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PMA2020 / PMA2014/Ethiopia-R1

PMA2014/Ethiopia-R1

SNAPSHOT OF INDICATORS

Summary of the sample design for PMA2014/Ethiopia-R1:

PMA2014/Ethiopia-R1, the first round of data collection in Ethiopia, used a multi-stage cluster design with urban/rural regions as strata. A total of 200 enumeration areas (EAs) were selected proportional to size with urban/rural stratification in 10 regions (excluding Addis Ababa city). The survey was targeted to be representative at the national level (including urban and rural areas) and in 5 of 11 regions (Amhara, Oromiya, SNNPR, Tigray, Addis Ababa city). The survey was also able to generate estimates on family planning services by including a random sample of up to three private service delivery points within each EA’s boundary. In addition, three public health service delivery points that serve the EA population were also selected—a health post, a health center and a district hospital designated to serve the EA area.

The table below provides a summary of key family planning indicators and their breakdown by respondent background characteristics. To view the breakdown by background characteristics of the respondents (including education level, wealth quintile, region etc.), please click on the respective indicator link.

PMA2020 Standard
Family Planning Indicators

 Round One
All Women Married Women
Utilization Indicators:
Contraceptive Use (click to see background characteristics)    
Contraceptive Prevalence Rate (CPR) 22.8 33.0
Modern Contraceptive Prevalence (mCPR) 22.5 32.7
Traditional Contraceptive Prevalence 0.3 0.3
Contraceptive Method Mix (by background characteristics)    
Contraceptive method mix (pie charts for married and all women)    
Number of modern contraceptive users (count of users in the sample) 1,614 1,373
Demand Indicators:
Unmet need for family planning (for spacing, limiting, and in total) 16.1 24.7
Total contraceptive demand (CPR & Unmet Need) 38.9 57.7
Percent of all/married women with demand satisfied by modern contraception 57.9 56.6
Percent of recent births unintended (wanted later/wanted no more)
Wanted Then 59.1 60.3
Wanted Later 25.6 25.6
Not At All 15.3 14.1
Indicators for Access, Equity, Quality & Choice :
Percent of users who chose their current method by themselves or jointly with a partner/provider 79.7 78.4
Percent of users who paid for family planning services 18.1 17.4
Method Information Index:    
Percent of recent/current users who were informed about other methods 50.1 50.0
Percent of recent/current users who were informed about side effects 39.0 38.6
Percent of recent/current users who were told what to do if they experienced side effects 80.7 82.5
Percent of recent/current users who would return and/or refer others to their provider 67.7 68.2
Percent of all/married women receiving family planning information in the past 12 months 21.1 25.5
Service Delivery Point Indicators:
Percentage of service delivery points that offer different contraceptive methods, by type of contraceptive method  
Percentage of service delivery points stocked out of modern contraceptives in the past 12 months, by method  
Number of family planning visits (new and continuing) in last month, by method  
Percent of service delivery points charging fees for family planning services  


The PMA2014/Ethiopia-R1 Survey in Detail

Sample Design

The PMA2020 survey collects annual data at the national and regional levels to allow the estimation of key indicators to monitor progress in family planning. The resident enumerator model enables replication of the surveys each year, and every six months for the first two years, to track progress.

For the first round of data collection (referred to as PMA2014/Ethiopia), the survey targeted a sample size of 200 enumeration areas, which were selected by CSA to be representative at the national level (including urban and rural areas) and in 5 of 11 regional divisions. The enumeration areas were selected systematically with probability proportional to size and urban or rural stratification in the 10 regions (excluding Addis Ababa city, which is only urban). The sample sizes for five regions (Amhara, Oromiya, SNNPR, Tigray and Addis Ababa city) were designed to provide regional estimates. CSA provided the enumeration area selection probabilities for the PMA2020 sampled clusters for constructing weights.

Prior to data collection, all households, health SDPs and key landmarks in each enumeration area were listed and mapped by the resident enumerators to create a frame for the second stage of the sampling process. This mapping and listing process took place in the first week of data collection in each enumeration area. Once listed, 35 households were randomly selected by field supervisors using a phone-based random number-generating application. All occupants in selected households were enumerated and from this list, all eligible women were approached and asked to give informed consent to participate in the study.

Up to three private SDPs within each enumeration area boundary were randomly selected from the listing. In addition, three public health SDPs—a health post, a health center, and a district hospital designated to serve the enumeration area population—were selected.

Weights were adjusted for non-response at the household and individual levels and applied to all household and individual estimates in this report.

Questionnaires

PMA2020 uses standardized questionnaires for households and SDPs to gather data that is comparable across program countries and consistent with existing national surveys. Prior to launching the survey in each country, these questionnaires are reviewed and modified by local experts to ensure all questions are appropriate to each setting.

