If fear of infertility restricts contraception use, what do we know about this fear? An examination in rural Ethiopia.

Background: Ethiopia has made great progress toward reducing unmet need for family planning and increasing contraception use over the last decade. However, almost one-quarter of women still have an unmet need. The primary reason for non-use is "method-related health concerns" and, within this broad category, the belief that using contraception will cause infertility is common. This belief extends beyond Ethiopia to low-, middle-, and high-income countries across the world. The objective of this paper is to examine associations with the belief that contraception use causes infertility and to subsequently suggest potential strategies to address this misperception. Methods: We collected data from women of reproductive age (between 15 and 49 years old) in 115 rural districts of Ethiopia (n = 706). Our main outcome variable was the belief that contraception causes infertility. We analyzed data, both individual-level factors and interpersonal factors, using nested logistic regression models. Results: Almost half of women in our sample (48.2%) believed that contraceptive use causes infertility. In the final model that included factors from both levels, self-efficacy to use contraception (AOR = 0.81, p < 0.05), visiting a health center and speaking to a provider about family planning in the last 12 months (AOR = 0.78, p < 0.05), and husband support of contraception (AOR = 0.77, p < 0.01) were associated with a reduction in the odds of believing that contraception causes infertility. The belief that infertility will result in abandonment from one's husband (AOR = 3.06, p < 0.001) was associated with an increase in the odds of holding the belief that contraception causes infertility. A home visit in the last 12 months from a health worker who discussed family planning was not associated with the belief that contraceptive use causes infertility. Conclusions: Given that this belief is both salient and positively associated with other fears such as abandonment from one's husband, it is critical for family planning programs to address it. Communication campaigns or interventions that address this misperception among couples may diminish this belief, thereby increasing contraception use and reducing unmet need in rural Ethiopia. Plain language summary: Qualitative research in sub-Saharan Africa has shown that women's belief that contraception use causes infertility is a barrier to contraception use. In this paper, we examine different factors related to this belief and suggest strategies to address this misperception. We surveyed 706 married women from 115 rural districts of Ethiopia. We found that women who believed that infertility would result in abandonment from one's husband had three times higher odds of believing that contraception causes infertility. We also found that some factors associated with a decreased odds in holding this belief included self-efficacy to use contraception, visiting a health center and speaking to a provider about family planning, and husband support of family contraception. A home visit from a health extension worker who discussed family planning was not associated with holding this belief. Our findings suggest some ways to address this misconception. Clearly, women's own self-efficacy, or believing that they can use family planning, is an important piece to any intervention. Given that husbands' support of contraception is associated with reduced odds of holding the belief that contraception causes infertility, including them in intervention efforts is also a logical step. Finally, a home visit from a health extension worker was not associated with reduced odds of holding this belief. Including information that contraception does not cause infertility and discussing the real causes of infertility as part of their education strategy may help debunk this myth and thereby reduce unmet need in rural Ethiopia. [ABSTRACT FROM AUTHOR]