Assessment of family planning service utilization and associated factors among female students at Assosa university, Ethiopia – Nature.com 15:50 

Scientific Reports volume 15, Article number: 11661 (2025) Cite this article

Abstract

Family planning is vital for reproductive health, enabling individuals to space children and plan their family size. Despite its importance, many women, especially students, don’t use family planning services. In Ethiopia, where the total fertility rate is 4.6 children per woman and 22% of women have an unmet need for family planning, this study assesses the use of family planning services among female students at Assosa University in Northwest Ethiopia. An institutional-based cross-sectional study was conducted among 351 female students at Assosa University from March to May 2023. Participants were randomly selected using stratified sampling. Data on demographics, family planning knowledge, attitude, and practice were collected through a pre-tested online questionnaire via Google Docs. The questionnaire, adapted from existing scales, was pilot-tested among 10% of the students before the main survey. Data analysis was performed using SPSS version 26, employing descriptive statistics, chi-square tests, and logistic regression. Results were reported as odds ratios with 95% confidence intervals, with a p-value of less than 0.05 considered statistically significant. Of the 345 female students surveyed, 98.3% participated. Most were young (18–20), single Christians with positive views on family planning. About 57.1% used family planning services, and religious reasons (75.4%) were the primary reason for non-use. Factors influencing service use included awareness of contraceptive benefits (AOR = 0.005, 95% CI: 0.000-0.460), prior use (AOR = 0.31, 95% CI: 0.124–0.781), side effects from discontinuation (AOR = 0.221, 95% CI: 0.101–0.487), and future intention (AOR = 4.812, 95% CI: 1.528–15.15). The study emphasizes that enhancing and promoting family planning services for female students at Assosa University is vital for overcoming socio-cultural and religious barriers.

Introduction

Family planning refers to the planning of when to have children and the use of birth control. It allows individuals and couples to anticipate and have their desired number of children, and to achieve healthy spacing and timing of their births1. Starting family planning utilization depends on various factors such as values, religion, culture, socioeconomic status, and knowledge about contraception2,3. Family planning also referred to as reproductive health, is a critical aspect of human life that enables individuals and couples to make informed decisions about their reproductive health and well-being4. It involves using various methods to control the number of children and space between pregnancies, thereby improving the overall health, education, and socio-economic status of individuals and communities5.

Globally, family planning is a vital component of healthcare systems, with an estimated 320 million women in developing countries having an unmet need for modern contraception6. In Africa, where high fertility rates are prevalent, family planning is crucial in addressing population growth and development challenges7.In Ethiopia, where the population is projected to reach 130 million by 2025, family planning is a key component of the country’s health strategy8. According to the Ethiopian Demographic and Health Survey (EDHS) 2016, the total fertility rate (TFR) stands at 4.3 children per woman, with significant disparities in utilization rates between urban and rural areas9. Specifically, only 36% of women in rural areas use modern family planning methods, compared to 63% in urban areas9.

The National Family Planning program provides free modern contraceptives, such as injections, weekly pills, and pills for breastfeeding mothers. You can also choose sterilization, IUDs, implants, oral drugs, condoms, and vaginal barriers. Traditional methods like rhythm and abstinence are also offered. But be careful with fertility awareness methods as they are hard to use and do not prevent infections10. Family planning is vital for development, Unfortunately, contraceptives are not widely accessible, affordable, or culturally accepted in many developing nations11. Condoms are a widely used form of dual protection that serves to prevent both unintended pregnancy and sexually transmitted infections (STIs), including HIV/AIDS12.

Ethiopia has made significant progress toward enhancing the accessibility of family planning to its population1. According to the 2019 EDHS, Ethiopia’s CPR (41.4%) is below the average of sub-Saharan Africa. The country also faces high unmet needs (22%) and fertility (4.6 children per woman), with regional disparities in contraceptive use. Some regions, such as Afar, Benishangul-Gumuz, Gambella, and Somali, have declined CPR13.