Three questionnaires were used to collect data from the PMA2014/Ethiopia-R1 survey: the household questionnaire, the female questionnaire and the service delivery point (SDP) questionnaire. These questionnaires are based on model surveys designed by PMA2020 staff at the Bill & Melinda Gates Institute for Population and Reproductive Health in Baltimore, Addis Ababa University (AAU), and fieldwork materials of the 2011 Ethiopia Demographic and Health Survey (EDHS).

All PMA2020 questionnaires are administered using Open Data Kit (ODK) software installed on mobile phones (smartphones) using the Android operating system. The PMA2014/Ethiopia questionnaires appeared in three local languages (Amharic, Afan Oromo and Tigrigna), in addition to English.

Female resident enumerators in each enumeration area administered the household questionnaire and female questionnaire in selected households, and the SDP questionnaire for sampled private SDPs. PMA2014/Ethiopia field supervisors administered the SDP questionnaire in public SDPs.

The household questionnaire gathers basic information about the household that is used to construct a wealth quintile index, such as ownership of durable goods, as well as characteristics of the dwelling unit, including wall, floor, and roof material, water sources and sanitation facilities. Using PMA2020’s innovative mobile technology, the household questionnaire is then linked with the female questionnaire, allowing for disaggregation of the indicators generated by data from the female questionnaire into household wealth quintiles.

The first section of the household questionnaire, the household roster, lists basic demographic information about all usual members of the household and visitors who stayed with the household the night before the interview. This roster is used to identify eligible respondents for the female questionnaire. In addition to the roster, the household questionnaire also gathers data that are used to measure key water, sanitation and hygiene (WASH) indicators, including regular sources and uses of water, sanitation facilities used and prevalence of open defecation by household members

The female questionnaire is used to collect information from all women ages 15 to 49 who were listed on the household roster at selected households. The female questionnaire gathers specific information on education; fertility and fertility preferences; family planning access, choice and use; quality of family planning services; exposure to family planning messaging in the media; and the burden of collecting water on women.

In each selected enumeration area, field supervisors randomly selected up to three private SDPs to be interviewed by a resident enumerator using the SDP questionnaire. The field supervisors themselves administered the SDP questionnaires at an additional three public SDPs that serve each enumeration area.

The SDP questionnaire collected information about the provision and quality of reproductive health services and products, integration of health services, and water and sanitation within the health facility.

Data Processing

The PMA2014/Ethiopia fieldwork training started with a two-week training of trainers of 5 regional coordinators, 30 field supervisors, and 3 central staff that was conducted from October 28 to November 8, 2013. The training was led by PMA2020 staff from the Bill & Melinda Gates Institute for Population and Reproductive Health. These field supervisors then became the trainers for four subsequent resident enumerator training sessions, with the first two trainings taking place from November 20 to November 30, 2013 in Bishoftu and January 1st to 4th, 2014 at Red Cross Training Center in Addis Ababa. In addition, concurrent trainings in Addis Ababa, Gondar, and Mekele towns were held January 14 to 24, 2014; a total of 200 resident enumerators received training.

All training participants were given comprehensive instruction on how to complete the household, female, and SDP questionnaires. In addition to PMA2020 survey training, all participants received training on contraceptive methods by an Ethiopian obstetrician/gynecologist.

Throughout the trainings, resident enumerators and supervisors were evaluated based on their performance on several written and phone-based assessments, mock field exercises and class participation. As all questionnaires were completed on project smartphones, the training also familiarized participants with Open Data Kit and smartphone use in general. All trainings included three days of field exercises, during which participants entered a mock enumeration area to practice listing, mapping and conducting household, female and SDP interviews; recording all responses on their project phones; and submitting to a practice cloud server—a centralized data storage system. The resident enumerator trainings were conducted primarily in Amharic, whereas some small group sessions were conducted in Afan Oromo and Tigrigna.

Supervisors received additional training on how to oversee fieldwork and complete household re-interviews used to carry out random spot-checks in 10 percentage of the households interviewed by resident enumerators.

Data collection was conducted between January and March 2014.

Unlike traditional paper-and-pencil surveys, PMA2020 uses Open Data Kit Collect, an open-source software application, to collect data on mobile phones. All the questionnaires were programmed using this software and installed onto all project smartphones. The Open Data Kit questionnaire forms are programmed with automatic skip-patterns and built-in response constraints to prevent data entry errors.

The Open Data Kit Collect application enabled resident enumerators and supervisors to collect and transfer survey data, via the General Packet Radio Service network, to a central Open Data Kit Aggregate cloud server in real time. This instantaneous aggregation of data also allowed for realtime monitoring of data collection progress, concurrent data processing and course corrections while PMA2020 was still active in the field. Throughout data collection, central staff at AAU in Ethiopia and a data manager in Baltimore routinely monitored the incoming data and notified field staff of any potential errors, missing data or problems found with form submissions on the central server.

