Solomon Abrha Damtew

Introduction: Under-five mortality has long been used as an indicator of the level of socio-economic development of a country. Global attention has been given to the issue through the Sustainable Development Goals, yet the burden continues to be disproportionately concentrated in Sub-Saharan Africa and South Asia. Ethiopia is one of six nations that together account for half of global under-five mortality, with particular burden observed among children born to older mothers. Hence, this study aimed to determine the magnitude of under-five mortality among children born from elder mothers, assess its trend over time, and identify associated factors. Methods: Data were drawn from the nationally representative Ethiopia Demographic and Health Surveys (EDHS) conducted in 2000, 2005, 2011, and 2016. The analytic sample comprised 6,199 children born to women aged 35–49 years in the five years preceding each survey. Information on mother and child characteristics, socio-economic factors, and environmental variables was collected through face-to-face household interviews. Descriptive statistics characterized the study participants. Multilevel binary logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals for factors associated with under-five mortality. Result: Under five mortality declined from 128 per 1000 live births during the year 2000–56 per 1000 live births in 2016. This study identified several factors contributing for under-five mortality among children of women aged 35–49 years. Protective factors included female child sex (AOR = 0.65, 95% CI: 0.53–0.79), maternal age at first birth of 31–40 years (AOR = 0.34, 95% CI: 0.11–0.98), family size of 6–10 members (AOR = 0.18, 95% CI: 0.14–0.24), birth interval greater than 3 years (AOR = 0.35, 95% CI: 0.26–0.47), and 1–3 antenatal care visits (AOR = 0.65, 95% CI: 0.50–0.84). In contrast, the following factors increased the odds: twin birth (AOR = 6.15, 95% CI: 3.94–9.60), four births in the last five years (AOR = 2.64, 95% CI: 1.15–6.06), nine or more children ever born (AOR = 3.79, 95% CI: 2.10–6.84), and maternal age at birth of the index child of 45–49 years (AOR = 2.13, 95% CI: 1.55–2.93). Conclusion: The decline in under-five mortality over the last 16 years in Ethiopia represents promising progress toward the targets set out in the Sustainable Development Goals and national health policy. However, targeted programs and interventions focusing on provision of the recommended antenatal care, adequate birth spacing, limiting the number of births within short intervals, discouraging pregnancies after age 40, and supporting smaller family sizes are essential to further reduce under-five mortality. The study findings highlight the importance of risk-pregnancy screening, well-spaced pregnancies, family health promotion, and strengthened childhood illness prevention and treatment services.

Background: Unmet contraceptive needs continue to be a serious public health concern in the world, despite modern contraception’s 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. Methods: The 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. Results: The 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 women’s 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. Conclusions: In Ethiopia, modern contraceptive utilization still remains below national target, influenced by both individual and community-level factors. Individual-level factors were women’s 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.

Women´s emotional fertility intentions to conceive are an integral part of Reproductive Health (RH) right which can also be considered as decision-mak

In Ethiopia, numerous efforts have been undertaken to control the rapid growth of the population and decrease the average number of births per woman, in the last ten years, though it has not been possible to achieve as much change as was planned and intended in the National Health Sector Transformation Plan (HSTP II) and reproductive health (RH 2015–2020) strategies. The annual growth of the population and fertility rates remained at 2.7 and 4.6, respectively. Fertility is one of the fundamental aspects influencing population dynamics, while women fertility desire to have a child plays a crucial role in determining actual fertility rates and can be acts as an indicator for future reproductive behavior, an insightful tool for grasping broader fertility patterns, and a key element in understanding overall demographic trends. Women’s fertility desire refers to the number of children they want to have in the near future, based on their evaluation of the cost and benefits of childbearing. This analysis used cross-sectional data from Performance Monitoring for Action Ethiopia (PMA-ET) 2021. A total of 4138 married or cohabiting individual women between the ages of 15 and 49 who were not pregnant were included in this analysis. Sampling weighting factor and design were applied in this analysis, and chi-square test statistics were computed to determine the overall association and to assess the adequacy of the cell sample size. Multilevel binary logistic regression was used to identify important predictors of women’s fertility desire. The results were presented as percentages and odds ratios with 95% confidence intervals (CIs). Statistical significance was declared at a significance level of 0.05. Approximately three-quarters (74.1%, 95% CI; 71.5%—76.6%) of reproductive-aged married/cohabiting women in Ethiopia desired to have a child. Remarkably, even among women aged 40 and above and those with six or more children, nearly 40% still reported wanting more children. Fertility desire was also positively associated with having secondary or higher education which is the finding that contrast with previous studies in similar settings. In multivariable analysis, fertility desire was also significantly higher among women who had experienced a forced pregnancy, identified as Muslim, or initiated sexual activity at age 19 or older. Conversely, lower odds of fertility desire were found among older women, those with older partners, higher parity, larger family size, or a history of contraceptive use. The persistently high fertility desire observed in Ethiopia highlights the complex interplay between cultural, religious, and socioeconomic factors, and suggests that simply expanding access to family planning information may not be sufficient to shift reproductive intentions. Policy and program efforts should move beyond a narrow focus on fertility reduction and instead center women’s voices, reproductive autonomy, and contextual realities. Our findings suggest that fertility desire in Ethiopia is shaped more by deeply rooted sociocultural and religious norms than by lack of access to family planning information. Accordingly, policy interventions should focus on engaging communities in meaningful dialogue, understanding and addressing the motivations behind high fertility preferences, and supporting reproductive autonomy for all women, including those who wish to have large families

