Factors affecting the knowledge and attitudes of pastoralist women toward long-acting reversible contraceptives utilization in Southern Ethiopia, 2024

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Therefore, this study investigated the factors that affect the knowledge and attitudes of women toward long-acting reversible contraceptives among pastoral women in southern Ethiopia. Methods A community-based cross-sectional study was conducted among 376 women of reproductive age who were randomly selected from three pastoral districts in the West Guji Zone. The data were collected by using a pretested interviewer-administered questionnaire. Ordinary logistic regression analyses with a p value < 0.05 were used to determine statistical significance. Results Less than half, 118 (31.40%), of the study participants had good knowledge, and 88 (23.40%) had a positive attitude toward long-acting reversible contraceptives. The negative predictors of good knowledge and positive attitudes were never attending school (OR: 0.31; 95% CI: 0.10, 0.96), not having a job (OR: 0.39; 95% CI: 0.19, 0.79), having an unplanned pregnancy (OR: 0.41; 95% CI: 0.24, 0.63) and not having a history of abortion (OR: 0.41; 95% CI: 0.21, 0.78). Conclusions Having maternal education, being employed, having a planned pregnancy, having partner support for family planning and having a history of abortion were predictors for good knowledge and positive attitudes. Thus, this study recommends collaborative efforts between the health sector and other stakeholders to support women’s employment and education, as well as developing a program to spread family planning-related messaging to enhance women’s attitudes and understanding. 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F1000Research 2024, 13 :1423 ( https://doi.org/10.12688/f1000research.158424.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Factors affecting the knowledge and attitudes of pastoralist women toward long-acting reversible contraceptives utilization in Southern Ethiopia, 2024 [version 1; peer review: awaiting peer review] Dawit Gelgelo https://orcid.org/0000-0003-3352-1542 1 , Dejene Hailu Kassa 2 , Sileshi Garoma 3 Dawit Gelgelo https://orcid.org/0000-0003-3352-1542 1 , Dejene Hailu Kassa 2 , Sileshi Garoma 3 PUBLISHED 25 Nov 2024 Author details Author details 1 Department of Public Health, Bule Hora University, Bule Hora, Oromia, 144, Ethiopia 2 Department of Public Health, Hawassa University College of Medicine and Health Sciences, Awassa, Ethiopia 3 Federal Ministry of Health, Addis Ababa, Ethiopia Dawit Gelgelo Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Resources, Validation Dejene Hailu Kassa Roles: Conceptualization, Validation, Visualization Sileshi Garoma Roles: Formal Analysis, Resources, Software, Writing – Original Draft Preparation OPEN PEER REVIEW REVIEWER STATUS AWAITING PEER REVIEW Abstract Introduction Many Ethiopian women, especially those who live in rural and pastoral areas, have little knowledge and a negative attitude toward long-acting reversible family planning. Therefore, this study investigated the factors that affect the knowledge and attitudes of women toward long-acting reversible contraceptives among pastoral women in southern Ethiopia. Methods A community-based cross-sectional study was conducted among 376 women of reproductive age who were randomly selected from three pastoral districts in the West Guji Zone. The data were collected by using a pretested interviewer-administered questionnaire. Ordinary logistic regression analyses with a p value < 0.05 were used to determine statistical significance. Results Less than half, 118 (31.40%), of the study participants had good knowledge, and 88 (23.40%) had a positive attitude toward long-acting reversible contraceptives. The negative predictors of good knowledge and positive attitudes were never attending school (OR: 0.31; 95% CI: 0.10, 0.96), not having a job (OR: 0.39; 95% CI: 0.19, 0.79), having an unplanned pregnancy (OR: 0.41; 95% CI: 0.24, 0.63) and not having a history of abortion (OR: 0.41; 95% CI: 0.21, 0.78). Conclusions Having maternal education, being employed, having a planned pregnancy, having partner support for family planning and having a history of abortion were predictors for good knowledge and