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Modern contraceptives have been identified as key strategies to control fertility and improve maternal health. However, it was poorly utilized in Ethiopia. Hence, this study aimed to assess modern contraceptive utilization and associated factors among married women of reproductive age groups in Holeta town, central Ethiopia, 2021.
Methods
A community-based, cross-sectional study was conducted from January 01–30, 2021, among 343 women of reproductive age in Holeta town. Pretested structured questionnaires were used to collect data. Both bivariate and a multivariable logistic regression model was used, and statistical significance was determined with a 95% confidence level and a P value of less than 0.05.
Result
The overall magnitude of modern contraceptive utilization was 52.5%. The desire for more children [AOR = 0.52, 95% CI: (0.26–0.89)], a history of child death [AOR = 1.54, 95% CI:(1.22–3.01)], religious prohibition [AOR = 0.37, 95% CI (1.01–3.84)], inter-spousal discussion [AOR = 5.95, 95% (1.31–7.01), and history of unintended pregnancy [AOR = 1.71, 95% CI (1.01–2.60)] were significantly associated with the use of modern contraceptive methods.
Conclusion and recommendation
In comparison to national goals set to be reached by 2024/25, the rate of current modern contraceptive use is determined to be good. Therefore, program implementers need to address these significant factors and encourage couples to discuss issues related to reproductive health, including family planning.
Family planning (FP) is a basic human right and a means by which individuals or couples space pregnancy and childbirth at mutually determined intervals by both husband and wife to have the desired number of children through the use of contraceptive methods.
Modern contraceptive methods include the pill, injectable, male and female condoms, emergency contraception, implants, intrauterine contraceptive device (IUCD), female and male sterilization, standard day method (SDM), and Lactational amenorrhea method (LAM).
In mid-2019, the world's population numbered nearly 7.7 billion, implying that the world has added approximately one billion inhabitants over the last twelve years. The world's population is projected to increase by slightly more than one billion people over the next few years, reaching 8.6 billion in 2030 and increasing further to 9.8 billion in 2050 and 11.2 billion by 2100. Of the additional 2.2 billion people who may be added between 2017 and 2050 1.3 billion will be in Africa.
Ethiopia is the second-most populous country in Africa next to Nigeria, with a total fertility rate of 4.6 children born per woman, and in 2050 the population of the country is projected to be 191 million. From 2017 to 2050, it is expected that half of the world's population growth will be concentrated in just nine countries, including Ethiopia.
Modern contraceptives (CPs) have been identified as an effective method for fertility reduction, and thus being widely promoted to slow rapid population growth, mainly in developing countries.
The use of modern contraceptives has slightly increased worldwide, from 54% in 1990 to 57.4% in 2015. It went from 23.6 in 2012 to 28.5% in 2017 in Africa.
The pooled prevalence of modern contraceptive utilization in East African countries was 20.68%, with the lowest modern contraceptive utilization in Mozambique (9.08%) and the highest modern contraceptive utilization in Comoros (61.49%).
Pooled prevalence and determinants of modern contraceptive utilization in East Africa: a multi-country analysis of recent demographic and health surveys.
Despite recent progress in increasing modern contraceptive service utilization, contraceptive utilization remains out of reach for many women of reproductive age worldwide, resulting in millions of unwanted pregnancies and unsafe abortions each year.
Prevalence and determinants of contraceptive utilization among married women at Dabat Health and Demographic Surveillance System site, northwest Ethiopia.
Worldwide, more than 41% of the 208 million pregnancies that occur each year are unplanned. Nearly half of these unplanned pregnancies end in an abortion. Each year, contraception prevents 188 million unplanned pregnancies, which results in 112 million fewer abortions, 1.1 million fewer new-born deaths, and 150,000 fewer maternal deaths.
However, in 2019, 190 million women of reproductive age worldwide who want to avoid pregnancy do not use any contraceptive method, up from 156 million in 2000. The proportion of women with unmet-needs for family planning is greater than 20% in 15 countries in sub-Saharan Africa.
Family planning improves the health of women and children by reducing the proportion of pregnancies that are considered to be high risk. FP also reduces the number of women exposed to pregnancy-related health-risk, thus lowering the number of unintended pregnancies and births.
Previous studies has linked maternal age, parity, maternal and husband's educational attainment, place of residence, religion and decision-making in the household to the were the use of modern contraceptive methods.
