Background: Ethiopia is the second-most populous country in Africa, known for its high fertility and low contraceptive use. The magnitude of contraceptive use in the emerging regions of the country is below the national average. However, there is a paucity of evidence regarding the reasons for low contraceptive use in these regions. Therefore, this study aimed to assess contraceptive use and associated factors in the emerging regions of Ethiopia. Methods: For the quantitative part, a community-based cross-sectional study was conducted among 2891 reproductive-age women who were selected by multistage sampling technique. Data were collected face to face using an open data kit software, and STATA version 14 was used for data analysis. Frequencies, percentages, summary measures, and tables were used to summarize and present the data. Bivariable and multivariable logistic regression analyses were performed to identify factors associated with contraceptive use, by computing the odds ratio with a 95% confidence interval. The level of significance was considered at a p-value < 0.05. For the qualitative part, a phenomenological study was conducted among 252 health care workers and community members who were selected purposely. The data were collected through focused group discussions, in-depth interviews, and key informant interviews. The data were audio-recorded in the local languages and then translated to English verbatim. NVivo version 11 was used to analyze the data through a thematic analysis method. Results: The overall contraceptive prevalence rate was 22.2%; with 11.7, 38.6, 25.5, and 8.8% for Afar, Benshangul Gumuz, Gambela, and Somali Regions, respectively. Age, religion, education, marital status, family size, ideal children, knowledge, and attitude were significantly associated with contraceptive use. Additionally, the qualitative study identified three themes as barriers to contraceptive use: individual, the health care system, and sociocultural factors. Conclusions: Contraceptive prevalence rate was low in this study compared to the national average. Age, religion, education, marital status, family size, ideal children, knowledge, and attitude were significantly associated with contraceptive use. From the qualitative aspect, the individual, health care system, and sociocultural factors were identified as barriers to contraceptive use. Therefore, the emerging regions of Ethiopia need special focus on increasing contraceptive use through behavioral influence/change.

• Prevalence
• Contraceptive
• Reproductive age
• Emerging regions
• Mixed method

Not mentioned by the data generating unit.

Ethiopia has set an ambitious plan to improve primary health care services. To this effect, the Federal Ministry of Health (FMoH) has developed a health sector transformation plan (HSTP), with due emphasis given to FP. Accordingly, CPR was expected to reach 55% by 2020. However, 41.4% of married women were using a modern contraceptive at the national level, as of the Ethiopian Mini Demographic and Health Survey of 2019. Meanwhile, the rapid expansion of health facilities/institutions and FP services task shifting to the lower levels, including health posts, has been made progressively since the last decade. Health posts and health centers are the front line for FP services delivery and about 16,559 health posts and 3982 health centers are providing contraceptives in the nation, granting 90% access to FP.

Despite promising changes in the country, both community surveys and facility reports show that contraceptive use in the emerging regions is far below the national goal. The FMoH reported that the contraceptive acceptance rate was very low in emerging regions. In contrast, emerging regions are known to be highly polygamous (19 to 29%) in addition to the high ideal desire of children (4.5–10.5), with poor access to FP services. To the level of our knowledge, there is no large-scale study done in the emerging regions with depth analysis. In response to this, a large-scale study, with quantitative and qualitative approaches, was done to assess the overall contraceptive use and its associated factors among reproductive-age women in the four emerging regions of Ethiopia.

Therefore, a community-based cross-sectional study design was applied for the quantitative study while a phenomenological study design/approach was used for the qualitative one. For the quantitative data, reproductive-age women (15–49 years old) were the study population, whereas health professionals working at different levels and community inhabitants, including community and religious leaders, were the study population for the qualitative study.

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