positive attitudes. Thus, this study recommends collaborative efforts between the health sector and other stakeholders to support women’s employment and education, as well as developing a program to spread family planning-related messaging to enhance women’s attitudes and understanding. READ ALL READ LESS Keywords Family Planning, Reproductive Age Group Women, Pastoralist Women, Bule Hora University. Corresponding Author(s) Dawit Gelgelo ( [email protected] ) Close Corresponding author: Dawit Gelgelo Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Gelgelo D et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Gelgelo D, Hailu Kassa D and Garoma S. Factors affecting the knowledge and attitudes of pastoralist women toward long-acting reversible contraceptives utilization in Southern Ethiopia, 2024 [version 1; peer review: awaiting peer review] . F1000Research 2024, 13 :1423 ( https://doi.org/10.12688/f1000research.158424.1 ) First published: 25 Nov 2024, 13 :1423 ( https://doi.org/10.12688/f1000research.158424.1 ) Latest published: 25 Nov 2024, 13 :1423 ( https://doi.org/10.12688/f1000research.158424.1 ) Introduction The estimated 214 million women of reproductive age lack access to contraceptives, leading to 67 million unintended pregnancies, 36 million induced abortions, and 76,000 maternal deaths each year. 1 Family planning is a critical intervention for preventing 90% of abortions, 32% of maternal deaths, and 20% of pregnancy-related morbidity, and reducing 44% of maternal mortality in low–income countries. 2 – 4 The use of long-acting reversible contraceptives (LARCs) is a modern family planning method that involves the use of an IUCD and sub dermal implants. These methods are better than other methods because they have minimal contraindications, are highly effective at preventing undesired pregnancies, do not need to be used continuously by the users, are inexpensive, do not need to be replenished often, and are reversible with a quick return to fertility after removal. 5 , 6 The Ethiopian Federal Ministry of Health (FMOH) has undertaken many initiatives to reduce maternal mortality. 7 Among these initiatives, the most important is the provision of family planning at all healthcare system levels. 2 However, many studies conducted on contraceptives have shown that many women, particularly rural and pastoralist women, have poor knowledge and negative attitudes toward family planning. 8 – 11 On the other hand, different researchers have shown that women are aware of family planning but not interested in using it. This is making the situation a serious challenge. 7 , 12 , 13 The majority of reproductive age group women are unaware of family planning methods. Even when they know the names of contraceptives, they don’t know where to get them or how to use them. These women have a negative attitude about family planning, and some have heard false and misleading information. Poor understanding and unfavorable attitudes toward FP methods could be some of the reasons for low utilization in emerging regions. 7 Sometimes, even if people are aware and educated about contraceptives, they may not use them. 14 Therefore, the current study investigated the factors that affect the knowledge and attitudes of women toward long-acting reversible contraceptives among pastoral women of West Guji Zone, southern Ethiopia. Methods Study area and period This study was conducted in three pastoral districts of the West Guji Zone, southern Oromia, Ethiopia. It is found at distances of 570 km from Addis Ababa, the capital city of Ethiopia. The zone was established by nine districts and two city administrations. The total number of reproductive-aged women living in the West Guji Zone was 199543. The zone has three primary hospitals and one teaching hospital. This study was conducted from 10/02/2023-02/04/2024. Study design and population A community-based cross-sectional study was conducted. All married women of reproductive age who resided in a randomly selected kebele (small administrative unit) and lived in the study area for the last six months as a resident were included in the study, while those respondents who reported having infertility or severe illness and who were unable to respond during the study time and who resided in the study areas for less than 6 