From Rapid Gains to Stalling: Two Decades of Modern Contraceptive Prevalence Rate in Ethiopia

BackgroundEthiopia, Africas second-most populous country, still faces high fertility and elevated maternal and child mortality. Although the country made substantial progress in expanding family planning uptake over the past decade, recent changes in contraceptive use trends remain insufficiently explored. This study uses nationally representative data to examine long-term trends in the modern contraceptive prevalence rate (mCPR). MethodWe analyzed mCPR trends among married women aged 15-49 using data from 10 national surveys (Demographic and Health Surveys [DHS] and Performance Monitoring for Action [PMA] surveys) conducted between 2000 and 2023. Piecewise regression models, adjusted for socio-demographic changes, were used to compare mCPR growth rates before and after 2015--the breakpoint identified by data visualization and confirmed by Chow test. ResultsEthiopias mCPR rose from 6.2% in 2000 to 36.2% in 2015, demonstrating significant progress during that time. However, after 2015, the growth rate slowed significantly, with mCPR recorded at 36.6% in 2023. The annual growth rate during post-2015 period was 0.37 percentage points, compared to 2.1 percentage points annually pre-2015 (p=0.000). In rural areas, mCPR rose from 3.2% in 2000 to 32.7% in 2015 and 33.5% in 2023. The corresponding rates in urban areas were 29% in 2000, 49.6% in 2015, and 44.6% in 2023. In rural areas, annual growth dropped from 2.2 percentage points pre-2015 to 0.39 percentage points post-2015 (p=0.000), while urban areas saw a reversal trend, with growth falling from 1.82 percentage points annually pre-2015 to a negative rate of -0.56 percentage points post-2015 (p=0.000). The multivariate analysis reveals mCPR stall remains evident even after adjusting for socio-demographic factors. ConclusionFollowing a period of steady growth, Ethiopias progress in increasing mCPR has recently slowed significantly, with national rates stalling below 40% and declining in urban areas. This stall underscores the pressing need for renewed family planning efforts to address unmet need and overcome persistent barriers, including sociocultural challenges, equitable access limitations, funding issues, and service delivery gaps, in order to revive mCPR momentum and sustain progress.