The level of utilization of family planning services among female university students in Ethiopia is particularly concerning. A study conducted among female university students in Addis Ababa found that only 21% of the sexually active students used modern family planning methods14. This suggests that there is a need for targeted interventions to improve access to family planning services among this population. Furthermore, university female students are often considered a key population for promoting reproductive health due to their increased awareness and access to information15. However, they may also face unique barriers to accessing family planning services due to cultural or social norms. Family planning (FP) is a basic right of women that helps improve their health and reduces the number of deaths during childbirth16. Female students in universities, like Assosa University in northwest Ethiopia, are at risk of getting pregnant unintentionally, having unsafe abortions, or contracting sexually transmitted infections (STIs). These problems can affect their studies, mental well-being, and future opportunities17.

Awareness of family planning refers to the extent to which individuals are informed about family planning methods, their use, benefits, and availability18. Female university students in Nigeria, Kenya, and Tanzania female students demonstrated varying levels of awareness regarding family planning. While some were knowledgeable about contraceptive methods, others relied on friends, relatives, or health workers for information. Factors like age, marital status, and religion influenced awareness19,20,21. The studies on family planning attitudes among female university students reveal that positive attitudes exist, but awareness doesn’t always translate into contraceptive use. Factors like gender, education, and social norms influence these attitudes. Unplanned pregnancies remain a challenge globally, emphasizing the need for innovative strategies and education on campuses22,23. Despite high awareness of family planning, many female university students in Ethiopia do not utilize family planning methods due to various reasons such as religious beliefs, embarrassment, side effects, and partner disapproval24,25.

Barriers to family planning use among female university students in Ethiopia are numerous and complex, hindering the effective use of family planning methods24. According to a study, religious norms26, fear of side effects27, cost25, and stigma24 are significant barriers to family planning use among female university students. There was a lack of research on how well female students in Ethiopia used FP services. This study aimed to fill this gap by investigating how often female students at Assosa University used FP services, what factors influenced their use, and what obstacles they faced when trying to access these services. The study also looked at how aware they were of different FP methods, where they got information about them, and how good the information was. This study was important because it provided valuable information to help improve FP services for female students at Assosa University and in Ethiopia as a whole. It also helped policymakers make better decisions about how to promote women’s reproductive health and rights. This study aims to investigate the level of utilization of family planning services among female university students of Assosa in Ethiopia and identify factors that influence their decision-making.

Methods and materials

Study area and period

The study focused on Assosa University, a public institution in Ethiopia’s Benishangul-Gumuz region. The region spans 50,699 km2 and has a population of 1,127,001, primarily engaged in rural activities including agriculture, mining, trade, forestry, and bamboo production. Assosa University is situated approximately 675 km west of Addis Ababa, at an elevation of 1570 m above sea level. It is in proximity to the Grand Ethiopian Renaissance Dam (230 km) and Sudan’s border 96 km. (EDHS, 2019).

The university was established in 2011 with five faculties and 1043 students. Currently, the university has grown to have seven colleges and one school, with a total of 6467 regular students, of whom 1956 were female. It also has various facilities such as a clinic, libraries, dining halls, cafeterias, Wi-Fi centers, and toilets. The university is undergoing reforms to adapt to the changing educational trends according to its education profile. The study period was from May to June 2023.

Study design

A descriptive institutional-based cross-sectional design was used.

Study population

The study population consisted of 351 female students aged 18 years and above who were enrolled in regular programs at Assosa University. They were randomly selected from all faculties and completed a self-administered questionnaire.

Inclusion criteria

Female students who were enrolled in regular programs at Assosa University and were sexually active or intended to be sexually active in the next 12 months.

Exclusion criteria

Female students who were pregnant, lactating, infertile, or had a medical condition that prevented them from using family planning services.

Sample size determination

The sample size for the study was calculated using the formula for a single population proportion (p). The proportion formula was assuming family planning utilization in Addis Ababa University, which was 44.4%, along with a 95% level of confidence and a 5% margin of error (precision).

no =(Za/2)2(d)2p (1−p)

The formula used to calculate the sample size for this study was as follows: no = (Zα/2) ²p(1-p) / d², where p is the proportion of family planning utilization among female students in Addis Ababa University (44.4%), 1-p is 0.556, d is the margin of error (0.05), and Zα/2 is the critical value for a 95% confidence level (1.96). Plugging in these values, no≈381.

