Time to use modern contraceptives and associated factors among women of reproductive age in Ethiopia: survival analysis of the 2016 Ethiopian demographic and health survey data
Authors: Bekere Shibabaw , Asena Tilahun , Tesfaw Dejen , Wube Asmare , Alemayehu Meseret 
Published: July 2022

Abstract
Background: Contraceptive methods are one of the most important health interventions of the twenty-first century, and they are critical in slowing population growth and improving women's and family health. Contraceptive methods are now a global issue in general, and in developing countries in particular. Method: This study sought to identify the factors associated with the timing of the use of modern contraceptive methods among Ethiopian women. The study's data were based on EDHS (2016) obtained from CSA. To identify the risk factors associated with when to use modern contraceptive methods, a parametric survival model with frailty was used and compared using AIC and log-likelihood ratio test. Result: The study found that out of a total of 7,890 women, 6,829 (86.55 percent) of the 7,890 women did not use modern contraceptive methods or were censored, while 1,061 (13.45 percent) used modern contraceptive methods during the follow-up period. The minimum and maximum value of time for women to use modern contraceptive methods was one and thirty years, respectively. During the study period, the overall mean and median uptake time were 23.45 and 22 years, respectively. About 20.69 percent of women between the ages of 25 and 29 have used modern contraceptive methods. It is estimated that 20.52 percent of women aged 20 to 24 have used a modern contraceptive method. The modern contraceptive method was used by 19.83 percent of women aged 30-34 years. Modern contraceptive methods were used by 5.56 percent of women aged 45-49 years. In terms of location, 6.83 percent of women in urban areas used modern contraceptive methods, while 6.62 percent of women in rural areas did. there is a significant relationship between women's age group and the time they use modern contraceptive methods. When all other variables were held constant, the estimated time to modern contraceptive uptake for women aged 35-39 years, 40-44 years, and 45-49 years increased by 21.6 percent, 28.5 percent, and 46.6 percent, respectively, when compared to women aged 15-19 years. In Ethiopia, the majority of women who do not receive medical care are those who live in rural areas, and the findings of this study revealed that residence has a significant impact, with women living in rural areas having a 15.5 percent shorter estimated time to use modern contraceptive methods than women living in urban areas. Table 4 further shows that the wealth index has a significant effect on the time to use modern contraceptive methods. When the effects of other variables were held constant, the relative risk of time to use modern contraceptive methods was reduced by 8.3 percent and 17.3 percent for women in the middle and rich wealth index categories, respectively, compared to women in the poor wealth index categories. The educational level of women had a significant impact on the time it took to use modern contraceptive methods. When other variables in the model were held constant, the estimated time to modern contraceptive uptake increased by 5.5 percent and 5.6 percent for primary, secondary, and higher education women, respectively, when compared to illiterate women.Conclusion: The Weibull regression survival model with Gamma frailty model was an appropriate fit of time to use modern contraceptive methods among the fitted frailty models. In comparison to the non-frailty survival models, the estimated frailty model, which accounts for unobservable regional heterogeneity, was found to be more appropriate for fitting time to use modern contraceptive methods across Ethiopian regions. Furthermore, using the selected frailty model results, the independent variables age, place of residence, wealth index, educational status, and television awareness information were identified as factors associated with the time to use modern contraceptive methods at a 5% level of significance.