Addis Ababa Medical and Business College

Research and Community Service

Assessment of magnitude and determinants of unmet need of

modern family planning among currently married women
attending health care service in selected public health facilities
of Kirkos Sub-city, Addis Ababa, Ethiopia

By: Meron Alemu

Advisor: Tefera Tezera (BSc, MPH, Ph.D.)

A THESIS PROPOSAL SUBMITTED TO THE RESEARCH AND

COMMUNITY SERVICE OFFICE, ADDIS ABABA MEDICAL AND

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BUSINESS COLLEGE, IN PARTIAL FULFILMENT OF THE
REQUIREMENTS FOR THE DEGREE OF MASTERS IN PUBLIC
HEATH

Addis Ababa, Ethiopia

July 2023

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 Addis Ababa Medical and Business College

Name of Investigator Meron Alemu

Name of Primary Advisor Tefera Tezera (BSc, MPH, Ph.D.)

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Full title of thesis research Assessment of magnitude and determinants of unmet
need of modern family planning among currently married
women of reproductive age group in selected health
facilities of Kirkos Sub-city, Addis Ababa, Ethiopia

Duration of Thesis Research July to September 2023

Study area Addis Ababa City Administration

Total cost of project 23,467.50 ETB

Address of investigator Tel: +251 911782821

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E-mail: meronalmu@gmail.com

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Acknowledgements
I wish to express my sincere thanks and gratitude to my advisor Dr Tefera Tezera, for his
unreserved encouragement and provision of relevant comments and guidance for the
development of the research proposal.

I would like to extend my heart full thanks to my families for their constructive comment and
support. My deepest thanks will also go to my friends for their comment in betterment of this
thesis proposal. At last, but not least my deep gratitude goes to Addis Ababa Medical and
Business college of Public Health Department to give this chance.

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Acronyms and Abbreviations

CBRHAs Community Based Reproductive Health Agents

CPR Contraceptive prevalence rate

CSA Central statistical Authority

DHS Demographic and Health Survey

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EDHS Ethiopia Demographic and Health survey

FMOH Federal ministry of Health

FP Family planning

FPET Family Planning Estimation Tool

HEWs Health Extension Workers

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MPH Masters of Public Health

SPSS Statistical package for Social Science

UN United Nation

UNDP United Nation Development Program

US United States

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 WHO World Health Organization

Table of Contents

Acknowledgements....................................................................................................................... II
Acronyms and Abbreviations........................................................................................................III
Table of Contents......................................................................................................................... III
List of Figures............................................................................................................................... IV
Summary....................................................................................................................................... V
1. INTRODUCTION.......................................................................................................................... I

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 1.1. Background of the Study......................................................................................................I
1.2. Statement of the Problem.................................................................................................III
1.3. Basic Research Questions..................................................................................................IV
1.4. Objective of the study........................................................................................................ V

1.4.1. General objective:....................................................................................................... V

1.4.2. Specific objectives:...................................................................................................... V

1.5. Justification of the study....................................................................................................VI

1.6. Significance of the study...................................................................................................VII
1.7. Scope of the Study............................................................................................................VII
1.8. Limitation of the Study.....................................................................................................VII
1.9. Definition of Key Terms...................................................................................................VIII
1.10. Organization of the Paper..............................................................................................VIII

2. Literature Review..................................................................................................................... IX

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 2.1. Prevalence of unmet need for FP......................................................................................IX
2.2. Determinants of Unmet need for FP..................................................................................XI

3. Materials and Methods........................................................................................................... XV

3.1 Study Area and Period.......................................................................................................XV

3.2 Research Design................................................................................................................ XV
3.3 Study Variables..................................................................................................................XV

3.3.1 Dependent variable....................................................................................................XV

3.3.2 Independent variables................................................................................................XV

3.4 Population, Sample and Sampling Technique....................................................................XV

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 3.4.1 Population.................................................................................................................. XV
3.4.2 Inclusion and Exclusion criteria.................................................................................XVI
3.4.3 Sample Size................................................................................................................XVI
3.4.4 Sampling procedure..................................................................................................XVII

3.4 Sources of Data.................................................................................................................XIX

3.4.1 Primary Data Sources.................................................................................................XIX

3.5 Data collection instrument and procedure.......................................................................XIX

3.5.1 Data Collection Instruments......................................................................................XIX

3.5.2 Data collectors and collection procedures.................................................................XIX

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 3.6 Method of Data Analysis...................................................................................................XIX
3.7 Data Quality Management................................................................................................ XX
3.8 Ethical consideration......................................................................................................... XX
3.9 Dissemination plan........................................................................................................... XXI

7. Plan of Activities.................................................................................................................... XXII

8 Budget break down............................................................................................................... XXIII
9. Reference............................................................................................................................. XXIV
ANNEXES................................................................................................................................ XXVIII

Annex I. English Information sheet and informed consent................................................XXVIII

Annex II. Amharic Information sheet and informed consent.................................................XXX
Annex III. Questionnaire English version..............................................................................XXXI

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List of Figures
Figure 1: Conceptual Framework for the Determinants of Unmet Need of Family planning
(Sours: The Researcher on the bases of reviewing the literature.)................................................ 13
Figure 2: Schematic presentation of sampling procedure............................................................. 17

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Summary
Background: Unmet need for family planning is a serious health problem in developing country.
From the stand point of women’s reproductive health rights, unmet need for family planning was
considered as one of the indicators for violation of such rights and one of the several basic
rationales for women empowerment. The 2016 Ethiopia Demographic and Health survey shows
that 22% of women had unmet need for family planning, 13% for spacing and 9% for limiting.
About 11% of currently married women living in the Addis Ababa have unmet need for modern
family planning.