To estimate the final sample size (nf) from a finite target population, the finite population correction formula: nf = no / [1 + (no / N)], where N is the total number of female students in the university (1956). Plugging in the value of no (381), nf = 319. To account for the 10% non-response rate, add 32 to the sample size, resulting in a final sample size of 351.

Sampling procedure

The study employed a stratified random sampling technique to select study participants (sample 351), from the list of female students obtained from the registrar’s office. The sample size was determined proportionally to the number of female students in each college. They randomly picked the first student in each group by drawing lots. The total number of participants was 351.

Participants from each college were selected by multiplying the sample proportion by the total population and the number of students in each college, ensuring a representative sample. The questionnaire had five sections: socio-demographic information, access and utilization of family planning services, awareness, attitude, and barriers regarding family planning services. Data on demographics, family planning knowledge, attitude, and practice were collected through a pre-tested online questionnaire via Google Docs. The questionnaire, adapted from existing scales, was pilot-tested among 10% of the students before the main survey.

Data quality control

A pre-test was conducted with 35 female students at Assosa College (10% of the sample size) to ensure data quality. Health professionals, trained for two days, collected the data under close supervision. The pre-test helped assess the reliability and validity of the questionnaire.

Data analysis

Data was coded, cleaned, edited, and analyzed using SPSS version 26. Descriptive statistics were presented using frequencies, summary measures, tables, and figures. The dependent variable in this study was the utilization of family planning services (measured as ‘yes’ or ‘no’). The independent variables included socio-demographic factors, awareness of family planning, attitudes toward family planning utilization, and barriers to accessing family planning services. Associations between variables were tested using chi-square at a 0.05 significance level, and logistic regression was used to report odds ratios with 95% confidence intervals.

Results

Sociodemographic characteristics of study participants

The study surveyed 345 female students. The majority (44.3%) were aged 18–20 years, 62.9% were single, and 40.9% identified as Christians. The Amhara ethnic group was the most represented at 27.2%. Regarding parental education, 33.9% of mothers and 27.5% of fathers were uneducated, while 31.6% of mothers and 32.2% of fathers had attended secondary school. 35.4%were from the agriculture and resource management department, and 33% were first-year students. In terms of income, 44.3% of respondents were unaware of their monthly income, 38.3% earned below 5000 birrs, 15.4% earned between 5000 and 10,000 birrs, and 2% earned above 10,000 birrs. Additionally, 56.2% had pocket money. For parents’ education, secondary school was the most common level for both fathers (27.5%) and mothers (31.6%). The least common was illiteracy, with 2% of fathers and 2.9% of mothers unable to read or write. Regarding occupation, 36.5% of respondents’ parents were peasants, followed by traders (35.1%), with 20.3% having both parents employed as shown in Table 1.Table 1 Socio-demographic data of participants at university of Assosa (n = 345) in 2023.

Full size table

Awareness of contraceptives and family planning methods

Among the respondents (80.6%) were aware of contraceptives and family planning. This knowledge was acquired at university (51.9%) and through friends (34.2%), with family members being the least common source (1.7%). Nearly half (47.2%) received classroom instruction on family planning, predominantly at the university level, followed by secondary and primary levels. The most recognized contraceptive methods were oral pills (49.9%), injectables (21.7%), and implants (10.4%), while awareness of natural methods (1.2%) and lactational female sterilization (0.6%) was minimal. Further details on awareness and information sources are provided in Table 2.Table 2 Family planning awareness, sources, and benefits among female students at Assosa university, 2023.

Full size table

Attitudes towards family planning

Among the respondents, 62.5% (216 out of 345) showed positive attitudes toward the measured perceptions. The highest positive attitudes were observed for health benefits, with over 90% agreeing that FP protects children’s and mother’s health. In contrast, the lowest positive attitudes were related to emotional and relational aspects, with around 40–45% agreement on statements like “Loving with a peaceful mind” and “Able to care for one another” (See Table 3).Table 3 Perceptions of family planning among female students at university of Assosa, Ethiopia, 2023.

