Measurements

Unmet need for FP among married HIV positive women was measured in this study by Revised definition of unmet need for currently married women [20]. The surveyed women were first divided into two groups, i.e., those who used contraceptives and those who didn’t use those methods. The nonusers were then subdivided into pregnant or amenorrhoeic women and non-pregnant or non-amenorrhoeic categorized at the time of the survey. The pregnant or amenorrhoeic women were further subdivided into three categories, i.e., those whose pregnancy was intended, mistimed, and unwanted at the time of the survey. Those who had mistimed and unwanted pregnancy was regarded as one component of the total unmet need. The other component consists of those who are neither pregnant nor amenorrhoeic. Further, they were divided into fecund or infecund; fecund women were again subdivided by their reproductive preference into 3 categories, i.e., those who want pregnancy soon (not included in unmet need), want no more pregnancy, and want pregnancy later (Fig 1). Knowledge about family planning was measured by using nine knowledge questions to construct a composite score. The first six questions have multiple responses and add each response from no answer to answering all options. The rest of the three questions are based on Yes and No by giving 1 to Yes and 0 to No. Based on the summation score, a score above 70% was considered as having good knowledge about family planning [21]. Attitude towards FP was measured by an attitude assessing tool using eight Likert scaled question items. Each item of the question has 5-points ranging from 1 (very unsatisfied) to 5 (very satisfied). A total score was calculated for each domain and transferred into ‘percent score’ by dividing the score with the possible maximum score and multiplying by 100. those who scored less than 85% were categorized as unfavorable whereas more or equal to 85% as favorable [22]. Married women decision-making power on modern FP use, scores have been developed for three sets of women: current users, Ever users, and None- users. Current users: six questions were asked to make a mean score. After computing the total, the score above the mean is said to have better decision-making power. Ever uses: Those who used modern FP at least once in their life time but currently not using; six questions were asked and the mean score above mean is said to have better decision-making power. Non-users: if their main reason for non- use is opposition from others the value was assigned as 0 and 1 if otherwise. Finally, married women ‘s decision-making in FP use among study units was set as a binary outcome variable by merging the three groups of women (woman’s only, Jointly with their husband and husband only) those scored mean and above the mean have better decision making power on modern FP use and who scored below the mean have less decision making power on modern FP use [23]. Client satisfaction with FP service was measured using fourteen Likert scaled question items. Each item of the question had 5-points ranging from 1 (very unsatisfied) to 5 (very satisfied) and finally, the mean score was computed to say women satisfied with the service. To apply the measurement first the women must be either ever user or current user [24]. The wealth index was measured by a simplified and updated Ethiopian wealth index equity tool. The tool contains 15 simplified household assets questions available from www.equitytool.org. The tool has an 84.2% agreement and 0.755 kappa statistics with the full Ethiopian Demographic Health Survey (EDHS,2016) wealth index measurement tool. Accordingly, the wealth index of the household was classified into three groups: poorest, middle and richest [25].