Prevalence and determinants of contraceptive utilization among married women at Dabat Health and Demographic Surveillance System site, northwest Ethiopia.
Prevalence and factors associated with modern contraceptive use among women of reproductive age in 20 African countries: a large population-based study.
Modern contraceptive methods utilization and associated factors among reproductive aged women in rural Dembia District, northwest Ethiopia: community based cross-sectional study.
International Journal of Reproductive BioMedicine.2017; 15: 367
Contraceptive utilization and associated factors among women of reproductive age group in Southern Nations Nationalities and Peoples' Region, Ethiopia: cross-sectional survey, mixed-methods.
Contraception and reproductive medicine.2017; 2: 1-9
Prevalence and associated factors of modern contraceptive utilization among married women in reproductive age group in Misha Woreda Hadiya Zone, South Ethiopia.
Full access to reproductive health care is crucial to attaining many of the Sustainable Development Goals (SDGs). Increasing contraceptive prevalence and reducing unmet-needs for family planning are crucial in improving maternal and child health.
The Ethiopian government also committed itself toward the achievement of SDGs, believing that family planning is one of the key strategies for improving maternal health and planned to increase contraceptive prevalence among married women from 41% to 50% by the year 2024/25.
As a result, in Ethiopia contraceptives are given for free in public health facilities, on top of that these modern contraceptives are available in private health facilities with minimal cost. Despite this plan, the findings of the studies showed that, the prevalence of modern contraceptive method utilization in different parts of Ethiopia was found to be low and shows variation from place to place. Therefore, the aim of this study was to assess the magnitude of modern contraceptive utilization and its associated factors among married women of reproductive age in Holeta town, central Ethiopia. The study's findings are very helpful to aid policymakers, regulating authorities, health institutions, communities, and other groups working on maternal and child health, in improving maternal, new-born, and child health through effective utilization of the modern contraceptives.
2. Methods
2.1 Study area and period
The study was conducted from January 01–30,2021. The study was conducted in Holeta Town, Oromia special zone surrounding Finfine, which is located around 38 km from Addis Ababa on the way to Ambo, Western Ethiopia. The town has eight kebeles (small administrative units in Ethiopia). The population of the town receives health services through two government health centers, eight health posts, nine private health clinics of different levels and, seven private pharmacies.
A Community-based cross-sectional study design was conducted to assess the utilization and factors associated with modern contraceptive utilization among married women of reproductive age (15–49) in Holeta town, central Ethiopia, 2021.
2.3. Population
The source population was all married women of reproductive age who had been living in Holeta town. On top of that, all married women of reproductive age who had been living in selected kebeles of Holeta town for at least 6 months during the data collection period were considered as the study population.
2.4 Eligibility criteria
All married women in reproductive age who had lived for a minimum of six months in Holeta town were included in the study, whereas married women who had undergone a hysterectomy were excluded from this study.
2.5 Sample size determination
The sample size was determined based on a single population proportion formula considering the utilization of modern contraceptives among women of reproductive age in Nekemte town, which was 71.9%,
Predictors of modern contraceptive methods use among married women of reproductive age groups in Western Ethiopia: a community based cross-sectional study.
with a 95% confidence level, 5% marginal error, and a 10% non-response rate.
Using the formula: N =
N = = 311 + 33(10% non-response rate) = 343
2.6 Sampling technique and procedure
Holeta town has eight kebeles. Four kebeles were randomly selected. In selected kebeles, a preliminary survey was conducted to identify households with married women of reproductive age. The determined sample size (N = 343) was proportionally allocated to the selected kebeles based on the total number of married women of reproductive age in each kebele (Fig. 1) The list of the respondents was obtained from health extension worker of the town. Finally, a systematic random sampling technique was employed to select study participants at every sampling interval (K).
Fig. 1Schematic presentation of sampling procedure.
K was determined by dividing the total available households in the town by the total sample size, which is every 27th. A simple random sampling technique with a lottery method was used to select the first house hold from the list of their house hold numbers. In the event there was no illegible respondent in the selected house hold, data was collected from the next house hold to the higher number.
2.7 Operational definition
Modern contraceptive utilization was defined as a woman in the reproductive age group reported utilizing any method of modern family planning or contraceptives (e.g. injectable, regular pills, emergency pills, Implants, intrauterine contraceptive device (IUCD), condom, and surgical methods at least once after the current marriage.