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Experience of participants with contraceptives and family planning

Among the respondents 42.9%were using a contraceptive method at the time of the study, with condoms being the most popular (42%), followed by injectable (13.5%). The main reasons for using contraceptives were to prevent pregnancy (66.9%) and STIs (29.9%). However, 42.9% were not using any contraceptive method, with reasons including using alternative pregnancy prevention methods (9.9%), not being sexually active (2.6%), and believing they could not get pregnant (44.9%). Additionally, 73% had previously stopped using contraceptives due to side effects. The table provides further details on respondents’ experiences with contraceptives and family planning as shown in Table 4.Table 4 Current use, methods, and reasons for using or not using contraceptives among female students at Assosa university, 2023.

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Access and barriers to family planning services

As shown in Table 5, 75.9% respondents reported easy access to family planning services, with half (51%) finding them consistently available. However, only 8.7% were very satisfied with these services, while 27.8% were dissatisfied. The majority (84.1%) found the services within 1 km of their location, and 80% were aware of campus services. Despite this, 8.1% had experienced denial of services, and 46.1% found service hours inconvenient. Religion was a barrier for 75.4% in accessing modern contraceptives, and 61% lacked family support for family planning. While 14.8% found the costs acceptable, 43.8% felt they were somewhat expensive.Table 5 Access and barriers to family planning services among female students at Assosa university, 2023.

Full size table

Factors associated with the utilization of family planning

This study identified several factors affecting the use of family planning services among female students at Assosa University. Positive influences included religion, mother’s education level, contraceptive awareness, university education on family planning, satisfaction with service quality, and ease of access. Conversely, factors decreasing utilization included lack of prior use, discomfort discussing methods with healthcare providers, unawareness of service centers, and distance from service centers.

Logistic regression revealed that Awareness of contraceptives for birth control and spacing was associated with lower utilization (AOR = 0.005, 95% CI: 0.000-0.460), Previous use of family planning methods reduced the likelihood of current use (AOR = 0.31, 95% CI: 0.124–0.781), Discontinuation due to side effects was linked to lower utilization (AOR = 0.221, 95% CI: 0.101–0.487) and Students intending to use family planning in the future were five times more likely to use services (AOR = 4.812, 95% CI: 1.528–15.15) as shown in Table 6.Table 6 The COR and AOR for each predictor variable of family planning service utilization among female students at Assosa university, 2023.

Full size table

Discussion

This study observed that the portion of the respondents were predominantly young (44.3% aged 18–20), single (62.9%), and Christian (40.9%), with the Amhara ethnic group most represented (27.2%). Many students were unaware of their monthly income (44.3%), and a substantial proportion earned below 5000 Birr (38.3%). Parental education was primarily secondary school level (31.6% mothers, 32.2% fathers), and parents were peasants (36.5%) or traders (35.1%). The socioeconomic profile of the participants, with many from farming and trading families, aligns with the general socioeconomic conditions in many parts of Ethiopia. Informal sources of family planning information such as friends and relatives were common information sources for young people but yet prone to misconceptions, distortions, and half-truths. Family played a limited role (1.7%) in providing family planning information, while friends were the dominant source (34.2%). This is in line with the study conducted in 2022 at Abia State University, Uturu, Abia State, Nigeria19. This study discovered that (80.6%) of the participants had a high level of awareness of family planning methods. This is higher than national reports on family planning awareness at the University for Development Studies in Tamale, Ghana, and a significant departure from many other studies21,28,29.

Over half of the study respondents (51.9%) had come to know about family planning during their university education level, and this agrees with some previous findings. Most of the respondents felt that family planning should be taught formally in schools as part of the academic curriculum. Secondary school may be the most appropriate academic level for formal teaching about family planning, and this has been propagated by Family Health International in sub-Saharan Africa14.

The most known and used methods of modern contraceptives were condoms, the Pill, injectables, emergency contraceptive pills, implants, and the intra-uterine contraceptive device (IUCD). The level of awareness of contraceptives and family planning (80.6%) was similar to levels in studies among African university students (43.5–58%) but lower among the University of Buea (96.1%) which was conducted in Cameroon in 2021, using a descriptive cross-sectional design with multi-stage stratified sampling29. Marital unfaithfulness, an increase in promiscuity, decreased sexual pleasure, cancer, and unreliability were perceived as potential negative results of family planning by some of the respondents in this study. This finding is almost in line with the cross-sectional study conducted at Asella Preparatory School, Ethiopia. This study identified inconvenient service hours as a barrier for 46.1% of respondents, lower than the 61% reported in the Asella Preparatory School study, Ethiopia. Religious concerns were more prevalent here, affecting 75.4% of respondents compared to 43.3% in the Asella study. Cost emerged as a significant barrier for 43.8% of respondents. Additionally, 61% reported a lack of family support, contrasting sharply with the 5.7% in the Asella study who discussed family planning with their families. These disparities highlight varying cultural, socioeconomic, and structural influences on family planning access and use30.