Background Preconception care is often overlooked by women of reproductive age, with less than one-third seeking such care and this is particularly prevalent in low-income countries. To shed light on this issue, a study was conducted in Wolaita Sodo town to determine the knowledge, attitude, and practice of preconception care among health professionals and mothers. Methods The study employed a descriptive phenomenological qualitative research design. Participants in the twelve in-depth interviews and two focus group discussions were selected using a purposive sampling technique. Interview guide was used to collect the data. The interview continued until information saturation was reached. Transcripts were imported into NVivo 14 software to code and facilitate the analysis. Thematic analysis was used to analyze the identified themes and subthemes with inductive qualitative data analysis method. Results The study revealed that inadequate knowledge and practice of preconception care exists among health professionals and mothers. To enable preconception service uptake, it is essential to improve the knowledge and awareness of health professionals and mothers. Although the healthcare providers and community members have a positive attitude toward the service, there is no experience in providing the service by the health professionals for the community unless needed in special conditions. Conclusion The study also identified several barriers to providing preconception care, including lack of awareness, inadequate knowledge, and limited resources. To implement preconception care effectively, there is a need to create awareness among healthcare providers and the community about the importance of preconception care and its benefits.

Women´s index pregnancy emotional fertility intention was measured by asking the pregnant women how they would felt when they learned about their index pregnancy. Emotional health and couples´ communication are key during pregnancy and child birth with simultaneous minimization of reproductive coercion. Emotional fertility intention is critical for healthy and spaced pregnancies, as well as for better maternal and newborns outcomes. Besides, intentions to conceive and emotional fertility intention on pregnancy are the integral parts of women reproductive health (RH) right and can be considered as women decision-making ability over their fertility. Moreover, in low and middle-income countries including Ethiopia where the sole male´s dominance is culturally accepted and socially constructed, males take the lead in each decision making process including household-level decision, determining the family´s fertility and reproductive health service use. This dominance interferes with women fertility intention and their health status including their emotional feeling towards conception. In such a scenario, women are less likely for their say to be heard. Hence, this study aimed to determine pregnant women index pregnancy emotional fertility intention and to identify the associated covariates contributing to it in Ethiopia. This is a very critical step to generate and make actionable evidence available for the health ministry and relevant partners working on reproductive and women´s psycho-social health. This evidence could serve as an action point to empower women regarding their reproductive health right and the control over their fertility. Nationally representative cross sectional baseline data from the Ethiopian performance monitoring for action (Ethiopian PMA) cohort one survey, which enrolled and collected data from currently pregnant and 6 weeks postpartum women were used for this study. This study collected real time data on various sexual, reproductive, maternal and new born nationwide priority indicators using customized Open Data Kit Mobile application. These data were collected using standard pretested questionnaire prepared in English and the three local languages (Amharic, Afan Oromo and Tigrigna) by well experienced resident enumerators. This study was restricted to 2,236 pregnant women at the enrollment. Frequencies were computed to characterize pregnant women, and chi-square statistics was used to assess cell sample size adequacy. Multinomial logistics regression statistical modeling was fitted to identify correlates affecting index pregnancy women´s emotional fertility intention. Results were presented in the form of percentages and odds ratio with 95% Confidence Intervals. Candidate variables were selected using a p-value of 0.25. Statistical significance was declared at p-value of 0.05. The overall proportion of index pregnancy emotional fertility intention of being happy was found to be 67.81%: (95%CI: 65.38, 70.13). The proportion of pregnant women who felt very unhappy was 8% (95%CI: 6.64, 9.5) while 8.45% (95%CI: 7.13, 10.0) and 15.79% (95%CI: 14.01, 17.76) of the pregnant women reported that they felt a sort of unhappy and mixed feelings respectively. Besides, older women, those from the well to do households, those who wanted to have another child were found to have (AOR 95%CI: 2.82 (1.30, 6.13), (AOR 95%CI: 2.05 (1.04, 4.04) and (AOR 95%CI: 2.96 (1.95, 4.52) times increased likelihood of index pregnancy emotional fertility intention of being happy when they have learned about their index pregnancy. The likelihood of index pregnancy emotional fertility intention was found to be AOR 95%CI: 0.34 (0.19, 0.62), (AOR 95%CI: 0.50 (0.32, 0.78), (AOR 95%CI: 0.26 (0.17, 0.40) and (AOR 95%CI: 0.38 (0.25, 0.58) lower among women with high birth order, those who intended to have no more child, among residents of Oromiya and among the residents of the former Southern nations, nationalities and peoples regions. Moreover, the likelihood of index pregnancy women emotional fertility intention of being in a mixed feelings was found to be (AOR 95%CI: 0.62 (0.41, 0.95), (AOR 95%CI: 0.30 (0.13, 0.67) and (AOR 95%CI: 0.33 (0.14, 0.77) among women who attended primary education, those whose desired birth attendant was health professional and family member respectively. The finding that 2/3 of the pregnant women felt happier calls us up to work on intended and spaced pregnancies by ensuring women reproductive and economic empowerment. Region specific and age sensitive activities and efforts that promote intended pregnancy, empower women economically; increase women´s enrollment to secondary education or above and assisting them in identifying their desired birth attendant as part of birth preparedness and complication readiness are hoped to enhance pregnant women index pregnancy emotional fertility intentions. Empowering women economically and improving women educational enrollment were found very critical to address women emotional fertility intention. Installing inter pregnancy preconception care packages in the health care system and postpartum contraceptive counseling’s and provision were found to be the main implications of the study´s findings.

