Spatial disparities and determinants of modern contraceptive use among reproductive age women in Ethiopia: application of multilevel spatial analysis

Background: Contraception aims to prevent unintended pregnancies, significantly impacting maternal and infant mortality in sub-Saharan Africa, especially in Ethiopia. This study investigates factors influencing modern contraceptive use among reproductive-age women in Ethiopia. Methods: We analyzed the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) dataset, which includes 8,196 weighted samples of women and girls aged 15-49. Data management utilized STATA version 17, R version 4.2.2, and Arc GIS 10.8 for mapping. We employed multilevel and spatial analyses to identify determinants. Results: Only 26% of the women used modern contraceptives, with notable spatial clustering (Global Moran's Index = 0.237776, p < 0.001). Hotspots were identified in Benishangul-Gumuz; Gambela; Southern Nations, Nationalities, and Peoples' Region (SNNPR); and eastern Oromia. Being in the 25-34 age group [adjusted hazard ratio (AHR) = 1.346, 95% CI: 1.143, 1.585]; having a higher [adjusted odds ratio (AOR) = 1.919, 95% CI: 1.380, 2.669], secondary (AOR = 1.554, 95% CI: 1.261, 1.914), or primary education level (AOR: 1.3514, 95% CI: 1.1624, 1.5712); being married (AOR = 25.953, 95% CI: 20.397, 32.942); and higher community wealth (AOR = 1.497, 95% CI: 1.114, 2.011) were positively associated with contraceptive usage, whereas being aged 35-49 (AOR = 0.538, 95% CI: 0.446, 0.649), having three or more children (AOR = 0.634, 95% CI: 0.460, 0.872), and living in the Somali region (AOR = 0.114, 95% CI: 0.045, 0.2882) were negatively associated with contraceptive usage. The best-fitting model included individual, community, and spatial variables, with an intra-class correlation coefficient indicating that 15.57% of the variability in contraceptive use was due to cluster differences. Conclusions: Modern contraceptive use among Ethiopian women is low and varies by cluster. Factors positively associated include age of 25-34, education, marital status, and community wealth. Conversely, women aged 35-49, those with three or more children, and those in the Somali region showed lower usage. Community-level interventions are necessary to improve modern contraceptive adoption.