Objectives: The objective of the study will be assessing the prevalence and associated factors of
unmet need for modern family planning among currently married women attending health care
service in selected public health facilities of Kirkos Sub-city, Addis Ababa, Ethiopia

Methods: An institutional-based cross-sectional study design will employed using multistage

stratified sampling technique. Data will be collected through face-to-face interviewing of 315
currently married women in reproductive age group attending health care service by using
structured questionnaire. The data will be entered by Epi info software and processed and
analyzed using SPSS version 25. Logistic regression analysis will be used to identify factors
independently associated with unmet need for modern family planning.

Project Budget: 23,467.50 ETB

Keywords: Contraception, Family Planning, Unmet need,

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1. INTRODUCTION
1.1. Background of the Study
Family Planning (FP) involves managing the number of children in a family and the gaps
between their births. It is accomplished through the utilization of contraceptive methods and
addressing issues related to infertility. The purpose of family planning is to enable individuals to
achieve their desired number of children, if they so choose, and to have control over the timing
of their pregnancies. Access to accurate information and services regarding contraception is
essential for promoting the health and preserving the human rights of all individuals (1,2).

According to World Health Organization (WHO), more than half of the women who can get
pregnant (1.1 billion out of 1.9 billion) have expressed a desire to control the number and timing
of their pregnancies, either by using contraceptives or by having an unmet need for them. The
finding also shows that most of the women who have a demand for family planning (842 million
out of 1.1 billion) use modern methods of contraception, while a smaller proportion (80 million
out of 1.1 billion) use traditional methods. However, there is a large gap between the demand
and the use of family planning, as 190 million women who can get pregnant and do not want to
have a baby do not use any method of contraception at all. This means they are exposed to the
risk of unintended pregnancy, which can have negative consequences for their health, well-being
and opportunities. The finding also indicates that this gap has increased over time, as the number
of women who do not use any contraception has risen from 156 million in 2000 to 190 million in
2019 (2,3).

The unmet need for modern family planning refers to the gap between individuals' desire to
avoid pregnancy and their use of effective contraception. Women with unmet need are those who

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are fecund and sexually active but are not using any method of contraception, and report not
wanting any more children or wanting to delay the next child. Unmet needs can have profound
implications for their educational attainment, career prospects, and overall well-being (4–6).

Despite the multiple benefits of family planning and improvements in access, in 2019, an
estimated 160 million women globally had an unmet need for family planning with over half of
the women with unmet need living in Sub-Saharan Africa and South Asia. The increment of
unmet need for family planning has a greater risk of unintended/unwanted pregnancy. Its
consequences exposed the women to pregnancy complication, induced abortion, also considered
as one of contributors to high maternal and infant mortalities, leading to high fertility rates and
for rapid population growth. Hence it becomes a country’s main objectives to address unmet
need for family planning by setting structured policies and planning programs to meet these and
prepare a valuable blueprint program and plan, and decision-makers require considering the
reasons why women with unmet need are not using contraceptives (7–9).

Understanding the magnitude of unmet need for modern family planning is important to get
supplementary information and determine whom to specifically target to lower unmet need for
FP by adopting utilization of modern contraceptive through FP programs in Addis Ababa. Such
information is significant to Ethiopian policy decision-makers, planners, and the Ministry of
Health package implementation specifically FP strategies to addressing and minimize unwanted
pregnancy and induced abortion.

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1.2. Statement of the Problem
The global population is expected to reach 8 billion, with an annual growth of over 80 million.
The UN projects that it could increase to 8.5 billion by 2030 and 9.7 billion by 2050, peaking at
around 10.4 billion in the 2080s. Nevertheless, rapid population growth poses a significant
challenge to political and economic progress. Sub-Saharan Africa has experienced a staggering
increase of nearly 3% annually since the mid-1970s, doubling its population in just 25 years.
Projections indicate that Africa’s population is expected to double once again within less than
three decades, surpassing the current level of 620 million (10–13).

The rapid growth in population has placed significant strain on the already limited resources,
presenting a formidable obstacle for developing nations. Numerous low-income countries find
themselves trapped in a vicious cycle, where attempts to enhance living standards and reduce
poverty are overshadowed by the requirement to cater to the expanding population's basic needs.
Governments are faced with the challenge of allocating stretched resources to provide even the
most fundamental requirements such as education, healthcare, housing, water, and sanitation.
Consequently, the implementation of family planning services has emerged as the preferred
intervention to curb this demographic explosion and mitigate its adverse effect (12–14).

Family planning as a program that gives couples and individuals the ability to plan childbirth,
and space and time pregnancies. Its benefits touch all levels- individuals, family, community,
national, and global- enhances the quality of life by reducing infant mortality, improving
maternal health, and alleviating pressure on governments to meet social and economic needs.
Ensuring access for all people to their preferred contraceptive methods advances several human
rights including the right to life and liberty, freedom of opinion and expression and the right to

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work and education, as well as bringing significant health and other benefits. Use of
contraception prevents pregnancy-related health risks for women. Because of family planning
programs in the past, the world now contains 400 million fewer people than it would otherwise
(2,15,16).

According to a study published in The Lancet in 2021, there were 160 million women and
adolescents with an unmet need for contraception in 2019. Meeting all women’s need for modern
methods of contraception would avert an additional 67 million unintended pregnancies annually.
Out of the global 1.9 billion women of reproductive age, 874 million use modern contraceptives
and 92 million use traditional methods. Despite the number of modern contraceptive users
doubling since 1990, there are still 164 million women with an unmet need for family planning.
The Guttmacher Institute estimated in a 2009 report that if all women who wanted to avoid
pregnancy were using modern contraceptives, the number of unintended pregnancies in
developing regions would fall from 75 million to 22 million annually, implying that about 53
million pregnancies per year were due to contraceptive unmet need in developing regions. The
World Health Organization (WHO) estimated in a 2015 report that there were 214 million
women of reproductive age in developing regions who had an unmet need for modern(9,17–19).

