Prevalence and predictors of modern contraceptive method utilization among married couples in the pastoralist communities of Fentale district, Eastern Ethiopia

Despite progress in contraceptive use, Ethiopia faces significant challenges in adopting modern methods, particularly in pastoralist areas. Existing studies predominantly focus on women's family planning (FP) service utilization, often overlooking couple-level outcomes and male perspectives. This study aims to fill this gap by exploring factors affecting modern contraceptive use among couples in the Fentale District of Eastern Ethiopia. This mixed-methods cross-sectional study collected qualitative data from August 1 to September 20, 2021, and quantitative data from October 1 to December 25, 2021. A total of 1496 married couples were sampled using multi-stage systematic sampling. Quantitative data were gathered via semi-structured questionnaires, while qualitative data were obtained from 10 focus group discussions (FGDs), 20 key informant interviews (KIIs), and 30 in-depth interviews (IIDs). Quantitative analysis employed multivariable logistic regression modeling, and qualitative data were analyzed thematically without computer software. Among participants, 46.3% married at age 15 or younger, 53.8% lacked formal education, and 64.6% were nomadic pastoralists. Notably, 94.2% never discussed family planning, and only 27.4% used any form of family planning, with 18.2% opting for modern methods. Short-term methods like pills (13.7%), injectables (5.9%), and male condoms (7.5%) were more prevalent than traditional methods (9.0%) or long-term methods (1.6%). Concerns included a desire for more children (68.7%), religious opposition (63.0%), partner opposition (51.1%), and fear of side effects (42.9%). Early marriage (AOR = 0.613, 95% CI 0.315-1.193) and no formal education (AOR = 2.878, 95% CI 1.976-4.191) decreased contraceptive use odds, while being in business increased odds (AOR = 7.461, 95% CI 3.324-16.748). Mobile phone ownership increased use odds (AOR = 3.628, 95% CI 1.573-8.363), while having a bank account decreased odds (AOR = 0.017, 95% CI 0.006-0.045). Discussing family planning significantly increased contraceptive use odds (AOR = 15.708, 95% CI 2.320-106.369), while desiring more children decreased odds (AOR = 0.406, 95% CI 0.185-0.890). These findings underscore the importance of socio-demographic, socio-economic, reproductive history factors, spousal communication, and male involvement in modern contraceptive use among pastoralist communities. The study reveals unique reproductive challenges faced by pastoralist couples, driven by socio-demographic, socio-economic, reproductive history factors, and cultural beliefs that impact modern contraceptive use. Tailored interventions, including promotion of long-term contraceptive methods, educational campaigns involving religious leaders, and mobile health services, are essential to address limited healthcare access. Engaging both spouses in family planning, promoting male involvement, and fostering joint decision-making through effective communication are crucial for enhancing contraceptive uptake and improving reproductive health outcomes. Collaboration with community members and stakeholders is vital for the success of targeted interventions.