months were excluded from the study. Sample size determination The sample size was calculated using the single population proportion formula by taking into account the following assumptions: at the 95% confidence level, 5% margin of error (d) between the sample and population parameters, and the overall prevalence (p) of LARC utilization was 33.4% 15 according to previous studies. N = Z α / 2 2 * p * ( 1 − p ) / d 2 Where Z α/2 is the critical value of the normal distribution at α/2, d is the margin of error, P is the sample proportion, and N is the sample size. After adding 10% of the possible nonresponse rate, the final sample size computed is 376. Sampling procedure There are a total of 9 districts and one city administration in the West Guji zone. Among the 9 districts and one city administration, three districts are categorized as pastoralist districts. This study included all three pastoral districts (Dugda Dawa, Surro Barbuda, and Malka Soda). First, from the 27 kebeles of three pastoral districts, 12 kebeles were selected by lottery methods, four of which were from each district. Then, 376 calculated sample size were assigned to the respective kebeles using a proportional allocation based on their number of reproductive age group women. Before actual data collection, the number of women in the reproductive age group was obtained from the district health office before actual data collection. The interval was estimated (k=2), and eligible women of reproductive age were selected through a systematic random sampling procedure. The lottery method was used to select one woman to be included in the study in households with more than one eligible woman. Data collection tool and procedures Six midwives with a diplomas were recruited for data collection, and two public health officers were recruited to supervise and facilitate the data collection process. The questionnaire was adapted from different literature 15 – 17 and first formulated in English and then translated into the regional working language, Afan Oromo, and back-translated to English to check its consistency by language experts in both languages. The questionnaire comprised a total of 52 questions arranged in 7 sections. The first section is composed of 4 questions to assess the location of the study participants. The second section is composed of 14 questions to assess the socioeconomic and demographic characteristics of the respondents. The third section is composed of 8 questions to assess respondents’ housing conditions. The fourth and fifth sections comprised 12 questions to assess the knowledge and attitudes of the study participants regarding LARC. The knowledge part comprised dichotomous questions (true or false) to assess the participant’s knowledge of LARCs. The following knowledge items questions were used to assess the knowledge of participants: - 1. The IUCD is not appropriate for females at high risk of contracting sexually transmitted infections. 2. Preventing pregnancy for 5 years; 3. The IUCD has no interference with sexual intercourse or desire; 4. Long-acting reversible contraceptives are immediately reversible; 5. The IUCD can prevent pregnancies for more than 10 years; 6. Insertion and removal of implants require minor surgical procedures) The attitude section is composed of trichotomies’ questions (agree, not sure, and not agree). The following attitude items questions were used to assess participants’ attitudes: - 1. The utilization of long-acting reversible contraceptives imposes restrictions on routine daily activities. It is shameful that privacy is lost during intrauterine contraceptive device insertion. The use of implants or the IUCD can store blood in the abdomen and cause cancer. The utilization of implants may result in substantial and irregular monthly hemorrhages; 5. The insertion and removal of the IUCD is extremely painful. The use of long-acting reversible contraceptives requires adequate nutrition. The sixth and seventh sections of the study are composed of 17 questions that assess the study participants reproductive factors and client- and service-related factors. Measurements of variables The participants’ knowledge was assessed by the total number of correct answers to six items on knowledge questions, with a minimum score of 0 and a maximum score of 1. The participants’ knowledge was measured by the total number of correct answers to six items on knowledge. A score of 1 was assigned to every correct response, whereas a score of zero was assigned to an incorrect response. Knowledge questions were scored and combined, and the mean score was computed to determine the participants’ overall knowledge. The mean knowledge score was classified into the percentiles of poor, moderate and good knowledge. 