Globally, over 20 million women suffer from health problems due to pregnancy every year, and
many of them die or become disabled from complications related to pregnancy and childbirth.
Many women who do not want to be pregnant end their pregnancies early, often using unsafe
and harmful methods that cause serious health issues. It is projected that the demand for family
planning services will increase by 40% worldwide in the next 15 years (20).

Ethiopia has among the highest levels of unmet need for contraception in Africa. In Ethiopia the
prevalence of unmet need for family planning is ranges from 26.52 to 36.39%. That is more than 1 in
5 women in Ethiopia have an unmet need for family planning (21).

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1.3. Basic Research Questions

1. What is the current level of prevalence of unmet need for modern family planning among
currently married women attending health care service in selected public health facilities
of Kirkos Sub-city, Addis Ababa, Ethiopia?

2. What factors that influence unmet need for modern family planning among currently
married women attending health care service in selected public health facilities of Kirkos
Sub-city, Addis Ababa, Ethiopia?

1.4. Objective of the study

1.4.1. General objective:
To assess the prevalence and associated factors of unmet need for modern family planning
among currently married women attending health care service in selected public health facilities
of Kirkos Sub-city, Addis Ababa, Ethiopia

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1.4.2. Specific objectives:

· To assess the prevalence of unmet need for modern family planning among currently
married women attending health care service in selected public health facilities of Kirkos
Sub-city, Addis Ababa, Ethiopia
· To identify the associated factors of unmet need for modern family planning among
currently married women attending health care service in selected public health facilities
of Kirkos Sub-city, Addis Ababa, Ethiopia

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1.5. Justification of the study
There is concerted effort from the Ethiopian government, non-governmental organizations and
associations to improve family planning information and services in order to decrease the unmet
need. Facility based programs, community-based programs [(CBRHAs (Community Based
Reproductive Health Agents), HEWs (Health Extension Workers)] and social marketing are
among those efforts. This study will help to know the current status of family planning unmet
need of reproductive age group women in Kirkos sub-city.

The study of unmet need and associated factors is important for several reasons. First, it can help
to identify the gaps and barriers that prevent women from accessing and using family planning
services and methods that match their reproductive intentions. Second, it can help design and
implement effective interventions and programs that address the needs and preferences of
different groups of women and their partners. Third, it can help monitor and evaluate the
progress and impact of family planning policies and strategies on improving the reproductive
health and rights of women and their families. Fourth, it can help generate evidence and
advocacy for increasing the awareness, demand and support for family planning among various
stakeholders and decision-makers (18,22).

The study of conducting the unmet need for contraception and its associated factors holds
significant importance in the field of public health and reproductive healthcare. Understanding
the unmet need for contraception helps identify gaps in reproductive healthcare and family
planning services. By addressing these gaps, individuals can make informed choices about their
reproductive health, leading to improved outcomes for maternal and child health. In addition, this
study will inform the development of more effective and accessible family planning services. It

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helps healthcare providers offer a wide range of contraceptive options and improve counseling to
meet the diverse needs of individuals and communities. Conducting this study will also aligns
with global development goals, including those related to health, gender equality, and poverty
reduction. By reducing unmet need, societies can promote sustainable development and improve
overall well-being. And improved access to family planning services and reduced unmet need
contribute to a decline in maternal and child mortality rates. When women can plan and space
their pregnancies, it positively impacts their health and the health of their children (22,23).

There are very few studies done on reproductive age women on family planning in Addis Ababa.
This study will provide more information than available for future researches and help program
and policy makers.

1.6. Significance of the study

The study will provide important information to the government, NGOs and donors who are
interested in working towards unmet need for family planning and associated factors among
reproductive age women in the study area. Furthermore, this study will help to fill the literature
gap by providing information to the existing body of knowledge in order to improve the
potentials of women’s family planning service utilization in the study area. Since there were
limited numbers of previous study done on this topic around the study area, it can be used as a
base line data for the study area for farther study.

1.7. Scope of the Study

The scope of the study aims to provide a comprehensive understanding of the unmet need for
modern family planning among currently married women attending health care services in
selected public health facilities of Kirkos Sub-city, Addis Ababa. The findings will contribute to
informed decision-making, policy formulation, and targeted interventions to address the unmet
need and promote better reproductive health outcomes in the study area.

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1.8. Limitation of the Study
This study restricted only unmet need for family planning on married women in the Kirkos sub-
city without the inclusion of men hence, due to the large population size of this sub-city that
leads to miss information about the influence of unmet need for family planning both men and
women. In addition, Participants may not always provide accurate information about their family
planning practices due to social desirability bias.

Besides, the research is limited to quantitative data analysis and could not use qualitative
research that could have helped for more understanding of the determinants of unmet need of FP
among married women aged 15-49. The cross-sectional study design may limit the ability to
establish causal relationships between variables.

1.9. Definition of Key Terms

· Unmet need for family planning: is referring to the case were women who prefer to
space or limit childbearing but not using any effective modern contraceptive to fulfill its.

· Unmet need for spacing: women with unmet need for spacing births are those who are
fecund and sexually active but are not using any method of contraception, and report
wanting to delay the next child.

· Unmet need for limiting: are those who desire no additional children and who do not
currently use a contraceptive method.

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 · Family Planning: is the decision-making process by couples, together or individually, on
the number of children that they would like to have in their lifetime, and the age interval
between children. This means that both halves of a couple have equal rights to decide on
their future fertility. In planning their future children, partners need to have the right
information on when and how to get and use methods of their choice without any form of
coercion. Such planning therefore helps mothers and their children enjoy the benefits of
birth spacing and having planned pregnancies (24).

· Fecund: a woman of reproductive age who is not pregnant at the moment but is capable
of childbearing.

· Current users: are women who are using contraception until the day of interview.

· Ever users: are women who have used contraceptive some times in the past, but have
discontinued during the time of the survey.