Factors associated with self medication practice among pregnant mothers attending antenatal care at governmental health centers in Bahir Dar city administration, Northwest Ethiopia, a cross sectional study.
Prevalence of self-medication and its associated factors among pregnant women attending antenatal care at Nekemte Referral Hospital, Oromia Regional State, West Ethiopia.
Self-medication during pregnancy and associated factors among pregnant women in Goba town, southeast Ethiopia: a community based cross sectional study.
and modified to fit the current study. The questionnaire was written in English and translated into the local language (Afaan Oromo), containing all relevant variables based on the study objectives, before being translated back into English. Data was collected by four BSc midwives and supervised by two master's holders in reproductive health.
2.9 Data quality control
A pre-test was conducted in Ginchi town on 5% (18 women) of the participants. According to the results of the pre-test, the questionnaire was further modified (such as the addition of more questions, reordering, and clarity of the questions). Data collectors and supervisors were given training for two days before data collection on the objective of the study, the procedure of data collection, the art of interviewing, confidentiality of information and clarification were given. Every day after data collection, questionnaires were reviewed and checked for completeness and relevance by supervisors and the principal investigators.
2.10 Data processing and analysis
The data was checked for completeness manually and then coded, entered into Epi Data version 3.1software, and exported to SPSS version 25 software for analysis. Descriptive statistics were computed to determine frequencies and summary statistics (mean, standard deviation, and percentage) to describe the study population in relation to socio-demographic and other relevant variables. The data was presented using tables, graphs, and figures. Bivariate logistic regression analysis was employed to check the crude association between modern contraceptive utilization and independent variables. Variables with a P-value <0.25 in bivariate logistic regression analysis was entered into multivariable logistic regression analysis to control the possible effect of confounders and identify significant factors of modern contraceptive utilization. To quantify the degree and direction of association between modern contraceptive method use and independent variables, the adjusted odds ratio and the corresponding 95% confidence interval (CI) were used. P-value <0.05 was considered as the cut point to declare the presence of a statistically significant association.
3. Results
3.1 Socio-demographic characteristics of the study participants
In this study, a total of 343 married women of reproductive age participated, making a response rate of 100%. The mean age of the study participants was 28.5 years, with a standard deviation of ±7.7 years (28.5 ± 7.7). One hundred twenty-one (35.28%) were in the age range of 15–24 and 243 (70.8%) were from the Oromo ethnic group. More than half, 199(58%) of the participants were orthodox in religion. The majority of the respondents, 233(68%) attended primary school and above (Table 1).
Table 1Socio demographic characteristics of married women of Reproductive age group in Holeta town (n = 343), central Ethiopia, 2021.
Pooled prevalence and determinants of modern contraceptive utilization in East Africa: a multi-country analysis of recent demographic and health surveys.
Pooled prevalence and determinants of modern contraceptive utilization in East Africa: a multi-country analysis of recent demographic and health surveys.
The reproductive and fertility-related history of married women of reproductive age was assessed, and the majority of the respondents 309 (90.08%) had been pregnant at least once during their life. Among the respondents, 53 (17.15%) respondents had experienced abortion, 18 (5.83%) experienced an incident of stillbirth, and 23 (7.4%) experienced child death after birth in their life. Regarding their desire for more children, 242 (70.6%) want more children in the future. One hundred twelve (53.85%) of the respondents want more children because of their desire to have more sons. (Table 2).
Table 2Distribution of reproductive related history among married women of reproductive age group in Holeta town (n = 343), Central Ethiopia, 2021.
3.3 Knowledge and awareness of modern contraceptive
The knowledge of women about modern contraceptives was also assessed. The majority of the respondents, 246 (71.7%) had good knowledge of modern contraceptives. Health institutions 280 (81.6%) were the most common source of contraceptive information, followed by health extension 179 (52.2%), friends 169 (49.3%), and mass media 105 (30.3%). Among women who had information about family planning, 266 (77.6%) of the women stated that contraceptive methods have the advantage of spacing children, and 134 (32.9%) reported that it have the role of limiting the number of children. Moreover, 82 (23.9%) of the women mentioned that family planning methods have an advantage in preventing unintended pregnancy, and 30 (8.7%) stated that they have an advantage in preventing sexually transmitted diseases (STD), including HIV/AIDS.