7 Similarly, the participants’ attitudes were measured by the total number six items, with a minimum score of 1 and a maximum score of three. This was measured using six items on a 3-point Likert-type scale (1= agree, 2=not sure, 3= not agree) computed and combined, and the mean score was computed to determine the overall attitudes of participants. The mean attitude score was classified into percentiles of negative, moderate and positive attitudes. 7 , 12 Data analysis All documented questionnaires were checked for completeness, consistency, and accuracy. The data were entered into Epi-Data version 4.6 18 and exported to SPSS version 25 statistical software for further analysis. 19 Descriptive analyses (frequency, mean, percentage) were carried out for exposure variables. Ordinal logistic regression was used to determine the relationship between the outcome and each independent variable. The odds ratio and 95% confidence interval were estimated to specify factors associated with the outcome variable. The level of statistical significance was indicated by a p value less than 0.05 in the model. The results were presented in tables, graphs, and text. Ethical considerations Ethical information was obtained from the Bule Hora University Ethical Review (ERC) Board. Ethical Review Committee Decision: Meeting No: 2/2024: Protocol number: 025/24/IHSGS Ref.no. BHU-IOH 02-012 Review Date: February- 14/2024. The purpose of the study was explained to the study participants that the study is an attempt to improve knowledge and attitudes about family planning and contraception methods, and written and verbal informed consent was obtained from each participant. The research was conducted according to the Declaration of Helsinki. Results Socio-demographic characteristics of the respondents A total of 376 participants were included in this study with a response rate of 100%. About 163 (43.40%) were urban residents, while 213 (56.60%) were rural residents. Seventy-one (18.90%) respondents completed grades 9-10+, while 122 (32.40%) did not attend any school. The majority, 354 (94.20%) of the women, were housewives, and 125 (33.20%) were poor ( Table 1 ). Table 1. Socio-demographic characteristics of the pastoralist women in three districts of West Guji Zone, 2024. Variables Frequency (n=376) (%) Residence Urban 163(43.4) Rural 213(56.60) Age of respondent 35 76(20.20) Marital status Married 360(95.70) Divorced 5(1.30) Widowed 11(2.90) Ethnicity Oromo 371(98.70) Other 5(1.30) Religion Christian 277(73.70) Muslim 62(16.50) Other (wakefata) 37(9.80) Wife education status Never attended school 122(32.40) Grades 1-4 completed 110(29.30) Grades 5-8 completed 73(19.40) Grades 9-10+ completed 71(18.90) Husband educational status Never attended school 78(20.70) Grades 1-4 completed 79(21.00) Grades 5-8 completed 98(26.10) Grades 9-10+ completed 121(32.20) Wife's position in the family Head of household 22(5.90) Housewife 354(94.20) Occupation Has no job 98(26.10) Farmer 158(42.00) Government employee 42(11.20) Trader 78(20.70) Family size 1-4 109(29.00) 5-10 226(60.10) >11 41(10.90) Wealth index Poor 125(33.20) Medium 126(33.50) Rich 125(33.20) Reproductive health characteristics of the respondents Among the 376 study participants, 42 (11.80%) women were primigravida, while 121 (34.00%) were multigravida with more than five living children. The majority, 218 (58.00%) women, had not planned for their last pregnancy. Among the 233 (62.00%) women who had ANC for their last pregnancy, 139 (37.00%) obtained family planning counseling. Approximately 139 (37.00%) women discussed family planning with their partner, and 130 (34.60%) of them obtained support from their partner. The majority, 217 (57.70%), of the women delivered at home, while 149 (39.60%) delivered at a health institution ( Figure 1 ). Figure 1. Reproductive health