Modern contraceptive utilization and associated factors among reproductive age women in Ethiopia,2025, evidence from PMA Ethiopia 2023 survey

BackgroundUnmet contraceptive needs continue to be a serious public health concern in the world, despite modern contraceptions critical role in enhancing maternal and child health. Existing publications focus on out-of-date data and overlook community-level factors, such as community FP knowledge. Therefore, this study employs the most recent Performance Monitoring for Action (PMA) Ethiopia 2023 survey to assess both individual and community-level variables of modern contraception use. MethodsThe study used nationally representative PMA 2023 cross-sectional data with a two-stage cluster sampling technique. Data were cleaned and prepared for analysis using STATA version 14. 5,250 reproductive-age, sexually active, and non-pregnant women were included in the study. Descriptive statistics and bivariate analysis were performed. To identify associated factors, multilevel binary logistic regression analysis was used. ICC, MOR, PVC, log-likelihood, and deviance were used for model comparison and fitness. To identify significantly associated factors with modern contraceptive utilization, AOR with 95% CI was used. A p-value of 0.05 was used to declare significance. ResultsThe magnitude of modern contraceptive utilization in Ethiopia was 41.7%. The multilevel analysis demonstrated that women aged 35-49 years [AOR = 0.50; 95% CI: 0.35-0.71], not currently married [AOR = 0.45; 95% CI: 0.33-0.61], with parity of more than 5 children [AOR = 0.54; 95% CI: 0.35-0.83], and residing in pastoralist regions [AOR = 0.31; 95% CI: 0.19-0.51] were negatively associated with modern contraceptive utilization. In contrast, household size of 4-5 members [AOR = 1.44; 95% CI: 1.15-1.81], mixed feelings if pregnant now [AOR = 2.56; 95% CI: 1.98-3.31], unhappy feelings if pregnant now [AOR = 2.13; 95% CI: 1.74-2.61], recent health facility visit [AOR = 1.53; 95% CI: 1.19-1.97], moderate family planning knowledge [AOR = 1.35; 95% CI: 1.01-1.81], Muslim religion [AOR = 1.48; 95% CI: 1.13-1.96], residing in communities with high levels of womens education [AOR = 1.82; 95% CI: 1.28-2.60], and communities with high media exposure [AOR = 1.42; 95% CI: 1.00-2.00] were positively associated with modern contraceptive utilization. ConclusionsIn Ethiopia, modern contraceptive utilization still remains below national target, influenced by both individual and community-level factors. Individual-level factors were womens age, married status, religion, parity, visited health facility, household member size, reaction if got pregnant and FP knowledge. Community-level factors such as region, community women education, and community media exposure were identified. These findings highlight the significance of multilevel, context-specific interventions. Older women, women with high parity, and those who live in pastoral areas require special care.