The use of mobile phones combined data collection and data entry into one step; therefore, data entry was completed when the last interview form was uploaded at the end of data collection in March.

Once all data were on the server, data analysts cleaned and de-identified the data, applied survey weights, and prepared the final data set for analysis using Stata® version 12 software. Ongoing data analysis was conducted between February and May 2014 and the national dissemination workshop was held on May 27, 2014, in Addis Ababa, Ethiopia.

Response Rates

The response rates at the household and female respondent levels are shown in Table 1 for both PMA2014/Ethiopia-R1 and the EDHS 2011. Of the households selected for surveys, a total of 6,919 households were found to be occupied at the time of the fieldwork. Of these 6,919 potential respondents, 6,772 consented to the household interview, for a response rate of 97.9%. The response rate was similar for both urban and rural areas (97.9%).

In the selected households, 6,611 eligible women ages 15 to 49 were identified, and 6,468 of them participated in interviews (97.8% response rate). The participation rate was similarly high in urban areas (98.0%) and rural areas (97.6%).

  EDHS 2011   PMA2014/Ethiopia-R1
Result Urban Rural Total   Urban Rural Total
Household interviews              
Households selected 5,518 12,299 17,817   3,595 3,384 6,979
Households occupied 5,272 11,746 17,018   3,570 3,349 6,919
Households interviewed 5,112 11,590 16,702   3,495 3,277 6,772
Household response rate* 97.0% 98.7% 98.1%   97.9% 97.9% 97.9%
             
Interviews with women age 15-49
Number of eligible women** 5,656 11,729 17,385   3,565 3,046 6,611
Number of eligible women interviewed 5,329 11,186 16,515   3,494 2,974 6,468
Eligible women response rate 94.2% 95.4% 95.0%   98.0% 97.6% 97.8%
*Household response rate=number of household interviews/households occupied

**Eligible women response rates include only women identified in completed household interviews

†Eligible women response rate = eligible women interviewed/eligible women

Sources: Central Statistical Agency [Ethiopia] and ICF International. 2012. Ethiopia Demographic and Health Survey 2011. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ICF International and the Performance Monitoring and Accountability 2020 (PMA2020) survey carried out in Ethiopia in 2014.

The tables in this report are weighted and adjusted for non-response households and women interviewed.

Sample Error Estimates

The following table shows sample errors for the PMA2020 indicators described above. For more information about PMA2020 indicators, including estimate type and base population, click here.

    Confidence Intervals
Variable Value [R] Standard Error (SE) R-2SE R+2SE
Age-specific fertility rate for women ages 15-19 0.055 0.005 0.046 0.064
All women ages 15-49
Currently using a modern method 0.225 0.013 0.199 0.251
Currently using a traditional method 0.003 0.001 0.001 0.004
Currently using any contraceptive method 0.228 0.013 0.202 0.253
Currently using injectables 0.164 0.011 0.142 0.186
Currently using male condoms 0.005 0.001 0.003 0.007
Currently using implants 0.036 0.005 0.027 0.046
Chose method by self or jointly in past 12 months 0.787 0.026 0.735 0.839
Paid fees for family planning services in past 12 months 0.181 0.020 0.140 0.221
Informed by provider about other methods 0.501 0.022 0.457 0.545
Informed by provider about side effects 0.390 0.032 0.326 0.453
Satisfied with provider: Would return and refer friend/relative to provider 0.677 0.031 0.615 0.739
Visited by health worker who talked about family planning in past 12 months 0.211 0.022 0.167 0.255
Women in union ages 15-49
Currently using a modern method 0.327 0.022 0.283 0.370
Currently using a traditional method 0.003 0.022 0.283 0.370
Currently using any contraceptive modern method 0.330 0.022 0.287 0.373
Currently using injectables 0.245 0.018 0.208 0.281
Currently using male condoms 0.003 0.001 0.001 0.006
Currently using implants 0.053 0.007 0.038 0.067
Chose method by self or jointly in past 12 months 0.772 0.028 0.716 0.827
Paid fees for family planning services in past 12 months 0.174 0.022 0.132 0.217
Informed by provider about other methods 0.500 0.023 0.454 0.546
Informed by provider about side effects 0.386 0.030 0.326 0.445
Satisfied with provider: Would return and refer friend/relative to provider 0.682 0.031 0.621 0.743
Visited by health worker who talked about family planning in past 12 months 0.255 0.024 0.207 0.303
*Current or recent users = women currently using contraception, or have used in the last 12 months.