around 157 (43.2%) of respondents had been counseled by healthcare professionals on modern contraceptive methods, while 248 (56.8%) were not counseled.

Factors associated with contraceptive use to delay the first birth

In the covariates for the logistic regression model variables such as age range 20-24yrs, educational status secondary education and above, exposure to contraceptive information, Good knowledge of contraception, favorable attitude towards contraceptive use, Intention to use contraceptives, Social approval to use contraceptives, not belief in contraceptive myth and misconceptions, Community support for contraceptive use to delay the first birth and having counseling on FP were significant variables with p-vale of <0.25 were selected as candidate variables for the multivariable logistic regression analysis. Using the stepwise method (Table 8).

Table 8.

Bivariate logistic regression analysis for factors associated with contraceptive use to delay the first birth among married young women at Central Oromia, Ethiopia,2024.

Variables	User (%)	Non-user (%)	COR (95% CI)	P-value
Age
15-19yrs	21(11.8)	157(88.2)	1
20-24yrs	45(19.8)	182(80.2	1.85(1.06,3.24) *	0.032
Educational status
No formal education	7(11.9)	52(88.1)	1
Primary education	26((11.0)	210(89.0	0.92(0.38,2.23)	0.853
Secondary and above	33(30.0)	77(70.0)	3.18(1.31,7.74) *	0.011
Exposure to information
No	25 (8.2)	279 (91.8)	1
Yes	41(40.6)	60(59.4)	7.63(4.31,13.49) *	<0.001(0.000)
Maintained privacy to use contraception in a health care setting
No	17(17.3%)	81(82.7%)	1
Yes	49(16%)	258(84.0%)	0.905(0.49,1.66)	0.74
Decision-making autonomy
No	12(12.6%)	83(87.4%)	1
Yes	54(17.4%)	256(82.6%)	1.46(0.745,2.86)	0.27
Interspousal communication
No	26(14.4%)	155(85.6%)	1
Yes	40(17.9%)	184(82.1%)	1.29(0.76,2.22)	0.345
Knowledge of contraceptives
Poor knowledge	5(7.9)	58(92.1)	1
Moderate knowledge	12(8.2)	135(91.8	1.03(0.35,3.06)	0.956
Good knowledge	49(25.1)	146(74.9)	3.89(1.48,10.26) *	0.006
Attitude about contraceptives
Unfavorable attitude	31(10.9)	254(89.1)	1
Favorable attitude	35(29.2)	85(70.8)	3.37(1.96,5.80) *	<0.001(0.000)
Intention to use a contraceptive
No intention to use	15(6.5)	215(93.5)	1
Intention to use	51(29.1)	124(70.9)	5.89(3.18,10.92*	<0.001(0.000)
Perceived social approval
Did not approve to use FP	17(7.5)	211(92.5)	1
Social approval to use FP	49(27.7)	128(72.3)	4.75(2.62,8.60) *	<0.001(0.000)
Belief in contraceptive myths
Believe in CM/M	28(10.0)	252(90.0)	1
No belief in CM/M	38(30.4)	87(69.6)	3.93(2.28,6.78) *	<0.001(0.000)
Community support for contraceptive use to delay the first birth
No	39(13.7)	246(86.3)	1
Yes	27(22.5)	93(77.5)	1.83(1.06,3.16) *	0.030
Counseling on FP
No	16(7.0)	214(93.0)	1
Yes	50(28.5)	125(71.4)	5.35(2.92,9.79) *	<0.001(0.000)
Distance from home to health facility
>=5Km	47(14.8%)	271(85.2%)	1
<5Km	19(21.8%)	68(78.2%)	0.95(0.81,1.11)	0.497

In multivariable analysis, variables such as exposure to information about contraceptives, attitude towards contraceptives, intention to use contraceptives, perceived social approval, beliefs in contraceptive myths, and counseling on contraceptive methods were found to be factors associated with contraceptive use to delay first birth at a P value of less than 0.05 and 95% CI. Multi-collinearity among independent variables was checked using the variance inflation factor (VIF), and model fitness was evaluated using Hosmer-Lemeshow’s goodness-of-fit test.