1.10. Organization of the Paper

This research thesis will organize into five major chapters. The first chapter deals with the
introduction that includes the background of the study, statement of the problem, research
question, objective, significance and scope and limitation of the research. The second chapter
deals with a detailed literature review. The third chapter is containing the research design and
methodology, chapter four describes in detail results and discussion and lastly in chapter five
includes conclusions and recommendation.

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2. Literature Review
2.1. Prevalence of unmet need for FP
Although significant efforts have been made to promote the use of contraceptive methods, the
overall met need for family planning has not shown substantial improvement over time.
However, there are notable regional disparities in the total unmet need, with similar determining
factors observed across many regions. Various groups of women continue to experience a high
unmet need for family planning, including those who are younger or older in age, have low
education levels, have a higher number of living children, possess limited knowledge about
contraceptives, lack exposure to mass media, and belong to the lowest wealth quintiles (2,25).

In most regions of the world, at least 10% of married or in-union women have an unmet need for
family planning. In 2015, it was estimated that 12% of married or in-union women worldwide
had an unmet need for family planning, meaning they wanted to stop or delay childbearing but
were not using any contraception. By using of an updated version of the Family Planning
Estimation Tool (FPET) to construct estimates and projections of the modern contraceptive
prevalence rate (mCPR), unmet need for, and demand satisfied with modern methods of
contraception among women of reproductive age who are married or in a union in the focus
countries indicates that the global prevalence of unmet need for modern contraception methods
was 21.6% (26).

A study conducted in United States (US) indicates that, married or cohabiting women have 9%
unmet need of modern contraception methods. A similar survey of 3890 married or cohabiting
women 15-49 years of age documented an overall unmet need for contraception of 29%. Another
study conducted from 685 married women aged 15-49 years in Nusa Tenggara Barat, Indonesia

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shows that, unmet need rate for contraception was 17.1%, specifically 11.5% for spacing and
5.6% for limiting (27–29).

Regarding in Africa, based on an analysis conducted by the Demographic Health Survey (DHS)
the unmet needs of sub-Saharan African populations, approximately 8 million married women in
the region lack access to contraception. Furthermore, the study discovered that 7.8 million
women across 18 countries have an unmet need for limiting their future births. The overall
prevalence of unmet need for family planning among married women of reproductive age in the
sub-region for the period under study was 22.9%. The prevalence varied across countries from
10% in Zimbabwe to 38% and 38% in Sao Tome and Principe and Angola, respectively. In east
African studies about the magnitude of unmet among reproductive age women shows that, the
prevalence of unmet need among reproductive age women in east Africa were 24.7%. Unmet
needs due to limiting ranged from 6% in Central Africa to 9% in East Africa. On the other hand,
the prevalence of unmet needs due to spacing was highest in Central Africa and lowest in
Southern Africa (30–32).

In Ethiopia, the demand for family planning among currently married women aged 15-49 has
increased over time, from 45% in 2000 to 58% in 2016. The use of modern methods to meet the
need for family planning has also increased, from 8% in 2000 to 41% in 2019. Despite this
increase, Ethiopia still has one of the highest levels of unmet need for contraception in Africa.
According to the 2016 Ethiopia Demographic and Health Survey (EDHS) and meta-analysis and
systematic review research, 22.3% and 19.99% of women had an unmet need for family
planning. Unmet need for both spacing and limiting is higher among rural residents than urban
residents, with overall unmet need for family planning being 15% among urban residents and
27.5% among rural residents (33–35).

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There is a significant disparity in the unmet need for contraception across different regions and
socio-demographic indicators in Ethiopia. For instance, the unmet need ranges from 10.5% in
Addis Ababa to 30.9% in Debre Birhan town. Studies conducted in Finoteselam District,
Hawassa, Toke Kutaye District, Oromia and Bishoftu town found that the unmet need for family
planning among reproductive age women was 29.7%, 18.1%, 23.1%, and 26% respectively
(33,36–39).

2.2. Determinants of Unmet need for FP

Despite a majority of developing countries having very small decrease in unmet need of family
planning, it was found that the determinants for not using contraception or family planning
services are varying due to differences in social, economic and cultural backgrounds among
married women. Unmet need is often portrayed as a problem of access, leaving the perception
that women do not use contraceptives because they cannot find or afford them or they have to
travel too far to get them. But while access is an issue, women have many other reasons for not
using family planning, including personal, cultural, or religious objections, fear of side effects,
health concerns, and lack of knowledge. For this reason, just making contraceptives available
does not ensure that women will use them (2,25).

2.2.1 Socio-demographic characteristics

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The use of contraceptives and unmet needs for family planning are important indicators of
reproductive health and women’s empowerment. However, these outcomes may vary depending
on the social, cultural, and economic context of different countries. Some studies have explored
how various demographic variables can influence the use of contraceptives and unmet needs for
family planning. According to various studies conducted in Indonesia, Saudi Arabia, and Nepal,
various demographic variables can influence the use of contraceptives and unmet need for family
planning. These variables include discussion of family planning within the couple, partner’s
approval of contraception, household assets, parity, women's education level, religious beliefs,
number of living sons, husband's education level, having very good knowledge about method
and husband's occupational status. These factors were found to be significantly associated with
the use of contraceptives and unmet need for family planning (29,40,41).

According to several studies conducted in different African countries, there are various factors
that influence the unmet need of contraception among women. Studies conducted in Cameron,
multilevel analysis in Malawi, Gambia & Mozambique, Zambia and A community-based cross
sectional household survey in Sudan indicates that; the age of the woman, level of education of
the woman, the level of education of the husband, the income of the household, the occupation of
the woman, the number of living children that a woman has, exposure to media, having good
knowledge, contraceptive side effects and husband opposition to contraceptives were associated
with the total unmet need of contraception (42–46).

In sub-Saharan Africa, the two most commonly cited reasons were health risks/side effects and
opposition by the woman and/or partner. In South Central Asia, opposition by the woman and/or
partner was the main reason, followed by infrequent sex. In Southeast Asia, health concerns and
side effects were cited most, followed by infrequent sex (47).