characteristics of pastoralist women aged 15-49 at three districts of West Guji Zone, 2024. Knowledge of pastoralist women toward the long acting reversible contraceptive This study revealed that 54 (14.40%), 204 (54.30%) and 118 (31.40%) women had poor, moderate and good knowledge of LARCs, respectively. Accordingly, 35.60% of the participants stated that IUCD is not appropriate for females at high risk of contracting sexually transmitted infections. Similarly, 44.90% of the respondents indicated that the use of implants prevented pregnancy for 5 years, and 60.60% of respondents expressed that the IUCD did not interfere with sexual intercourse or desire ( Table 2 ). Table 2. Knowledge of pastoralist women toward long-acting reversible contraceptives at three districts of West Guji Zone, 2024. Items FALSE TRUE N (%) N (%) The IUCD is not appropriate for females at high risk of getting sexually transmitted infections 242(64.40) 134(35.60) Implants prevent pregnancy for 5 years 207 (55.10) 169(44.90) The IUCD has no interference with sexual intercourse or desire 148(39.40) 228(60.60) Long-acting reversible contraceptives are immediately reversible 94(25.00) 282(75.00) The IUCD can prevent pregnancies for more than 10 years. 202(53.70) 174(46.30) Insertion and removal of implants require minor surgical procedures 250(66.50) 126(33.50) Frequency (%) Knowledge levels of respondents (n=376) Poor knowledge 54(14.40) Moderate knowledge 204(54.30) Good knowledge 118(31.40) Factors affecting the knowledge of pastoralist women toward the long acting reversible contraceptive An ordinal logistic regression was conducted in order to assess the association between socio-demographic characteristics and reproductive health factors with knowledge sore level. Accordingly, having jobs, education status and having planned pregnancy were significantly associated with knowledge level score. The odds of having good knowledge about contraceptives decreased by 61% for women who had no jobs compared with their counterparts (OR: 0.39; 95% CI: 0.19, 0.79). The odds of having good knowledge decreased by 69% and 63% for women who never attended school (OR: 0.31; 95% CI: 0.10, 0.96) and completed grades 1-4 (OR: 0.37; 95% CI: 0.14, 0.95), respectively, compared to women who completed grades 9-10+. The probability of having good knowledge decreased by 59% for women with no planned pregnancy compared with women who had planned for their pregnancy (OR: 0.41; 95% CI: 0.24, 0.63) ( Table 3 ). Table 3. Ordinary logistic regression analysis of factors affecting women’s knowledge toward long-acting reversible contraceptives at three districts of West Guji Zone, 2024. Variables Frequency (%) B (estimates) P-VALUE OR(95%CI) Residence Urban 163(43.40) 0.132 0.595 1.14(0.7,1.85) Rural 213(56.60) I.00 1.00 1.00 Age of respondent 35 76(20.20) 1.00 1.00 1.00 Occupation Has no job 98(26.10) -0.92 0.009 0.39(0.19,0.79) Farmer 158(42.00) -0.26 0.457 0.77(0.39,1.53) Government employee 42(11.20) 0.16 0.757 1.17(0.43,3.11) Trader 78(20.70) 1.00 1.00 1.00 Maternal education Never attended school 122(32.40) -1.15 0.042 0.31(0.10,0.96) Grades 1-4 completed 110(29.30) -0.99 0.04 0.37(0.14,0.95) Grades 5-8 completed 73(19.40) -0.44 0.305 0.63(0.27,1.50) Grades 9-10+ completed 71(18.90) 1.00 1.00 1.00 History of abortion No 286(76.10) -0.20 0.441 0.81(0.48,1.37) Yes 90(23.90) 1.00 1.00 1.00 Planned pregnancy 0.41(0.24,0.63) Unplanned 218(58.00) -0.88 0.001 0.41(0.24,0.63) Planned 158(42.00) 1.00 1.00 1.00 Have ANC No 143(38.00) 0.03 0.91 1.03(0.60,1.77) Yes 233(62.00) 1.00 1.00 1.00 Get counselling No 237(63.00) -0.14 0.602 0.86(0.49,1.50) Yes 139(37.00) 1.00 1.00 1.00 Attitudes of women toward long-acting reversible contraception In the current study, 168 (44.70%), 120 (31.90%), and 88 (23.40%) women had negative attitudes, moderate attitudes, and positive attitudes toward LARC, respectively. About, 14% of respondents agreed that long-acting reversible contraceptives restrict normal daily activities, and 24.70% of respondents agreed that implants cause heavy, irregular monthly bleeding. Additionally, 13.60% and 47.90% of respondents confirmed that using implants or an IUCD that stores blood in the abdomen and causes cancer and the insertion and removal of the IUCD is highly painful ( Table 4 ). Table 