Of 343 study subjects, the majority of women 328 (95.6%) heard about modern contraceptive methods, and they were able to mention at least one method. The most commonly reported methods were injectable 286 (83.4%), pills 222 (64.7%), implants 206 (60.1%), IUCD 133 (38.8%), Male condom 83 (24.2%), female sterilization 27 (7.9%) and 20 (4.8%) heard other contraceptive methods like spermicides, male sterilization and traditional or natural methods of family planning. (Fig. 2).
Fig. 2Types of Modern contraceptive methods mentioned by married women of reproductive age group in Holeta town, Central Ethiopia, 2021.
This study assessed that 232 (67.6%) women have ever used modern contraceptives in their lives, while 52.5% (95% CI: 46.9–58) are currently using modern contraceptive methods. The majority of the users, 88(48.9%) are using injectable contraceptive followed by implants 42 (23.3%) and IUCD 26 (14.4%). Almost all 178 (98.9%) are using a method of their choice.
Regarding their future desire to use modern contraceptives, 251 (73.2%) of them have a plan to use them in the future. Most of them want to use injectable 135 (53.7%), Implants 53 (21.11%), IUCDs 35 (13.94%), Pills 25 (9.96%), whereas the remaining three women (1.26%) want to use different a methods like a condom, female sterilization, and natural method of family planning (Fig. 3). The majority of the respondents who don't want to use MCs in the future stated their future desire to have more children as the main factors, 61 (66.30%) and religious prohibition, 29 (31.52%).
Fig. 3The current use and the future desire to use MC among married women of reproductive age group in Holeta town, Central Ethiopia, 2021.
3.5 Reasons for not using modern contraceptive methods
The opinion of the study participants regarding the reason for women's not using contraceptives was assessed, and most of the respondents revealed that fear of side effects 212(61.8) is the most important reason women are not using modern contraceptives, followed by religious prohibition 153(44.6%), rumours 93(27.1%) and sex preference 76(22.2%) for the children. (Fig. 4).
Fig. 4The reasons women are not using modern contraceptive among married women of reproductive age in Holeta town, Central Ethiopia, 2021.
Regarding the communication about MCs utilization among the couples, the majority of them stated that they discussed it usually with each other and made the decision jointly. On the other hand, 212(61.8%) of the respondents stated that the use of modern contraceptives is acceptable in the culture and they have the desire to use modern contraceptive methods in the future.
3.6 Factors associated with modern contraceptive methods utilization
Bivariate logistic regression analysis showed that desire for more children, prior experience of using modern contraceptive, history of child death, religious prohibition, discussion between spouse, age at first pregnancy, history of unintended pregnancy and cultural myth were significantly associated with modern contraceptive utilization among married women in the town. All variables that showed P-value less than 0.25 in bivariate logistic regression were entered into a multivariable logistic regression to rule out possible confounders. Accordingly, respondents who want more children were 48% less likely to use modern contraceptives [AOR = 0.52, 95% CI: (0.26–0.89)] as compared to those who didn't desire more children. Married women with no history of child death were 1.5 times more likely to use modern contraceptive methods [AOR = 1.54, 95% CI: (1.22–3.01)]. Participants that stated religious prohibition were 63% less likely to use modern contraceptives [AOR = 0.37, 95% CI (1.01–3.84)]. Participants that usually discuss with their spouse were 6 times more likely to use modern contraceptives [AOR = 5.95, 95% (1.31–7.01) compared with those who have no intention to discuss with their spouse. Married women with the history of unintended pregnancy were two times [AOR = 1.71, 95% CI (1.01–2.60)] more likely to use modern contraceptives compared with their counter-parts (Table 3).
Table 3Bivariate and multivariable logistic regression analysis on determinants of MC among married women of reproductive age in Holeta town, central Ethiopia, 2021.
This community-based cross-sectional study was employed to determine the prevalence and identify factors associated with modern contraceptive utilization among married women of reproductive age in Holeta town, central Ethiopia.
In this study, the overall prevalence of modern contraceptive utilization was 52.5% (95% CI: 46.9–58). This is in line with two previous studies conducted in different parts of Ethiopia, namely in Harar, eastern Ethiopia and the Southern Nations Nationalities and Peoples’ Region, Ethiopia showing modern contraceptive prevalence of 57.1% and 53.3% respectively.