Background: Maternal and newborns care continuum service use decision making process is influenced by seeking validation and the sole approval from significant others. Evidences has shown that one of the bottlenecks hindering the completion of the maternal and newborns care continuum is community acceptance and/or encouragement for the care continuum. Besides, among the critical determinants for the success of the new maternal, new born and child health care continuum (MCH) paradigm shift is the acceptance and support of the community for women and newborns to obtain the three recommend cares and their retention in the care. This is less explored, leading a dearth of evidence. Hence, this study aimed at documenting the level of pregnant women maternal and newborns care continuum perceived community acceptance and identify associated factors among pregnant women. The findings could provide actionable evidence for the Health Ministry and relevant developmental partners to improve maternal and newborns health outcomes. Methods: This study used the baseline cross sectional data form the Ethiopian Performance Monitoring for Action (EPMA) cohort one survey. The study screened, enrolled and collected data from pregnant and six week postpartum women. The analytic sample were 2,219 pregnant women. Frequencies were computed to describe the pregnant women. Multinomial logistics regression statistical modeling was fitted to identify correlates of maternal and newborns care continuum perceived community acceptance. Results were presented in the form of percentages and odds ratio with 95% Confidence Intervals. Statistical significance was declared at p-value of 0.05. Results: The overall proportion of perceived maternal and newborns care continuum community acceptance was 93.30% (95%CI: 91.61%, 94.41%). However, this proportion of perceiving for most and few people in their community to accept and/or encourage women to obtain the three domains of maternal and newborns care continuum services was found to be only 33.66% (31.42%, 35.96%) and 31.93 (29.60%, 34.36%) respectively. Women age, secondary educational status, contraceptive ever use history, health facility as desired place of delivery and residing in Oromiya regional state were found to increase the likelihood of maternal and newborns care continuum perceived community acceptance. On the contrary, this likelihood was lowered by factors: higher birth order, rural residence, higher wealth index and family member and desired birth attendant. Conclusions: This suboptimal level of maternal and newborns care continuum perceived community acceptance by most people in the community signals that the global community have a long way to go to achieve nurturing a positive influence of the community for women to complete the care continuum. Context specific and age sensitive efforts and activities which targeted in diversifying contraceptive provision, postpartum contraceptive use counseling, which target less educated women, economically disadvantage women and those with polygamous marriage are imperative to improve perceived community acceptance on maternal and newborns care continuum. Installing the inter pregnancy preconception care packages is imperative in this regard. Working on mechanisms for incorporating community input is the core implication. These include strengthening the implementation of community score card and; scaling up the community maternal and newborns health family meetings.