4. Attitude of pastoralist women toward long –acting reversible contraceptives at three districts of West Guji Zone, 2024. Items Agree N (%) not sure N (%) not agree N (%) Long-acting reversible contraceptives utilization restricts normal daily activities 53(14.10) 131(34.80) 192(51.10) Loosing privacy during intrauterine contraceptive device insertion is shameful 53(14.10) 134(35.60) 189(50.30) Using implants or IUCD stores blood in the abdomen and causes cancer 51(13.60) 182(48.40) 143(38.00) Using implants causes heavy irregular monthly hemorrhage 93(24.70) 80(21.30) 203(54.00) Insertion and removal of IUCD are highly painful 180(47.90) 113(30.10) 83(22.10) Utilization of long-acting reversible contraceptives requires good nutrition 63(16.80) 53(14.10) 260(69.10) Frequency (%) Attitude score toward long-acting reversible contraceptives(n=376) Negative attitude 168(44.70) Moderate attitude 120(31.90) Positive attitude 88(23.40) Factors affecting the attitude of pastoralist women toward the long acting reversible contraceptive Socio-demographic characteristics and reproductive health factors that affect attitude score level were assessed using ordinary logistic regression. Accordingly, education status, and having a history of abortion were significantly associated with knowledge level scores. The odds of having a positive attitude toward contraceptives decreased by 78% for women who completed grades 1-4 (OR: 0.22; 95% CI: 0.06, 0.74) compared to women who completed grades 9-10+. The probability of having a positive attitude decreased by 59% for women who had no history of abortion (OR: 0.41; 95% CI: 0.21, 0.78) compared with women who had a history of abortion ( Table 5 ). Table 5. Ordinal logistic regression of factors affecting women’s attitudes toward long-acting reversible contraceptives in three districts of the West Guji Zone, 2024. Variables Frequency (%) B (estimates) P-VALUE OR(95%CI) Residence Urban 163(43.40) 0.12 0.699 1.13(0.60,2.06) Rural 213(56.60) I.00 1.00 1.00 Age of respondent 35 76(20.20) 1.00 1.00 1.00 Occupation Has no job 98(26.10) -0.21 0.614 0.80(0.34,1.87) Farmer 158(42.00) 0.27 0.489 1.31(0.60,2.87) Government employee 42(11.20) 0.91 0.093 2.50(0.85,7.30) Trader 78(20.70) 1.00 1.00 1.00 Maternal education - Never attended school 122(32.40) -1.06 0.134 0.34(0.08,1.36) Grades 1-4 completed 110(29.30) -1.48 0.015 0.22(0.06,0.74) Grades 5-8 completed 73(19.40) -0.67 0.201 0.51(0.18,1.43) Grades 9-10+ completed 71(18.90) 1.00 1.00 1.00 History of abortion No 286(76.10) -0.88 0.007 0.41(0.21,0.78) Yes 90(23.90) 1.00 1.00 1.00 Planned pregnancy 0.41(0.24,0.63) Unplanned 218(58.00) -0.01 0.868 0.98(0.82,1.17) Planned 158(42.00) 1.00 1.00 1.00 Have ANC No 143(38.00) 0.18 0.061 1.20(0.99,1.45) Yes 233(62.00) 1.00 1.00 1.00 Get counseling No 237(63.00) 0.006 0.955 1.00(0.82,1.22) Yes 139(37.00) 1.00 1.00 1.00 Discussion This study was conducted among pastoralist women to assess the factors that affect the knowledge and attitudes of women toward long-acting reversible contraceptives among pastoral women at the three districts of the West Guji Zone. This study revealed that 54 (14.40%), 204 (54.30%) and 118 (31.40%) women had poor, moderate and good knowledge of LARCs, respectively. Maternal education, being employed, having a planned pregnancy and obtaining partner support for family planning utilization were determining factors for good knowledge. Similarly, 168 (44.70%), 120 (31.90%) and 88 (23.40%) women had negative attitudes, moderate attitudes and positive attitudes toward LARC, respectively. Maternal education and having a history of abortion were determining factors for positive attitudes. In the current study, the proportion of women who had good knowledge was 31.40%, which is comparable to the findings reported by studies conducted in the pastoral communities of the Afar region (29.4%) 15 and Arba Minch region (33%). 20 However, these findings were lower than those of studies conducted in Mekelle city (54.1%), 21 Areka town (52.6%), 2 Jinka town (52.2%), 22 Gamo and Gofa Zone (78.9%) 23 and Gondar town (51.7%). 