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A study based on EDHS 2016 found that various factors influenced the unmet need for
contraception in Ethiopia. These factors included the number of children a woman had, whether
she worked or not, her level of education, her age at first marriage, her household wealth, how
far she lived from a health facility, the average education level of women in her community and
the average exposure to media in her community. These factors were all statistically significant
in relation to the unmet need for family planning (48). Another study that reviewed and analyzed
data from different sources in Ethiopia showed that; compared to women who worked for the
government, women who stayed at home were 1.6 times more likely to have an unmet need for
family planning. Furthermore, women who did not talk to their partner about family planning
were 1.87 times more likely to have an unmet need for family planning than women who did talk
to their partner (49).

A study that surveyed women of reproductive age in Debre Birhan town found that the unmet
need for contraception was related to the following factors: the woman's occupation, where she
got information about family planning, whether she had a conversation and support from her
husband (36). Another study that surveyed women in Tiro Afeta District, South West Ethiopia
identified the following factors as related to the unmet need for family planning: whether the
woman had ever used family planning, how many children she had, what her husband thought
about contraceptives, whether she received counseling and whether she had a radio and/or TV at
home (50). A similar study that surveyed women in Hawassa found that the following factors
were linked to the high unmet need for family planning: whether the woman was married before
18 years old, whether she had any formal education, whether her partner supported family
planning use and whether she had access to media at home (38).

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 Conceptual Framework

This Conceptual framework aims to show how the dependent and independent variables of
unmet need for FP among currently married women are related. The concept of unmet need for
FP reflects the difference between women's reproductive goals and their contraceptive use
behavior. The data on unmet need for family planning can help someone understand how
contraceptives are used and how common they are in the community. Moreover, the theoretical
framework shows the ways that demographic, socioeconomic, socio-cultural, reproductive
characteristics and institutional factors affect and influence the dependent variable.

Socio-demographic characteristics.
Reproductive characteristics
Age of respondents
Wealth status parity

Occupational status Age at first marriage

Marital status Desired number of
Educational status of children.
respondents
Educational status of Contraceptive practice
respondents’ husbands Knowledge of
Religion contraception
Family size
Ethnicity
Unmet
need for FP

Client related factors Access to health

Knowledge of FP methods information/services
Discussion with partner Listen to the radio
Husband support Watch Television
Attitude toward contraception
Reading newspaper
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Figure 1: Conceptual Framework for the Determinants of Unmet Need of Family planning (Sours: The
Researcher on the bases of reviewing the literature (25,42–50).

3. Materials and Methods

3.1 Study Area and Period
This study will be conducted in Addis Ababa, Kirkos sub-city public health facilities. Kirkos sub-city
is one of the eleven sub-cities found in Addis Ababa. Which is located at the center of Addis Ababa,
and it is the most destitute areas with the highest population concentration comparing with other sub-
cities. The total area of the sub city is 14.72 Sq.km. This sub-city has 2 hospitals and 8 health centers.

The study will be undertaken from August 11 – 30/2023

3.2 Research Design

An institutional based cross sectional study design will be employed

3.3 Study Variables

3.3.1 Dependent variable
Unmet need for family planning

3.3.2 Independent variables

The main independent variables that are considered in this study include

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 · Socio demographic variables: Age, Women Education, Partner education, religion,
marital status, income, work status

· Reproductive variables: Parity, number of living children, desire to have children

· Communication related variables: Exposure to family planning message, using media

· Client and facility related variables: Discussion with partner, partners support,
obstacles preventing from getting SRH services, knowledge about family planning.

3.4 Population, Sample and Sampling Technique

3.4.1 Population
3.4.1.1 Source population

The source population of the study will include all currently married women of reproductive age
group in the Kirkos sub-city, Addis Ababa.

3.4.1.2 Study population:

The study population will constitute of all sampled currently married women of reproductive age
group who attend health care service in Kirkos sub-city health facilities and are selected from
randomly selected health facilities in the Kirkos sub-city, Addis Ababa.

3.4.2 Inclusion and Exclusion criteria

3.4.2.1 Inclusion criteria

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Currently married women of reproductive age group who attend health care service in selected
health facilities during data collection period will be included in the study.

3.4.2.2 Exclusion criteria:

Those women do not live in the study area, critically ill during data collection time and unable to
respond will not be included in the study.

3.4.3 Sample Size

Sample size will be determined by using the formula for single population proportion with the
following assumption: Eleven percent prevalence of unmet need for family planning among
reproductive age women was taken from 2016 EDHS study (33), with confidence interval of
95%, margin of error 5% and non-response rate of 5%. Based on this assumption:

150

19
Were,

· n= Required Sample Size

· Zα/2 = Value of the standard normal distribution corresponding to a significant level of

alpha (α) 0.05, which is 1.96

· p = Proportion

· d= Degree of precision = 5%

Considering design effect 2 the sample size will be 300 and also adding non response rate 5%,
the required total sample size is =315

3.4.4 Sampling procedure

A multi stage stratified sampling technique will be used to select the subject to be included in the
study. In the study area, there are 2 hospitals and 8 health centers. Primarily, hospital and health
center as strata, one health facility from hospital and four health facilities from health center will
be selected using simple random sampling method (lottery method). From each selected health

20
facilities, the sample will be distributed proportionally according to the average reproductive age
women who attend health care service within the past three months.

The first respondent from each health facility will be selected randomly then subsequent
respondents will be selected every Kth where N/n (N is the total population and n is sample size)
of from the daily client’s flow until the required respondents will selected depends on voluntarily
consenting reproductive ages women who visit health facilities for health service except Family
Planning methods within two weeks of working days.

