The Role of Spousal Socio-Demographic Differences and Decision-Making Power Dynamics on Contraceptive Use Among Married Female Adolescents in Rural Ethiopia

Background: Ethiopia has one of the largest populations of married female adolescents in sub-Saharan Africa. These young women face challenges related to gender roles, socio-economic factors, and reproductive health, impacting their access to family planning services. This study examines how spousal socio-demographic differences and decision-making dynamics affect contraceptive use among these adolescents in rural Ethiopia. Methods: In January 2022, a household survey was conducted as part of the RISE intervention program, involving 2,125 married female adolescents aged 15–19 from rural areas. Multi-stage cluster sampling was used to select participants. Multivariate logistic regression models analyzed the effect of spousal characteristics on contraceptive use. Results: The average age of respondents was 17.9 years, with 56.5% having given birth and 84% having completed at least elementary education. The modern contraceptive prevalence rate (mCPR) was 38.5%, with injectables being the most used method. Husbands were on average eight years older, and a husband-wife age gap of 10 + years significantly reduced contraceptive use (AOR 0.69). Higher education levels among wives (AOR 1.69) and similar education between spouses (AOR 1.76) increased contraceptive use. Women involved in financial (AOR 1.94), healthcare (AOR 1.42), and family size decisions (AOR 1.35) were more likely to use contraception. Conclusion: Contraceptive use among married adolescents in rural Ethiopia is shaped by spousal age differences, education, and decision-making dynamics. Addressing gender power imbalances, promoting female education, and involving men in family planning are critical for improving outcomes.