This study assessed the prevalence of unmet need for modern family planning methods and associated factors among HIV-positive reproductive age women. The prevalence of unmet need for modern family planning among study participants was 25.67% (95%CI = 22.96–28.58) of which 132(14.46%) was for spacing and107 (11.49%) for limiting.
In this study, 25.67% reproductive age women had unmet need for modern family planning methods. This finding was in line with the findings from studies in Ghana (27.8%)(32) and Addis Ababa, Ethiopia (25.1%)(19). However, this finding was lower than study findings from South Africa (58.8%)(33), Nigeria (64.9%)(12) and Amhara regional state, Ethiopia (35.3%)(34).The reason for this discrepancy might be using a different study design(prospective cohort study), and unmet need definition, in study conducted South Africa, study participants with 12 month postpartum period and age restriction(18–35)years were considered(33), in study conducted in Nigeria were not used the revised definition for estimation of unmet need for contraception (31). In addition to this, high HIV prevalence among adults in sub-Saharan Africa may have contributed to a higher unmet need for family planning (35). The discrepancy in the study from the Amhara region might be, the previous study focuses on only women who give birth between 06 weeks to 24 months and pregnant mothers were excluded from the study. Mother on PMTCT not taking family planning due to less perception to pregnancy since breastfeeding and no menses return since last birth (19, 36, 37).
In contrast, the finding of the current study was higher than study findings from India (17%)(38), Zimbabwe(19%)(39), Nigeria (20%) (40), Hawassa, Ethiopia (19.1%) (21), and Nekemte, western, Ethiopia (15.4%) (20). This discrepancy might be due to the sample size difference. The sample size of a study done in India was four times less than the current study sample size. In a study done in Zimbabwe, the participants were mothers on PMTCT(9–18 months) and different study designs (39). In a study done in Nigeria, pregnant mothers were excluded (40). In a study done in a different area of Ethiopia, the discrepancy might be due to the different health service provision and different characteristic of study participants (41) or this difference might be explained by the different distribution of PLHIV per region, 30% in Amhara, 26% in Oromia and 9% in Southern Nations, Nationalities, and Peoples’ Region (42). unmet need for family planning in the general population as reported in the report of EDHS 2016 was (22%) (4). This discrepancy might be due to different study populations.
In the multivariable analysis, the unmet need for contraception was higher among old reproductive-age women. This finding was supported by study findings from rural Uganda (43), Nigeria (44, 45), Togo (46), and Ethiopia (20). This might be as the age of the women increases the risk of pregnancy will decrease (19, 47). It may be due to opposition to use contraception by partners, fears of contraception side effects, health concerns, the previous negative experience of using contraception and using family planning may interfere with sexual pleasure(19, 36, 48).
Another factor affecting the unmet need for family planning was educational status. Education was the most important factor in increasing contraceptive knowledge to plan the desire to limit or space births. In our study, women with educational status of (9–12) have a 75% lower risk of unmet need for family planning. This finding was contradicting with findings from Nigeria (40), Botswana (49) and western Ethiopia (20), which reports, women with no formal education and primary education had a higher prevalence of unmet need than those collages and above educational status. According to demographic health survey analytical studies, the relationship between education and unmet need for family planning was not constant across countries (31). In democratic Congo in 2007 as education increase, the unmet need for family planning also increases (CDHS,2007). But it needs further study focusing on the effect of education on unmet needs.
Ever use of contraception was also a significant factor affecting the unmet need for family planning. Women who didn’t ever use had higher unmet need than those who had ever used. This finding was supported by study findings from Federal Teaching Hospital Gombe, Nigeria (50), Hawassa, Ethiopia (21) and Gondar town, Ethiopia (51). This might be women on ART, contraception use may feel exacerbation of HIV disease progression (51). This might be due to a lack of awareness for contraception or fear of contraceptive side effects and heard miss information from previously experienced mothers leads to frustration (52). Previous use of family planning increases knowledge and decrease fear of family planning side effects.
Women who had five and above parity had a higher unmet need for family planning than those women who had none parity. This finding consistent with studies done in Nigeria (50) and Northern Uganda (53). This might be due to women who had none or one child want a child soon no need of limiting and spacing or may have the desire of more children (19, 54) and Multiparous mother may achieve desired family size. This might be as women have more children, the unmet need for spacing births tends to decrease, but the unmet need for limiting increases (31).
Counseling about contraception also affects the unmet need for family planning.
Women who were not counseled about contraception during HIV follow-up had a higher unmet need for family planning than those women who were counseled. This finding was consistent with Uganda and Ethiopia (19, 55). The possible explanation could be family planning counseling during ART follow up can create awareness and increase knowledge to use contraception and improving information about their risk of becoming pregnant and about the choices of contraception(36, 56).