21
 Kirkos sub-city
Health Facilities

2 Hospitals 8 Health Centers

Zewditu Felege Hiwot Feresmeda Meshualekiya Kirkos Health

Hospital Health Center Health center Health Center Center

1,365 340 387 421 313

152 38 43 47 35

Figure 2: Schematic presentation of sampling procedure

315 Study
participants

22
3.4 Sources of Data
3.4.1 Primary Data Sources
Primary data will be gathered by using interview administered questionnaire.

3.5 Data collection instrument and procedure

3.5.1 Data Collection Instruments
Data will be collected by standardized questionnaire adapting from Ethiopian Demographic and
Health Survey questionnaire. The developed questionnaire will translate in to Amharic and then
back to English again to maintain its consistency. The Amharic version will be used for data
collection. The main components of the questionnaire will be: socio demographic characteristics,
knowledge of the respondents towards family planning methods, Fertility related characteristics
and health facility related characteristics

3.5.2 Data collectors and collection procedures

Data will be collected using five female nurses. And two MPH supervisors will be hired. The
data collection team will train for two days before the actual data collection on the purpose and
scope of the study, how to approach the respondents, how to conduct the interview, how to
handle the reluctant respondents [her participation is on a voluntary basis, if she does not want to
continue she can stop at any point and leave the interview. All responses will be kept secret and
will be used for the research proposes only] and there will be practical session like interviewing
practice and discussion of unclear issues. The interviewing will be done under close supervision.

3.6 Method of Data Analysis

Data will be checked for completeness and coded and entered in the computer using EPI info
version 7.1 software. Then the data will be exported to SPSS version 25 program for analysis.

23
Descriptive statistics which involved frequency and percentage for the dependent and
independent variables will be used. Continuous variables will be expressed as mean ± standard
deviation. For skewed variables, median ± interquartile range will be reported. Categorical
variables will be expressed as number (percentage, %).

Multivariable logistic regression model will be fitted to predict the association between
contraceptive use and unmet need with their determinants. First, bivariate analysis will be done
to identify candidate variables for multivariable logistic regression. Second, to identify predictors
of contraceptive use and unmet need having a p <0.2 will be entered in the multivariable logistic
regression model. At this step, interaction between different independent variables will be
checked and collinearity diagnostics will be done by checking the variance inflation factor. All
statistical analysis will be set at 5% level of significance (i.e. p < 0.05. The results will be
reported using Odds Ratio and 95% CI. Appropriate tables and graphs will be used to present
findings.

3.7 Data Quality Management

The data collection questionnaire will be first prepared in English and then translated into
Amharic and back to English for checking language consistency by a different person with an
excellent Amharic and English-speaking skill. To ensure data quality, pre-test will be conducted
in associations not included in the study to assess the clarity of the questions, their sensitiveness
as well as understanding of the data collectors. Discussion will be held based on the result of the
pre-test and accordingly, some amendments will be made. A two days training will be given to
the supervisors and the data collectors on the procedure. The data will be checked for
completeness, accuracy, clarity, and consistency by the supervisors and the investigator on daily
basis. Any error or ambiguity and incompleteness will be corrected accordingly and shared with
data collectors.

24
3.8 Ethical consideration
The proposal will be reviewed by ethical review committee of Addis Ababa Medical and
Business College. The study will be started after verbal obtaining consent. Verbal consent will be
taken from each selected participant. Honest explanation of the survey purpose, description of
the benefits and an offer to answer all inquiries will be made to the respondents. It will explain
that answering the interview questions will have no harm on the participants and that their
participation will help to create awareness concerning the issue. Also, affirmation that they are
free to withdraw consent and to discontinue participation without any form of prejudice will
made. Privacy and confidentiality of collected information will be ensured by using anonymous
data collection tools and private rooms throughout the process.

3.9 Dissemination plan

After approval from Addis Ababa Medical and Business College, the findings of the study will
be disseminated to all relevant stakeholders. Copies of the research will be given to Addis Ababa
Medical and Business College, Collage of Health Sciences. Further effort will be made to
publish in peer- reviewed international journals.

25
7. Plan of Activities

Duration from July-Septmember 2023

Activities

July Aug. Sep.

S.no

1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th
Q Q Q Q Q Q Q Q Q Q Q Q

1 Title approval

26
2 Preparation of research proposal

3 Final proposal submission

4 Research ethical approval

5 Data collection

6 Research writes up

7 Submission of first draft

research thesis to the research

27
 advisor

Compile any advisors comment

8
and sudgestion

Submission of Final Thesis to

9 the research and community
service office

10 Final thesis defense

28
8 Budget break down
Table 1. Stationary Cost

Unit of Amount Unit Total

S.No Item type
measurement required price price

1 Pen Number 7 20 140

2 Pencil Number 7 10 70

3 Paper Pac 6 500 3,000

29
 4 Eraser Number 7 20 140

Total 3,350

Table 2: Other logistics cost

S.No Activities Total payment

1 Computer work 2000

2 Transport 1000

30
 Total 3,000

Table 3: Personnel costs

Number of ayment Number

S.No Category Total
Individuals Per day of days

1 Supervisors 2 300 10 6,000

Data
2 5 200 10 10,000
collectors

31
 Total
16,000

Sub total= 3,350+3,000+16,000=22,350

Contingency 5 % = 1,117.5

Ground Total= 23,467.50

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37
ANNEXES
Annex I. English Information sheet and informed consent
Introduction: My name is ______________. I am working with Meron Alemu who is doing
research for the partial fulfillment of a Master’s Degree in Public Health at Addis Ababa Medical
and Business College. This questionnaire is intended to assess the magnitude and associated
factors of contraception unmet needs among currently married women of reproductive age group
in selected health facilities in the Kirkos sub-city, Addis Ababa, Ethiopia. You are selected to be
one of the Participants in the study.

Study title: Assessment of magnitude and determinants of unmet need of modern family
planning among currently married women of reproductive age group in selected health facilities
of Kirkos Sub-city, Addis Ababa, Ethiopia.