Contraceptive utilization and associated factors among women of reproductive age group in Southern Nations Nationalities and Peoples' Region, Ethiopia: cross-sectional survey, mixed-methods.
Contraception and reproductive medicine.2017; 2: 1-9
However, the finding of this study is higher than those of previous studies conducted in Ethiopia: Bale Zone (20.8%), Dembia district (31.7%), Finote selam (37%), Gonder city (41.2%), Hadiya Zone (23.9%), Tigray region (41%), and EDHS, 2019 (41%).
Modern contraceptive methods utilization and associated factors among reproductive aged women in rural Dembia District, northwest Ethiopia: community based cross-sectional study.
International Journal of Reproductive BioMedicine.2017; 15: 367
Prevalence and associated factors of modern contraceptive utilization among married women in reproductive age group in Misha Woreda Hadiya Zone, South Ethiopia.
Moreover, the prevalence was also higher than the results of studies conducted in Uganda (25.3%), Senegal (26.3%), East Africa (20.6%), and twenty African countries (20%).
Pooled prevalence and determinants of modern contraceptive utilization in East Africa: a multi-country analysis of recent demographic and health surveys.
Prevalence and factors associated with modern contraceptive use among women of reproductive age in 20 African countries: a large population-based study.
On the other hand, the findings of this study is found to be lower than the results of the studies conducted in Arba Minch town (63.4%), Nekemte (71.9%) and Nigeria (66.6%).
Predictors of modern contraceptive methods use among married women of reproductive age groups in Western Ethiopia: a community based cross-sectional study.
Assessment of modern contraceptive method utilization and associated factors among women of reproductive age group in Arba minch town, SNNPR, Ethiopia.
This difference in utilization of modern contraceptives could be explained by variation in awareness of the people, availability of the contraceptive methods, the difference in study settings (Rural vs Urban) to access the service, study design (community vs institution-based), and sample size used for the study. The other possible reason might be cultural and religious differences related to the uptake of contraceptives to control fertility.
In this study, the desire for more children was found to be the significant determinant of modern contraceptive utilization among married women. Accordingly, respondents who want more children were less likely to use modern contraceptives as compared to those who didn't have any desire more children. This is supported by the finding of the study conducted in Gondar city, Dabat Health and Demographic Surveillance System site, Northwest Ethiopia and Senegal.
Prevalence and determinants of contraceptive utilization among married women at Dabat Health and Demographic Surveillance System site, northwest Ethiopia.
The possible justification would be that, most couples achieve their fertility desires and pregnancy spacing by using modern contraceptives. As a result, if women need more children, they do not use MCs. Desire for more children could be driven by preference for large families and a desire for sons.
Modern contraceptive methods utilization and associated factors among reproductive aged women in rural Dembia District, northwest Ethiopia: community based cross-sectional study.
International Journal of Reproductive BioMedicine.2017; 15: 367
Prevalence and associated factors of modern contraceptive utilization among married women in reproductive age group in Misha Woreda Hadiya Zone, South Ethiopia.
this study further revealed that modern contraceptive utilization was higher among the spouse who usually discuss with each other than those who have no intention of discussing with their spouses. This is because communication between the spouses plays an important role in making better reproductive health decisions, number of children, and timing of births, understand advantages and disadvantages of family planning methods, choice of contraceptive methods, and increased contraceptive use.
A significant association was also found between the history of child deaths and modern contraceptive methods utilization. Married women with no history of child death were more likely to use modern contraceptive methods compared to their counterparts. This is supported by the results of the study conducted in the Southern nation and nationalities of Ethiopia.
Contraceptive utilization and associated factors among women of reproductive age group in Southern Nations Nationalities and Peoples' Region, Ethiopia: cross-sectional survey, mixed-methods.
Contraception and reproductive medicine.2017; 2: 1-9
This might be due to an attempt to replace the dead child and the desire for more children.
Religious reason was also found to be another significant determinant factor of MCs utilization. Participants that stated religious prohibition were less likely to use modern contraceptives. This is consistent with a study conducted among rural women in Ethiopia, Ghana.
