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Contraceptive use intention and determinants among nonuser reproductive-aged married women in Ethiopia based on the theory of planned behavior - Discover Public Health

Background The intention to use contraceptives reflects an individual’s or couple’s plan to adopt contraceptive methods, thereby reinforcing women’s rights to reproductive autonomy. This choice is closely linked to significant health benefits, including reductions in unintended pregnancies and unsafe abortions, ultimately contributing to improved maternal and infant health outcomes. In Ethiopia, despite numerous efforts undertaken over the past decade to increase family planning use, contraceptive prevalence remains low at 36.6% among all women, while unmet need for contraception remains high at 22.3%. Achieving the desired level of change, particularly in rural and remote areas, has been challenging, as highlighted in the National Adolescent and Youth Health Strategies (2021–2025) and the Reproductive Health Strategies (2015–2020). Within this context, understanding women’s contraceptive use intention helps to identify motivations and barriers to future reproductive rights and autonomy of women and enables her to turn that intention into an action, which can inform the design of effective reproductive health, family planning and maternal and child health programs. Methods This study used cross-sectional data from Performance Monitoring for Action Ethiopia (PMA-ET) 2020. Applying a quantitative research methodology to access the relationship between dependent and independent variables, the hypothesis tested in this analysis adapted and used TPB constructs as a guiding behavioral socio-psychological theoretical model. This study included a weighted count of 3025 women aged between 15 and 49 years who were not contraceptive users. Frequencies and percentages were computed to describe the study participants. Chi-square tests were conducted to evaluate associations and assess sample cell size adequacy across categories. Important factors influencing women’s contraceptive intention were, determined using a multilevel binary logistic regression analysis. The findings were reported in terms of percentages and odds ratios along with, 95% confidence intervals. Statistical significance was established at a significance level of 0.05. Results Approximately one in two 46.4% (95% CI; 43.0−49.9%), of married reproductive-aged women in Ethiopia have a contraceptive use intention. Women who have a favorable attitude toward contraceptives, positive subjective social norm and high perceived contraceptive control were strongly associated with contraceptive use intention. Women who reported having a family size of above five members, better contraceptive knowledge, partner positive contraceptive feeling, visiting a facility and living in the Amhara, Oromia and SNNPR regions were found to increase the odds of contraceptive use intention. However, elderly women aged 30 years and above were, found to have lower odds of having a contraceptive use intention. Conclusion The prevailing proportion calls for multifaceted strategies to identify and address barriers that prevent women from deciding on their contraceptive use intention in order to maximize contraceptive use intention among those who are potential users. Accordingly, the construct of TPB, attitude, subjective social norm, and perceived control, as the main predictors, were found to impact women’s intention to use contraceptives. Awareness of these influencing factors is crucial for designing contraceptive programs and policies tailored to reproductive health strategies, especially these strategies should be diverse enough to create a positive social norm toward contraceptive use, which can lead to information sharing, reduced stigma and community support that can play significant importance in shaping individuals’ attitude toward reproductive behaviors.