Purpose: the purpose of the project is to assess the magnitude and associated factors of
contraception unmet needs among currently married women of reproductive age group in
selected health facilities in the Kirkos sub-city, Addis Ababa, Ethiopia. The other purpose is for
the fulfillment of my master's degree in public health. The information you provide here will be
very helpful to the investigator of this study to write a research paper for the requirement in
completion of the master’s program. The findings of this project could help in designing priority
intervention strategies for better implementation of family planning programs among
reproductive-age women.

Duration of the Study: From August to September/2023 GC

38
Procedures: There are questions that assess the magnitude and associated factors that influence
contraception unmet needs among reproductive-age women. I would like to ask you to give your
genuine and honest answers to the questions forwarded. If you need clarification, please ask me.
It will take you about 15-20 minutes to finish this survey.

Benefits and Risks: By participating in this study and answering our questions, you will not
receive any direct benefit. However, the information will help the researcher to understand
factors influencing the not use of contraception among women in order to appropriately identify
future interventions related to the problem to be found. Your participation in this study will not
involve any risks. If a question makes you feel uncomfortable, you may choose not to answer.

Confidentiality: you will not be asked your name to be written the survey questions. All the
information you give to us will be kept private. Whatever information you provide will be kept
strictly confidential. The information you give will be kept in a locked file cabinet. Only the
researcher will have access to see the answers you give. No information identifying you will ever
be released to anyone outside of this data collection activity.

Participation: Participation in the survey is completely voluntary. If you are not comfortable
answering any question(s), you can leave it blank. You can stop filling out the questionnaire at
any time without giving a reason and your relationship with the community or any other body
will not be affected in any way.

If you would like to know more, please contact the principal investigator: (Meron Alemu. Tel:
0911 782821). I thank you in advance for taking the time to answer questions. Would you be
willing to participate in the study?

39
If yes, I am in advance to ask you.

If not, please stop here

Consent of the participant: I the undersigned have been informed that the purpose of this
research project. Based on the above information I agree to participate in the research
voluntarily.

Signature of Participant ____________________Date_____________________

40
Annex II. Amharic Information sheet and informed consent
የመጀመሪያ የስምምነት ውል ቅፅ

መግቢያ: ጤና ይስጥሌኝ! እኔ_____________እባላለሁ፡፡የምሰራው በአዲስ አበባ ጤናና ቢዝነስ ኮሌጅ

የሁለተኛ ድግሪ ማሟያ ጥናታዊ ፅሑፍ/ምርምር/ በማድረግ ላይ ከሚገኙት ሜሮን አለሙ ከተባሉ ጥናት
አድራጊ ጋር ስሆን፤ በአዲስ አበባ ከተማ ውስጥ ያሉ ያገቡና በመውለድ እድሜ ላይ ባሉ ሴቶች የቤተሰብ እቅድ
መጠቀም አለመቻልን በተመለከተ ለማወቅ ቃለ መጠይቅ እያደረግሁኝ እገኛለሁ፡፡እርስዎም የጥናቱ ተሳታፊ
ይሆኑ ዘንድ ተመርጠዋል፡፡

የምርምሩ/ጥናቱ ርዕስ፡- በአዲስ አበባ ከተማ በሚኖሩ ያገቡና በመውለድ እድሜ ላይ ባሉ ሴቶች የቤተሰብ
እቅድ መጠቀም አለመችል በተመለከተ እና እንዳይጠቀሙ የሚያደርጉ ምክንያቶችን ለማወቅ የሚካሄዴ
ጥናት ነው፡፡

የጥናቱ ዓላማ፡- በአዲስ አበባ ከተማ በሚኖሩ ያገቡና በመውለድ እድሜ ላይ ባሉ ሴቶች የቤተሰብ እቅድ
መጠቀም አለመችል በተመለከተ ለማወቅና ከዚህ ጋር ተያያዥነት ያላቸውን ዋና ዋና ጉዳዮችን በመሰብሰብ
የቤተሰብ እቅድ አገልግሎቱንና ፕሮግራሙን ይበልጥ ለማሻሻል ነው፡፡ሌላው ደግሞ በህብረተሰብ ጤና ሳይንስ
የሁለተኛ ዲግሪ ማሟያ ፅሑፍ ለማቅረብ ነው፡፡ ከዚህ በላይ የጥናቱ ውጤት በቤተሰብ እቅዴ ዙሪያ ለሚሰሩ
አካላት/ሀላፊዎች/ ዕቅድ፤ ዝግጅትና ትግበራ ላይ ማሻሻያ ለማድረግ አስፈላጊነቱ የላቀ ይሆናል፡፡

አተገባበር፡- ከላይ የተመለከተውን ጥናት ለማካሄድ የተለያዩ ጥያቄዎች ይኖሩናል፡፡ ጥናቱ ውጤታማ ሊሆን
የሚችለው እርሶ በሚሰጡት ትክክለኛ መልስ ላይ በመሆኑ ጥያቄዎቹን በጥንቃቄ እንዲመልሱልን
ፍቃደኝነትዎን በትህትና እንጠይቃለን፡፡ ግልፅ ያሌሆነልዎን/እንዱብራራልዎት/ የሚፈልጉትን ጉዳይ ካሉ
መጠየቅ ይችላሉ፡፡ መጠይቁ 15-20 ደቂቃ አካባቢ የሚጨርስ መሆኑን ለመግለፅ እንወዳለን፡፡

የጥናቱ ጥቅምና ጉዳት ፡- እርሶ በዚህ ጥናት ተሳታፊ በመሆንዎ በቀጥታ ለያገኙ የሚችሉት ነገር ሊኖር
አይችልም፤ ነገር ግን የእርሶ ተሳትፎ በጥናቱ አላማ የወሊድ መከላከያ በመጠቀምና ባለመጠቀም ዙሪያ

