AUTHOR=Muchie Bisrategebriel Tesfaye , Woya Ashenafi Abate , Tegegne Awoke Seyoum , Kassie Maru Zewdu , Alene Assfaw Muluhabt , Zewdia Wondaya Fenta 

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

JOURNAL=Frontiers in Global Women's Health

VOLUME=Volume 6 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/global-womens-health/articles/10.3389/fgwh.2025.1505789

DOI=10.3389/fgwh.2025.1505789

ISSN=2673-5059

ABSTRACT=BackgroundContraception 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.MethodsWe 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.ResultsOnly 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.ConclusionsModern 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.