Accessibility to family planning methods on campus in this study was very high (80%), results from other similar studies were to the contrary. This research discovered that only 51% said that family planning helps to control the number of births, has no significant positive effect 4.9%, and enhances sexual performance 0.6%. This finding is lower than the descriptive cross-sectional study conducted at the University of Buea, Cameroon29.

Limitations of the study

The study was limited to a single University in one Town, so generalization of findings to different populations with varying cultural and socio-economic backgrounds globally or in other parts of Ethiopia may not be possible. Moreover, self-reported data from participants introduced the possibility of response bias, which relies on participant subjectivity. This bias may be influenced by social desirability, recall errors, or a lack of awareness about family planning services.

Conclusion

The study at Assosa University revealed that while most female students are familiar with contraceptives, their usage is mainly limited to condoms and injectables, primarily for pregnancy and STI prevention. Non-use is attributed to perceived low risk, lack of sexual activity, and reliance on alternative methods. Many students have stopped using contraceptives due to side effects. Although access to family planning services exists, dissatisfaction with their quality, availability, convenience, and cost persists. Additionally, factors such as religion, family opposition, and social stigma hinder contraceptive use. The study concludes that various influences affect family planning service utilization among female students and recommends targeted interventions to improve access and address socio-cultural and religious barriers.

Recommendations

Based on the findings, the Ministry of Health (MoH) and Assosa University need to design and implement targeted interventions aimed at enhancing the utilization of family planning services among female students. These interventions should focus on increasing access to reproductive health services, delivering culturally sensitive information and education, and addressing the social and economic barriers that hinder the use of family planning services.

Additionally, the university’s health services must cultivate a welcoming and approachable environment that facilitates easy access to family planning resources. Collaborating with student organizations to organize educational programs can further raise awareness and provide vital information about various family planning methods. This comprehensive approach will empower female students to make informed decisions regarding their reproductive health.

Data availability

The corresponding author will provide the datasets used and analyzed during the current research upon reasonable request.

Abbreviations

EDHS:

Ethiopian demographic and health surveyFP:

Family planningHIV/AIDS:

Human immunodeficiency virus/acquired immunodeficiency syndromeIUCD:

Intrauterine contraceptive deviceMoH:

Ministry of healthNGO:

Nongovernmental organizationSTIs:

Sexually transmitted infectionsSTDs:

Sexually transmitted diseasesTFR:

Total fertility rateWHO:

World Health Organization

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Authors and Affiliations

  1. Public Health Emergency Management Officer, Ethiopian Public Health Institute, Addis Ababa, EthiopiaYonas Gashaw
  2. Department of Statistics, College of Natural and Computational Sciences, Gambella University, Gambella, EthiopiaChekol Alemu

Contributions

YG contributed to the study design, data collection, and analysis, and was involved in drafting, and revising. CA assisted with data collection, conducted the literature review, contributed to data analysis, and reviewed, revised, and finalized the manuscript for intellectual content. All authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Chekol Alemu.

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The authors declare no competing interests.

Ethical approval

Ethical approval was obtained from the Research and Ethics Committee of the School of Public Health at Addis Ababa Medical and Business College (reference number: 148/AAMC/2023 and due to date: 23/2/2023). Verbal informed consent was secured from all participants, ensuring their anonymity for privacy and confidentiality. Personal information was kept secure and used solely for the study. Participants were informed of their right to refuse or withdraw from the study at any time. All methods were performed in accordance with the relevant guidelines and regulations of the journals.

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Gashaw, Y., Alemu, C. Assessment of family planning service utilization and associated factors among female students at Assosa university, Ethiopia. Sci Rep 15, 11661 (2025). https://doi.org/10.1038/s41598-025-94511-2

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