41
ያለውን ክፍተት ለማሳየት እና ትክክለኛ የመፍትሔ አቅጣጫ ለመጠቆም እጅግ በጣም አስፈላጊ ነው፡፡ በዚህ
ጥናት በመሳተፎ ምንም አይነት ጉዳት አይኖርቦትም፡፡ በመጠይቁ ውስጥ ለመመለስ የማይፈልጉት ጉዳይ
ካለም ምላሽ እንዲሰጡ አይገደዱም፡፡

ምስጢራዊነት፡- በዚህ ጥናት /ፕሮጀክት/ የሚሰበሰብ ማንኛውንም ዓይነት መረጃ ምስጢራዊነቱ የተጠበቀ
ሲሆን የርስዎም ስም ሳይፃፍበት ሚስጥራዊ ቁጥር ብቻ ተሰጥቶት በፋይል ውስጥ የሚቀመጥ ይሆናል
እንዱሁም መረጃው ጥናቱን ከሚያካሂደው ሰው በስተቀር ሌላ ለምንም ዓይነት ሰው ግሌፅ አይሆንም ፡፡

ተሳትፎ ፡- በዚህ ጥናት ላይ መሳተፍ/አለመሳተፍ/ ሙሉ በሙሉ በርስዎ ፍቃደኝነት ላይ የተመሰረተ ነው፡፡

ለጥያቄዎቹ በሙሉም ሆነ በከፊል መልስ ያለመስጠት መብት አለዎት፡፡ ይህ ደግሞ ማንኛውንም አይነት
ግልጋሎት ከማግኘት አያግድዎትም፡፡ እንዱሁም በፈለጉት ሰዓት ማንኛውንም መብትሆን ሳያጡ የማቋረጥ
ሙለ መብት አልዎት፡፡ የበለጠ መረጃ ካስፈለጎት የሚከተለት አድራሻ መጠቀም ይችላሉ፤ ጥናቱን
የሚያካሂደው ሰው አደራሻ፡ ሜሮን አለሙ ስ.ቁ 0911 782821

ለቃለ ምልልሱ ተስማምተዋለ? አዎ አልተስማማሁም

መልስዎ አዎ ከሆነ ጥያቄውን ይቀጥለ፡-- አሌተስማማሁም ከሆነ በዚህ እናቆማለን

የተሳታፊዋ የስምምነት ውል፡- እኔ ከዚህ በታች ፊርማዬን ያስቀመጥኩት ግለሰብ የዚህ ጥናት ዓላማ
ተገለፆልኛል፡፡ ከላይ በተገለፀልኝ መረጃ መሰረትም በጥናቱ ለመሳተፍ ተስማምቻለሁ፡፡

የተሳታፊ ፊርማ_____________________ ቀን__________________

ቃለ ምልልሱን ያካሄደው ሰው ስም____________________________ፊርማ____________

ቀን____________

ቃለ ምልልሱ የተጀመረበት ጊዜ _________ ቃለ ምልልሱን የተጠናቀቀበት ጊዜ_______

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ያረጋገጠው ሱፐርቫይዘር ስም _____________ፊርማ ____________ ቀን _________

ለትብብርዎት እናመሰግናለን፡፡

Annex III. Questionnaire English version

Addis Ababa Medical and Business College
Greeting
This questionnaire is designed to assess the magnitude and determinants of unmet need for
modern family planning among currently married women of reproductive age group in selected
health facilities of Kirkos Sub-city, Addis Ababa. All the respondents are kindly requested to
give their responses to all questions. Your genuine answer is of paramount importance to the
outcome of the research and all the answers and your identity are kept anonymous. If you need
clarification you can communicate with the assigned facilitators.

Thank you in advance!

Instruction: Circle the code number given parallel to the answer you choose and for
questions that you give a direct answer, write the answer in the space provided

Part I Socio-demographic Characteristics

S/No Question Response Skip

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101 How old are you? ……….. Years

102 What is your religion? 1. Orthodox

2. Muslim
3. Protestant
4. Catholic
99. Other specify……………

103 What is your ethnic group? 1. Oromo

2. Amhara
3. Tigray
4. Gurage
99. Other Specify……………

104 What is your educational status? 1. Illiterate

2. Read and write
3. Primary Education
4. Secondary Education
5. TVET
6. Diploma and above

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Part II Reproductive Characteristics

S/No Question Response Skip

201 At what age were you first married? ……….. Years

202 Have you ever been pregnant? 99. Yes

1. No

203 How many pregnancies have you had? _________

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 204 How old were you when you first got ________
pregnant?

Part III Practice of modern contraception

S/No Question Response Skip

46
 301 Have you ever used modern 1. Yes
contraceptives? 2. No
3. I don’t remember
4. No response

302 If the answer to ques 301 is yes, what 1. Pill

are the methods you used? Circle all 2. Implant (norplant)
mentioned. 3. Injectables
4. IUCD
5. Condom
6. Female sterilization
7. Male sterilization
8. Spermicidal
9. Natural method
99. Others (specify)

Part IV attitude towards contraception methods

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S/No Question Response Skip

401 Would you like to know more about 1. Yes

contraceptive methods? 2. No
3. Don’t know
4. No response

402 Do you yourself approve or disapprove 1. Approve

of couples using methods of family 2. Disapprove
planning? 3. Do not know

403 If no why? 1. Respondent's refusal

2. Husband or partner refusal
3. Family disapproval
4. Religion prohibition
5. Culture do not allow
6. Fear of side effect
7. Medical problem
8. Desire to have more children
1. Other specify________

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 404 Do you have discussed about 1. Yes
contraception with your husband or 2. No
partner within the last one-year? 3. Do not know

405 If the answer were yes, how many times 1. Only 1 time
have you discussed? 2. Discussed some time
3. Discussed often
4. I cannot remember

406 What is your husband or partner attitude 1. Approve

towards contraceptive methods? 2. Disapprove
3. Do not know

Part V knowledge about contraception methods

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S/No Question Response Skip

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