Unmet need for family planning among adolescent girls and young women (15–24 years) in Ethiopia during the FP2020 period: a propensity score matching analysis using PMA data

ABSTRACT: Adolescents and young women in Ethiopia have a high unmet need for family planning. The Family Planning 2020 strategy prioritized improving reproductive health among women aged 15-24 years. This study aims to assess the changes in unmet need for family planning among adolescent and young women aged 15-24 years in Ethiopia across the Family Planning 2020 period. A cross-sectional pre-post study using propensity score matching analyzed two rounds of Performance Monitoring for Action data: 2014 (pre-family planning 2020) and 2021 (post-family planning 2020). Propensity Score Kernel Matching was used, and covariate balance was assessed using standardized mean differences, median, and mean bias. A total of 3,128 adolescent and young women aged 15-24 years were included. The average treatment effect on the treated was estimated, and sensitivity analysis assessed robustness to hidden bias. Unmet need for family planning decreased from 22.9% (95% CI: 21.1-24.8) in 2014 to 17.8% (95% CI: 15.8-20.1) in 2021. Matching improved covariate balance, reducing mean bias (13.3 to 1.4), median bias (10.2 to 1.1), and standardized mean difference (58.8 to 5.8). The average treatment effect on the treated indicated a 2.5 percentage point reduction. Sensitivity analysis using Rosenbaum bounds showed the effect remained significant up to Γ = 2 (p < 0.0001), indicating robustness to hidden bias. Unmet need for family planning among Ethiopian adolescents and young women aged 15-24 years has declined. Continued efforts under the Family Planning 2030 strategy are needed to sustain and further improve access to family planning services. LAY SUMMARY: Adolescents and young women in Ethiopia still face serious challenges in family planning. The FP2020 strategy was designed to improve the family planning experience for women between the ages of 15 to 24 years. This study seeks to evaluate the effect of the strategy on the unmet needs of women for family planning by carrying out an assessment of data collected from national surveys conducted before the strategy was established in 2014 and after the establishment of the strategy in 2021. The data show that the unmet needs for family planning have reduced since the establishment of the strategy. After the analysis of the variance between the study groups, the study found that there is a reduction in unmet needs for family planning. However, unmet need remains, meaning that many young women still face challenges in obtaining contraception and making informed reproductive choices. Commitment to the new strategy, that is FP2030, is required for the improvement of family planning access and use for young women.