Women who had information about modern contraceptives were 4.4 times more likely to use contraceptives than their counterparts (AOR=4.36; 95% CI: 2.14-8.86). Women who had favorable attitudes towards modern contraceptive methods were 3.54 times more likely to use contraceptives to delay first birth than those women who had unfavorable attitudes (AOR=3.54; CI: 1.72, 7.31). Regarding the intention to use contraceptives by young married women who had the intention to use contraceptives were 4.16 times more likely to use contraceptives to delay their first birth than those who had no intention to use contraception (AOR=4.16; CI: 1.96, 8.84).

Women who had perceived that their referents approved of their contraceptive use were 3.48 times more likely to use contraceptives for delaying their first birth than those who did not perceive referent approval (AOR=3.48; 95%CI: 1.65, 7.35). Respondents living in a community that does not believe in contraceptive myths were 3.74 times more likely to use contraceptives to delay their first birth compared to those living in a community that holds such beliefs (AOR = 3.74; 95% CI: 1.82, 7.66).

Participants who had been counseled on contraceptive use to delay their first birth were 5.19 times more likely to use contraceptives to delay their first birth than those women who had not received counseling on modern contraceptives (AOR=5.19; 95% CI: 2.43, 11.08) (Table 9).

Table 9.

Multivariate logistic regression analysis for factors associated with contraceptive use to delay the first birth among married young women in Central Oromia, Ethiopia,2024.

Variables	User (%)	Nonuser (%)	COR (95% CI)	AOR (95% CI)	P-value
Age
15-19yrs	21(11.8)	157(88.2)	1
20-24yrs	45(19.8)	182(80.2	1.85(1.06,3.24) *	2.03(0.96,4.29)	0.063
Educational status
No formal education	7(11.9)	52(88.1)	1	1
Primary education	26((11.0)	210(89.0	0.92(0.38,2.23)	0.62(0.182,2.09	0.44
Secondary education and above	33(30.0)	77(70.0)	3.18(1.31,7.74) *	1.34(0.39,4.64)	0.64
Exposure to information
No	25 (8.2)	279 (91.8)	1	1
Yes	41(40.6)	60(59.4)	7.63(4.31,13.49) *	4.36(2.14,8.86) **	<0.001
Knowledge of contraceptives
Poor knowledge	5(7.9)	58(92.1)	1	1
Moderate knowledge	12(8.2)	135(91.8	1.03(0.35,3.06)	0.63(0.15,2.55)	0.514
Good knowledge	49(25.1)	146(74.9)	3.89(1.48,10.26) *	2.23(0.65,7.67)	0.20
Attitude about contraceptives
an unfavorable attitude	31(10.9)	254(89.1)	1	1
Favorable attitude	35(29.2)	85(70.8)	3.37(1.96,5.80) *	3.54(1.72,7.31) **	0.001
Intention to use a contraceptive
No intention to use	15(6.5)	215(93.5)	1	1
Intention to use	51(29.1)	124(70.9)	5.89(3.18,10.92*	4.16(1.96,8.84) **	<0.001
Perceived social approval
Did not approve to use FP	17(7.5)	211(92.5)	1	1
Social approval to use FP	49(27.7)	128(72.3)	4.75(2.62,8.60) *	3.48(1.65,7.35) **	0.001
Belief in contraceptive myths
Believe in CM/M	28(10.0)	252(90.0)	1	1
No belief in CM/M	38(30.4)	87(69.6)	3.93(2.28,6.78) *	3.74(1.82,7.66) **	<0.001
Community support for contraceptive use to delay the first birth
No	39(13.7)	246(86.3)	1
Yes	27(22.5)	93(77.5)	1.83(1.06,3.16) *	1.15(0.53,2.50)	0.72
Counseling on FP
No	16(7.0)	214(93.0)	1	1
Yes	50(28.5)	125(71.4)	5.35(2.92,9.79) *	5.19(2.43,11.08) **	<0.001

FP Family planning, 1 reference group, CM/M Contraceptive myths or misconceptions, Referents: close family or friends encourage to use contraceptives *(p<0.25) in bivariate, **= statistically significant in multivariable at p-value <0.05.