17 The possible reason for this difference may be that the majority of these studies were carried out in cities or towns where there may have been greater access to better infrastructure, more job opportunities, and easier access to knowledge as a result of advancements in communication, education, and transportation. Furthermore, the majority of these studies were conducted in health facilities, which raises the likelihood of an outcome of interest and response rate. However, the findings of the current study were greater than those of studies conducted in Silti District (21%) 24 and Debre Berhan (20%). 25 The potential cause of this discrepancy might be that 92.6% of respondents in earlier research identified as Muslims, which could contribute to a lower degree of support for family planning utilization. Similarly, this study revealed that approximately 23.40% of women had a positive attitude toward LARCs, which was comparable to that reported in a study conducted in Arba Minch (25%). However, the findings of the present study were lower than those of studies conducted in Mekelle city (47.1%), 21 Areka town (44.5%), 2 Jinka town (43.5%), 22 Gamo and Gofa Zone (60.6%) 23 and Gondar town (45%). 17 It is possible that the study environment made a difference. The majority of these studies were carried out on urban populations who had easier access to fundamental social and health services, including work and education. Education has a major impact on women’s attitudes, improving their capacity and their freedom to choose when and how many children to have. This study revealed that the odds of having good knowledge decreased by 69% and 63% among women who had never attended school and completed grades 1-4, respectively, compared to women who completed grades 9-10, and the odds of having a positive attitude about contraceptives decreased by 78% for women who completed grades 1-4, respectively, compared to women who completed grades 9-10, which was similar to the findings of studies conducted in South Achefer District, 12 Jimma Zone, 26 Dilla Town, 27 North Shewa Zone, 28 Sierra Leone, 14 and emerging regions of ethiopians. 7 Reasons for this include the possibility that educated women planned for their reproductive health to create a better future for themselves and their families, as well as the possibility that they had positive attitudes and good knowledge about family planning, which led them to postpone getting married and having children as well as adopting other protective health behaviors. Similarly, the odds of having good knowledge about contraceptives decreased by 61% for women who had no jobs compared with their counterparts, which was similar to the findings of a survey conducted in four regions of Ethiopia (Oromia, Amhara, the SNNRPR and Tigray), 29 the Kampla district in Uganda 30 and emerging regions of Ethiopia. 7 This could be because working women have greater access to knowledge about family planning and their rights related to reproductive health. Strength and limitation of study This study’s primary strength was the application of ordinal logistic regression, which considers cumulative probabilities rather than probabilities for discrete categories, and a community-based study design, which could help understand actual practices and related factors that impede women’s knowledge and attitudes about long-acting reversible contraceptives. However, the limitation of this study was the use of a cross-sectional study design, where it is impossible to determine a causal relationship between the outcomes and the explanatory variables. Additionally, the small sample size may have affected the generalizability of the findings. Conclusion and recommendation The knowledge of long-acting reversible contraceptives in the study setting was extremely low compared to that in the 2019 findings of the Ethiopian demographic and health survey. Similarly, the proportions of good knowledge and positive attitudes were also lower than those in many similar studies conducted across countries. Maternal education, being employed, having a planned pregnancy, obtaining partner support for family planning, and having a history of abortion were determining factors for good knowledge and positive attitudes. One of the main determinants of women’s attitudes toward and knowledge of family planning is maternal education. This suggested that women with a higher education level were more likely to be knowledgeable and to have a positive attitude. Thus, this study