In Ethiopia, despite different attempts to manage rapid population growth and reduce the average number of births per woman, the expected changes outlined in the National Health Sector Transformation Plan (HSTP II) and Reproductive health (RH 2015 2020) strategies have not been fully realized over the past decade. The population continues to grow at a rate of 2.7 and fertility rates remain at 4.6. Fertility is one of the three key aspects in shaping population dynamics, as women’s fertility intention for children play a significant role in determining actual fertility rates. In addition, it can be an instructive tool for discovering more about overall fertility patterns, which is important for understanding future reproductive behaviors. In women, fertility intention refers to their preferences regarding the number of children they wish to have in the future, considering factors such as the costs and benefits associated with childbearing. This study used cross-sectional data from Performance Monitoring for Action Ethiopia (PMA-ET) 2020.The hypothesis tested in this analysis was adapted and used TPB constructs as a guiding behavioral theoretical model. The study included 3916 women aged 15–49 years who were not pregnant. Frequencies and percentages were commuted to characterize women. Chi-square tests were conducted to evaluate associations and assess sample cell size adequacy across categories. Multilevel binary logistic regression statistical modeling was employed to identify important factors influencing women’s fertility intention. The findings were reported in terms of percentages and odds ratios, with 95% confidence intervals. Statistical significance was established at a significance level of 0.05. Three-quarters 74.9% (95% CI; 72.5%—77.1%) of married reproductive-aged women in Ethiopia intended to have a/another child. Women who reported having a forced pregnancy by partner, Muslim and Protestant religion, 19 years and above old at first sex, and secondary or higher education were found to increase the likelihood of fertility intention to have a child. However, women who reported 30 years of age or older, had three or more live births, had a family size of five or more members, had a moderate family planning (FP) knowledge, positive subjective social norm towards FP and living in Addis and Dire Dawa were found to have lower odds of women’s fertility intention. The prevailing strong intention for high fertility in Ethiopia delays efforts to quickly decrease fertility and calls for implementation of multifaceted strategies that maintain high fertility intention rates. Accordingly, demographic and socio-physiological factors were found to affect women’s intention to have children. Awareness of these influencing factors is crucial for designing fertility programs and policies tailored to demographics strategies. Specifically, these strategies should be sufficiently diverse to create a positive social norm toward FP use, which can lead to information sharing, reduced stigma, and community support that can play significant importance in shaping individuals’ fertility intention and reproductive behaviors.

Background: Perceived paternal emotional fertility intentions were measured by asking pregnant women how their husbands felt when they have learnt about the index pregnancy. Paternal emotion during pregnancy and childbirth is imperative for better maternal and newborn health outcomes, though policy and strategic framework has been lacking in Ethiopia. Therefore, this study aimed to explore perceived paternal emotional fertility intentions of their husbands and/or their male partners and examine its correlates among a panel of pregnant women in Ethiopia. Methods: Nationally representative data from cohort one baseline cross-sectional survey were used. A total of 2,115 pregnant women from a total of 217 enumeration areas were included in this further analysis. Frequencies were computed to describe pregnant women. Multinomial logistics regression statistical modeling was fitted to identify correlates of perceived paternal emotional fertility intentions. Results were presented in the form of percentages and odds ratio with 95% Confidence Intervals. Statistical significance was declared at a p-value of 0.05. Result: The proportion of perceived paternal emotional fertility intentions of being a sort of happy and very happy were found to be (35.40%; 95%CI: 33.00%, 37.87%) and (49.03%; 95%CI: 46.48%, 51.6%) respectively. The likelihood of perceived paternal emotional fertility intentions of being very happy was (AOR: 95%CI: 5.06: (1.73, 14.85) and (AOR: 95%CI: 2.65: (1.67, 4.20) times higher among older pregnant women and those who intended having another child respectively. On the contrary, those with higher birth order, who wanted no more another child, those living as a partner and; those residing in Addis Ababa and SNNPR had (AOR: 95%CI: 0.25: (0.15, 0.40), AOR: 95%CI: 0.14: (0.07, 0.27); (AOR: 95%CI: 0.54: (0.33, 0.90), (AOR: 95%CI: 0.34: (0.17, 0.67), (AOR: 95%CI: 0.27: (0.14, 0.53) and AOR: 95%CI: 0.25: (0.15, 0.40) times lower likelihood of perceived paternal emotional fertility intention of being very happy about the index pregnancy respectively. The likelihood of perceived paternal emotional fertility intentions of being a sort of happy was found to be (AOR: 95%CI: 1.93 (1.21, 3.10) times higher among those wanting to have another child. This likelihood was found to be (AOR: 95%CI: 0.62 (0.43, 0.89), (AOR: 95%CI: 0.43 (0.22, 0.85) and (AOR: 96%CI: 0.45 (0.28, 0.74) times lower among those whose desired place of delivery was health facility, with higher birth order and residents of Oromiya region respectively. Conclusion: Half of the pregnant women perceived that their husband felt very happy with calls up on a region specific age sensitive interventions in improving couples communication, and discussion on the spacing and timing of pregnancies as well as to work on improving childbirth preparedness and complication readiness. The ministry and relevant partners need to work strategically on male’s involvement in fertility desire along with emotional care and support. Women with future fertility intention, lower birth orders and those who have not legally married need to be targeted. Installing inter pregnancy preconception care package; improving counseling and provision of postpartum contraceptives; increasing men fertility knowledge and their emotional readiness; and lifestyle adjustment before pregnancy to improve psycho-social health during the perinatal period and paternal emotional fertility intentions are imperative.