This could be due to the fact that some religions believe that children are seen as a blessing and a gift from the Almighty (God/Allah) and it is sinful to prevent pregnancies. In these religions, each sexual act in a marriage needs to be open to the possibility of conceiving a child. Using contraception is also considered contrary to the Almighty's will for marriage because it separates the act of conception from sexual union.
The study further showed that married women with a history of unintended pregnancy were more likely to use modern contraceptives compared with their counterparts. The possible reasons would be that the modern contraceptive are the safe and cost-effective means of preventing unintended pregnancy, child spacing, and limiting family size.
Limitations of this study include that the study was carried out in an urban setting and may not be representative of rural women. The study was also based on self-reported data, which may have some element of social desirability bias. It also shares the drawbacks of the cross-sectional nature of the study.
6. Conclusion
This study revealed that the magnitude of modern contraceptive utilization in Holeta town was found to be 52.5%. The study highlighted factors like desire for more children, history of child death, religious prohibition, inter-spousal discussion, and previous history of unintended pregnancy were found to be determinants of modern contraceptive methods utilization. Therefore, the federal ministry of health and other stakeholders should better provide family planning information, education, and communication programs on family planning and encourage couples to discuss on issues related to reproductive health, including family planning. Educating women through their religious leaders without violating the norms and cultures of their society is also an effective means of increasing contraceptive use.
Author's contributions
Ephrem Yohannes conceived the idea and drafted the proposal. All authors (GG, BI, DN, EY, AT, MR) contributed to the design of the study and the interpretation of data. GGB performed the data analysis and drafted the manuscript. All authors critically revised the manuscript and approved the final version.
Funding
No funding was received for this study.
Patient consent for publication
Not applicable.
Availability of data and materials
Full data for this research is available through the first author up on request.
Ethical consideration
The study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Research review committee of the College of Medicine and Health Sciences, Ambo University. Then an official letter of support was written to the Holeta town health Office. The town health office then sent the letter of permission to all kebeles in which the actual data collection was undertaken. A clear description of the study title, purpose, procedure, duration, and possible risk benefits of the study was explained to each study participant. Participants were informed about the objectives of the study and reassured about the confidentiality of the findings. Written consent was obtained from all study participants by prior to the interview.
Declaration of competing interest
The authors declare that they have no conflict of interests.
Acknowledgement
We are grateful to the staff of Holeta town health office for their cooperation and providing important information.
It is also our pleasure to acknowledge data collectors, supervisors, and study participants for their willingness to participate in this study period.
Abbreviations
AOR
Adjusted Odds Ratio
COR
Crude Odds Ratio
CI
Confidence Interval
FP
Family planning
IUCD
Intra uterine contraceptive device
MC
Modern Contraceptive
SGD
Sustainable Development Goal
SPSS
Statistical Package for Social Science
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Pooled prevalence and determinants of modern contraceptive utilization in East Africa: a multi-country analysis of recent demographic and health surveys.
Prevalence and determinants of contraceptive utilization among married women at Dabat Health and Demographic Surveillance System site, northwest Ethiopia.
Prevalence and factors associated with modern contraceptive use among women of reproductive age in 20 African countries: a large population-based study.
Modern contraceptive methods utilization and associated factors among reproductive aged women in rural Dembia District, northwest Ethiopia: community based cross-sectional study.
International Journal of Reproductive BioMedicine.2017; 15: 367
Contraceptive utilization and associated factors among women of reproductive age group in Southern Nations Nationalities and Peoples' Region, Ethiopia: cross-sectional survey, mixed-methods.
Contraception and reproductive medicine.2017; 2: 1-9
Prevalence and associated factors of modern contraceptive utilization among married women in reproductive age group in Misha Woreda Hadiya Zone, South Ethiopia.
Predictors of modern contraceptive methods use among married women of reproductive age groups in Western Ethiopia: a community based cross-sectional study.
Factors associated with self medication practice among pregnant mothers attending antenatal care at governmental health centers in Bahir Dar city administration, Northwest Ethiopia, a cross sectional study.
Prevalence of self-medication and its associated factors among pregnant women attending antenatal care at Nekemte Referral Hospital, Oromia Regional State, West Ethiopia.
Self-medication during pregnancy and associated factors among pregnant women in Goba town, southeast Ethiopia: a community based cross sectional study.
Assessment of modern contraceptive method utilization and associated factors among women of reproductive age group in Arba minch town, SNNPR, Ethiopia.
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