A total of three thousand, three hundred fifty-two (3352) and three thousand, one hundred ninety-six (3196) women aged 15–49 years were included in the 2012 and 2017 surveys, respectively. Out of 3352 women in the 2012 survey, 414 (12.4%) were living with HIV, 2140 (64.4%) were residing in rural areas and 1895 (56.5%) were reported to complete primary level of education with only 449 (13.4%) reported to attend secondary school education.

Out of 3196 women in the 2017 survey, 237 (7.4%) were living with HIV, 1841 (57.6%) were residing in rural areas and 1684 (52.7%) completed a primary level of education, with only 642 (20.01%) attending secondary school education. Details on the characteristics of the women in each survey are shown in Table 1.

Table 1 Unmet need for Contraception in women of reproductive age by the year of the surveyThe level of unmet need for modern contraception

Unmet needs for modern contraception in women aged 15–49 years were 30.9% (95% CI 29.4–32.6) and 31.6% (95% CI 30.0–33.3) in the 2012 and 2017 surveys, respectively. In the 2012 survey, the unmet need for modern contraception in women by age group was as low as 7.1% (95% CI 5.3–8.9) in those aged 15–19 years and as high as 89.2% (95% CI 85.0–92.9) in those aged 45–49 years. Similarly, in the 2017 survey, the estimate by age group was as low as 24.6% (95% CI 21.5–27.8) in those aged 15–19 years to as high as 89.2% (95% CI 85.3–93.1) in those aged 45- 49 years. Overall, the unmet need for modern contraceptives tended to increase with increasing age in both surveys (Fig. 1). In the 2017 survey, the unmet need for modern contraception was 24% (95% CI 21.49–27.75) among women of adolescent age [2, 8, 14,15,16]. This level is higher than the subsequent middle-aged women.

Fig. 1

Unmet neeed for modern contraception by age group and year of the survey

Women with the highest education achievement represented the group of women with the lowest unmet need for modern contraceptives in both surveys. The levels of unmet need for contraceptives among highly educated women rose from 9.6%% (95% CI 6.8–12.3) in 2012 to 22.1% (95% CI 18.9–25.3) in 2017.

Women who were described as “braid winners” for their families were found to have an increased level of unmet need for contraceptives compared to women who were not earning for their family in both surveys. In 2012, the unmet need for modern contraception was 37.5% (35.7–39.4), P < 0.0001, while in 2017, it was 32.7% (30.9–39.5), P < 0.0001. Details on the estimated levels of unmet need for modern contraception are shown in Table 1.

Unmet need for modern contraception: crude and age-adjusted analysis.

The unmet need for contraceptives in WLHIV aged 15–49 years was 41.3% (95% CI 34.53–45.29) in the 2012 survey, while in HIV-uninfected women, the unmet need for contraceptives was 29.5% (95% CI 27.89–31.19). Similarly, in the 2017 survey, the unmet need for contraceptives in WLHIV was 45.5% (95% CI 38.77–51.53), while in HIV-uninfected women, the unmet need for contraceptives was 30.5% (95% CI 28.89–32.21). In comparison, the level of unmet needs for contraception was higher in WLHIV than in their counterparts’ women in both surveys (Fig. 2).

Fig. 2

Unmet need for modern contraception by HIV status and year of the survey

On crude analysis, unmet need for modern contraception in HIV-uninfected women was reduced by 40% compared to unmet need for modern contraception in WLHIV (OR = O.6, 95% CI 0.482–0.736, p < 0.001). A similar analysis in 2017 showed that the unmet need for contraception in HIV-uninfected women was nearly halved compared to the unmet need for contraception in WLHIV (OR = O.5, 95% CI 0.409–0.698, p < 0.001). (Table 2).

Table 2 Factors associated with unmet need for contraception in women of reproductive age by year of survey: Crude and age-adjusted analysisFactors associated with unmet need for modern contraception: multivariable analysis

We finally conducted the multivariable analysis using logistic regression to explore association between the unmet need for modern contraception and associated risk factors. In this model we adjusted for age, education level, place of residence, reports on personal earning for the family, alcohol drinking and number of living children. Unmet need for modern contraception was associated with HIV infection in the 2012 survey (adjusted OR = 0.74; 95% CI 0.569–0.973); p = 0.031). A similar analysis for the 2017 survey, the unmet need for modern contraception was not found to be associated with HIV infection (adjusted OR = 0.78; 95% CI 0.559–1.126; p = 0.196).

In the 2012 survey, we found the following factors to be associated with increased level of unmet need for modern contraception: increasing age (adjusted OR = 2.14; 95% CI 1.899–2.193); p < 0.0001) and increasing number of living children (adjusted OR = 1.23; 95% CI 1.163–1.300); p < 0.0001). However, the following factors were found to decrease the level of unmet need for modern contraception: HIV infection (adjusted OR = 0.74; 95% CI 0.569–0.973); p = 0.031), currently married status against single women (adjusted OR = 0.768; 95% CI0.743–0.794); p < 0.0001), higher education against those who had not been to school (adjusted OR = 0.768; 95% CI0.743–0.794); p < 0.0001), and women who were taking alcohol (adjusted OR = 0.768; 95% CI0.743–0.794); p < 0.0001).

Similar analysis on the 2017 survey data, only two factors were found to increase the level of unmet need for modern contraception: increasing age (adjusted OR = 2.09; 95% CI 1.897–2.193); p < 0.0001) and increasing number of living children (adjusted OR = 1.34; 95% CI 1.260–1.423); p < 0.0001). However, the following factors were found to decrease the level of unmet need for modern contraception: currently married status against single women (adjusted OR = 0.46; 95% CI 0.305–0.722); p = 0.001) and women who were reported to earn money for their families (adjusted OR = 0.66; 95% CI 0.494–0.887); p = 0.006).The final Multivariable model for both surveys, adjustment was for age, education level, place of residence, reports on personal earning for the family, alcohol drinking and number of living children (Table 3).

Table 3 Factors associated with unmet need for contraception in women of reproductive age by year of the survey: Adjusted analysis