Persisting Regional Disparities in Modern Contraceptive Use and Unmet Need for Contraception among Nigerian Women

Background. Evidence suggests that equitable provision of contraceptive services can help women achieve their reproductive goals and has significant impact on reducing the rates abortion and unintended pregnancy at large. However, regional disparities continue to persist on top of low family planning prevalence which is a critical public health challenge for fast growing populations like Nigeria. Objectives. The present study aimed to explore the prevalence of (1) nonuse of modern contraceptives, (2) unmet need for contraception, and (3) regional disparities in these two. Methods. The present study used cross-sectional data obtained from the Nigeria Demographic and Health Surveys conducted in 2003, 2008, and 2013. Participants were women of reproductive of age (15-49 years) regardless of marital status. Regional disparities of nonuse of modern contraceptives and unmet need were analysed by descriptive and multivariate regression methods. Results. In the pooled sample of 79,656 participants during 2003, 2008, and 2013, 88.6% reported not using any modern methods, and 13.5% reported having unmet need for contraception. The prevalence rates of nonuse were, respectively, 91.8%, 90.6%, and 88.6% and those of unmet need were 14.2%, 16.6%, and 13.5% in the years 2003, 2008, and 2013. Significant differences were observed in the odds of reporting nonuse and unmet need for contraception across the geopolitical zones. Conclusions. The rates of nonuse of contraception are remarkably high among women in Nigeria with significant disparities across the six geopolitical zones. Efforts should be made to address the regional disparities in order to achieve the goals of universal coverage of family planning services in the country.

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A qualitative exploration of contraceptive use and discontinuation among women with an unmet need for modern contraception in Kenya

Reproductive Health ◽

10.1186/s12978-021-01094-y ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Susan Ontiri ◽

Lilian Mutea ◽

Violet Naanyu ◽

Mark Kabue ◽

Regien Biesma ◽

...

Keyword(s):

Family Planning ◽

Side Effects ◽

Peer Influence ◽

Contraceptive Use ◽

Unmet Need ◽

Modern Contraceptive ◽

Modern Contraception ◽

Modern Contraceptives ◽

Family Planning Programs ◽

Contraceptive Discontinuation

Abstract Background Addressing the unmet need for modern contraception underpins the goal of all family planning and contraception programs. Contraceptive discontinuation among those in need of a method hinders the attainment of the fertility desires of women, which may result in unintended pregnancies. This paper presents experiences of contraceptive use, reasons for discontinuation, and future intentions to use modern contraceptives. Methods Qualitative data were collected in two rural counties in Kenya in 2019 from women with unmet need for contraception who were former modern contraceptive users. Additional data was collected from male partners of some of the women interviewed. In-depth interviews and focus group discussions explored previous experience with contraceptive use, reasons for discontinuation, and future intentionality to use. Following data collection, digitally recorded data were transcribed verbatim, translated, and coded using thematic analysis through an inductive approach. Results Use of modern contraception to prevent pregnancy and plan for family size was a strong motivator for uptake of contraceptives. The contraceptive methods used were mainly sourced from public health facilities though adolescents got them from the private sector. Reasons for discontinued use included side effects, method failure, peer influence, gender-based violence due to covert use of contraceptives, and failure within the health system. Five reasons were provided for those not willing to use in the future: fear of side effects, cost of contraceptive services, family conflicts over the use of modern contraceptives, reduced need, and a shift to traditional methods. Conclusion This study expands the literature by examining reasons for contraceptive discontinuation and future intentionality to use among women in need of contraception. The results underscore the need for family planning interventions that incorporate quality of care in service provision to address contraceptive discontinuation. Engaging men and other social influencers in family planning programs and services will help garner support for contraception, rather than focusing exclusively on women. The results of this study can inform implementation of family planning programs in Kenya and beyond to ensure they address the concerns of former modern contraception users.

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Predictors of modern contraceptive use among women and men in Uganda: a population-level analysis

BMJ Open ◽

10.1136/bmjopen-2019-034675 ◽

2020 ◽

Vol 10 (2) ◽

pp. e034675 ◽

Cited By ~ 2

Author(s):

Amrita Namasivayam ◽

Sarah Lovell ◽

Sarah Namutamba ◽

Philip J Schluter

Keyword(s):