Discussions

Young women’s pregnancy is a serious public health issue that negatively affects both the mother’s and the child’s health. However, limited studies have been done on the use of contraceptives to delay first birth and associated factors among married young women aged 15-24 in Ethiopia.

This study revealed that the magnitude of contraceptive use to delay the first birth was lower when compared to studies conducted in four emerging regions of Ethiopia (22.2%) and India (21.49%), in Latin America and the Caribbean (29.0%).^16,21,33 The reason for the discrepancy might be due to fear of infertility and the pressure from family to conceive immediately after marriage in the study area, different study settings, and sample size.

In multivariable analysis, having exposure to information about contraception, attitude towards FP, intention to use contraception, perceived social approval, belief in contraception myths, and counseling on contraceptive methods were factors affecting contraceptive use to delay first birth among respondents.

In this study, women who had exposure to family planning messages from at least one media platform were over four times more likely to delay the first birth than those who did not. This finding is supported by studies conducted in Nigeria, Senegal, the Philippines, and Myanmar.^34–36 This might be because mass media remains a vital source of information, and can raise awareness, increase knowledge levels, influence attitudes towards contraceptive use to delay first birth, and address social and cultural barriers to contraceptive use.³⁷

Current contraceptive use is over three times more likely among those who had a favorable attitude towards modern contraceptives used to delay their first birth than those who had an unfavorable attitude. This finding is supported by studies conducted in low- and middle-income countries, Nigeria, and Northwest Ethiopia.^22,32,38 This might be due to pro-natal attitudes, which act as social scripts that women are expected to follow and may discourage the use of contraceptives through increased pressure on young women to secure their marriage and gain respect.^39,40

The study also revealed that the odds of modern contraceptive use delaying first birth among married young women were higher among respondents who intended to use modern contraceptives than their counterparts. This finding is in line with a study conducted in Kpando Municipality, Ghana.⁴¹ The possible explanation might be that the intention to use family planning is a motivational factor that influences family planning use, and greatly influences contraceptive use behavior. Therefore, it is an important indicator of the potential demand for services.⁴²

This study showed that the odds of contraceptive use to delay the first birth were three times more likely among married young women who strongly perceived their referents’ approval of their contraceptive use than those who did not perceive their referents would approve of their contraceptive use. This finding is in line with studies conducted in Nigeria, Guinea, Bale Zone, and rural Ethiopia.^23,29,43,44^,45 This indicates that perceived approval or disapproval by the woman is a much stronger determinant of modern contraceptive use, due to the socio-cultural pressure to prove fertility immediately after marriage and norms that encourage large family size in rural settings of some low- and middle-income countries.^32,46,47

Respondents who lived in communities where there was a strong belief in modern contraceptive myths had at least three times fewer odds of using contraceptives to delay their first birth than those who lived in communities where there was no belief in contraceptive myths. This is consistent with the findings of studies conducted in Kenya and rural Ethiopia, which show that the fewer young women who believe in contraceptive-related myths and misconceptions, the higher the likelihood of reporting contraceptive use.^23,48 A possible explanation might be that contraceptive-related myths and misconceptions are learned from social networks, which leads to social disapproval of contraceptives at a young age and prevents young women from using modern contraceptive methods.⁴⁹