recommends collaborative efforts between the health sector and other stakeholders to support women’s employment and education, as well as developing a programme to spread FP-related messaging to enhance women’s attitudes and understanding. In addition, women who have received support from their partners are well-informed about long-acting reversible contraceptives. Therefore, it is necessary to encourage spousal communication on family planning topics, and an effort should be made in this direction. Ethical considerations Ethical information was obtained from the Bule Hora University Ethical Review (ERC) Board. Ethical Review Committee Decision: Meeting No: 2/2024: Protocol number: 025/24/IHSGS Ref.no. BHU-IOH 02-012 Review Date: February- 14/2024. The purpose of the study was explained to the study participants that the study is an attempt to improve knowledge and attitudes about family planning and contraception methods, and written and verbal informed consent was obtained from each participant. The research was conducted according to the Declaration of Helsinki. Data availability Underlying data Figshare: Factors affecting the knowledge and attitudes of pastoralist women toward long-acting reversible contraceptives utilization in Southern Ethiopia: a cross-sectional study: DOI: https://doi.org/10.6084/m9.figshare.27292044.v3 . 31 The study contain the following data: • Raw data Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Extended data Figshare: Factors affecting the knowledge and attitudes of pastoralist women toward long-acting reversible contraceptives utilization in Southern Ethiopia: a cross-sectional study: DOI: https://doi.org/10.6084/m9.figshare.27292044.v3 . 31 This project contains the following: • Questionnaire Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Reporting guideline Figshare: Factors affecting the knowledge and attitudes of pastoralist women toward long-acting reversible contraceptives utilization in Southern Ethiopia: a cross-sectional study: DOI: https://doi.org/10.6084/m9.figshare.27292044.v3 . 31 This project contains the following: • Strobe checklist Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Acknowledgments We would like to express my utmost gratitude to the administrators of West Guji Zones, data collectors who diligently collected the data, as well as the individuals who participated in the study. Their contributions have been crucial to the success of this research. Also, we want to thank Mr. Shiferaw Gelchu for his guidance and advice during the process of this project. References 1. Lovita BT, Mariana A, Malik DM, et al. : Factors associated with the utilization of long-acting reversible contraceptives among family planning clients at the Pameungpeuk Rural Hospital. Indonesia: 2019. 2. Kastro S, Dake SK, Abiso TL: Reversible Long Term Contraceptives Utilization among Married Women of Reproductive Age Group in Southern Ethiopia.2020. 3. Negash WD, Belachew TB, Asmamaw DB: Long acting reversible contraceptive utilization and its associated factors among modern contraceptive users in high fertility sub-Saharan Africa countries.2022; 4–11. 4. 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Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 25 Nov 2024 ADD YOUR COMMENT Comment Author details Author details 1 Department of Public Health, Bule Hora University, Bule Hora, Oromia, 144, Ethiopia 2 Department of Public Health, Hawassa University College of Medicine and Health Sciences, Awassa, Ethiopia 3 Federal Ministry of Health, Addis Ababa, Ethiopia Dawit Gelgelo Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Resources, Validation Dejene Hailu Kassa Roles: Conceptualization, Validation, Visualization Sileshi Garoma Roles: Formal Analysis, Resources, Software, Writing – Original Draft Preparation Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 25 Nov 2024, 13:1423 https://doi.org/10.12688/f1000research.158424.1 Copyright © 2024 Gelgelo D et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Gelgelo D, Hailu Kassa D and Garoma S. Factors affecting the knowledge and attitudes of pastoralist women toward long-acting reversible contraceptives utilization in Southern Ethiopia, 2024 [version 1; peer review: awaiting peer review] . 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