The findings of this study are inconsistent with the study conducted in urban Africa, which showed that increased community-level belief in myths regarding contraceptives among women was positively associated with contraceptive use in Nigeria. This difference might be due to the correct information about the mechanism of action and potential side effects of modern methods provided, the socio-geographic difference in which all of the participants were urban residents, and there might be measurement errors during data collection among these urban Nigerian populations.¹⁰

Furthermore, using contraceptives to delay the first birth was more than five times more likely among respondents who had been counseled on modern contraceptive methods than those who had never been counseled. This study result is in line with a related study conducted in rural Uttar Pradesh (India) and the Metekel Zone in Northwest Ethiopia.^24,50 This might be due to counseling providing opportunities for information exchange to support a choice that fits the reproductive needs and goals of women and helps them to be aware of social norms regarding marriage and fertility expectations, as well as other cultural barriers, to make informed decisions about family planning service utilization.⁵⁰

Limitations

Due to the nature of the cross-sectional study design, the causal relationship of contraception use to delay first birth and its associated factors was not examined. So, strong study designs like follow-up and randomized control trial studies are recommended for future researchers to address causal relationships.⁵¹

Implications of the study

The findings from this study can inform the stakeholders in the development of targeted interventions, such as exposure to contraceptive information, having a favorable attitude, intention to use contraceptives, perceived social approval, and good beliefs about contraceptives and family planning counseling by healthcare providers, which were among the factors for delaying first birth among young married women. The study highlights the need for behavioral interventions (KAP) aimed at changing mindsets by educating the public about the health benefits of delaying the first birth in young married women. Moreover, the results from this cross-sectional study were instrumental in designing an intervention to enhance the uptake of modern contraceptive methods by young married women to delay their first birth in Ethiopia.

Conclusions

This study indicates a low prevalence of contraceptive use to delay the first birth among married young women. Exposure to information, attitude, and intention to use contraceptives, perceived social approval, belief in contraceptive myths, and counseling on modern contraceptive methods were some of the factors associated with contraceptive utilization among young married women. Therefore, healthcare providers, policymakers, and program designers should work on raising awareness of contraceptive use to delay the first birth among young married women.

Supplemental material

Supplemental Material - Prevalence of contraceptive use to delay first birth and its associated factors among married young women in rural parts of central Oromia, Ethiopia: A community-based cross-sectional study

Supplemental material for contraceptive use to delay first birth and its associated factors among married young women in rural parts of central Oromia, Ethiopia: A community-based cross-sectional study by Hawi Gobena, Desta Workneh, Zinash Teferu, Bontu Mathewos, Endashaw Fantaye, Meseret Birhanu, Gadisa Bekele and Rebuma Sorsa in Women’s Health.

Footnotes

Acknowledgments

Our heartfelt gratitude also goes to all data collectors, supervisors, and respondents, without whom this thesis would not have been realized.

ORCID iDs

Gadisa Bekele

Rebuma Sorsa

Ethical considerations

This study was conducted in accordance with the declarations of Helsinki and was approved by the Institutional ethical review board of the Jimma University Institute of Health, Institutional Review Board (JUIHIRB) approval number 75/24. As the study was community-based and involved participants with poor literacy levels, written consent was waived, and verbal informed consent was secured from all participants before data collection.

Consent for publication

The informed consent provided by the participants included the use of their anonymous data for study documents and the communication of the study results.

Author contributions

Hawi Gobena, Desta Workineh, and Gadisa Bekele were involved in the selection of articles, proposal writing, designing the study, data extraction, and statistical analysis. Rebuma Sorsa, Zinash Terefu, Meseret Birhanu, Bontu Mathewos, and Endashaw Fantaye were variously involved in the conceptualization, writing the first draft of the manuscript, and editing of the manuscript. All authors read and approved the final version of the manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to this article.

Data Availability Statement

Supplementary materials and data can be provided based on your reasonable request to the corresponding author via hawigobena2011@gmail.com.

Supplemental material

Supplemental material for this article is available online.

Appendix

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