Family Planning ◽

Contraceptive Use ◽

Unmet Need ◽

Secondary Data ◽

Population Level ◽

Modern Contraceptive ◽

Cross Sectional ◽

Factors Affecting ◽

Logistic Regression Models ◽

Modern Contraceptive Use

Objective(s)Despite substantial and rapid improvements in contraceptive uptake in Uganda, many women continue to have unmet need for contraception. As factors affecting contraceptive use are dynamic and complex, this study seeks to identify current predictors and provide effect size estimates of contraceptive use among women and men in Uganda.Study designA nationally representative cross-sectional population survey, using secondary data from Uganda’s 2016 Demographic and Health Survey. Stratified by sex, weighted bivariable and multivariable logistic regression models were derived from a suite of potential predictor variables. Predictive abilities were assessed via 10-fold cross-validated area under the receiver operating characteristic curves (AUCs).SettingUganda.ParticipantsAll women aged 15–49 years who were permanent residents of the selected households or stayed in the household the night before the survey were eligible to participate. In one-third of the sampled households, all men aged 15–54 years who met the same residence criteria were also eligible.Primary outcome measuresModern contraceptive use.ResultsOverall, 4914 (26.6%) women and 1897 (35.6%) men reported using a modern contraceptive method. For women and men, both demographic and proximate variables were significantly associated with contraceptive use, although notable differences in effect sizes existed between sexes—especially for age, level of education and parity. Predictively, the multivariable model was acceptable for women with AUC=0.714 (95% CI 0.704 to 0.720) but less so for men with AUC=0.654 (95% CI 0.636 to 0.666).Conclusion(s)Contemporary significant predictors of contraceptive use among women and men were reported, thereby enabling key Ugandan subpopulations who would benefit from more targeted family planning initiatives to be identified. However, the acceptable AUC for women and modest AUC for men suggest that other important unmeasured predictors may exist. Nonetheless, these evidence-based findings remain important for informing future programmatic and policy directions for family planning in Uganda.

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Modern contraceptive use among female adolescents in rural Nigeria: Does exposure to family planning messages matter? A cross-sectional study

Gates Open Research ◽

10.12688/gatesopenres.12904.1 ◽

2019 ◽

Vol 3 ◽

pp. 627

Author(s):

Victor Chima ◽

Oluwatobi Abel Alawode

Keyword(s):

Family Planning ◽

Mass Media ◽

Rural Areas ◽

Contraceptive Use ◽

Female Adolescents ◽

Rural Adolescents ◽

Modern Contraceptive ◽

Cross Sectional ◽

Modern Contraceptives ◽

Rural Nigeria

Background: The world currently has the highest number of adolescents in all of history. Africa is home to quite a number of them, with most of these adolescents in Africa live in rural areas where they are more disadvantaged and their reproductive decisions could have telling impacts on their lives, family planning (contraception) has been identified as important to avoid such impacts. Factors associated with the use of modern contraceptives among female adolescents have been extensively researched but the importance of mass media family planning messages on modern contraceptives use among female adolescents in rural Nigeria is under-researched, hence this study. Method: This paper uses the 2013 Nigeria Demographic and Health Survey (NDHS) data with a weighted sample size (n=4473) to examine the association between exposure to family planning messages and use of modern contraceptives among female adolescents in rural Nigeria. Results: Findings indicated that exposure to family planning messages on radio and television were significantly associated with use, however, educational attainment and region of residence were other factors that influenced contraceptive use. Therefore, family planning messages through traditional media (radio and television) is associated with the use of modern contraceptives among female rural adolescents in Nigeria. Conclusion: The study concludes that family planning messages through mass media especially radio and televisions are associated with modern contraceptives use among rural adolescents. The continued use of mass media could create opportunities to achieve more results in family planning although the messages should be resident-specific and targeted to various cadres of people with consideration for the level of education to ensure efficiency of the message.

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Unmet Need for Family Planning among Urban and Rural Married Women in Yangon Region, Myanmar—a Cross-Sectional Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16193742 ◽

2019 ◽

Vol 16 (19) ◽

pp. 3742 ◽

Cited By ~ 1

Author(s):

Myint Myint Wai ◽

Espen Bjertness ◽

Hein Stigum ◽

Thein Thein Htay ◽

Tippawan Liabsuetrakul ◽

...

Keyword(s):

Family Planning ◽

Rural Women ◽

Contraceptive Use ◽

Unmet Need ◽

Married Women ◽

Considerable Proportion ◽

Demographic And Health Surveys ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Unintended Pregnancies

Despite increasing contraceptive use and prevalence, many women who want to avoid or delay pregnancy are not using contraceptives. This results in unintended pregnancies, which increases the risk of unsafe abortions. This study aimed to explore the extent of the unmet need for family planning (FP) among urban and rural married women in Myanmar and their demand for and satisfaction with FP. A cross-sectional survey using adapted Demographic and Health surveys questions was conducted in south and north Yangon from September 2016 to November 2016. A total of 1100 currently married women of 18–49 years participated. The contraceptive prevalence was 67.2% in total, 63% urban, and 70% rural. About 19.4% (95% CI: 16.7%–22.4%) of the studied women had an unmet need for FP, significantly higher in urban than rural women (22.6% versus 16.6%). Rural women also showed significant lesser odds (adjusted OR: 0.63; 95% CI: 0.461–0.849) of unmet need than the urban counterparts. About 86% of the women had demand for contraception and 77% of them satisfied their demand. The study population revealed a fairly good contraceptive coverage; however, a considerable proportion of women had an unmet need for FP, especially the urban women. The demand for contraception is increasing, and contraceptive services need to expand coverage to marginalized groups in order to reduce the risk of unsafe abortions.

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Levels and trends in family planning method use among urban adolescents and young women in Guinea: analysis of Demographic and Health Surveys from 1999 to 2018

10.21203/rs.3.rs-50093/v1 ◽

2020 ◽

Author(s):

Sidikiba Sidibe ◽

Alexandre Delamou ◽

Bienvenu Salim Camara ◽

Nafissatou Camara ◽

Hawa Manet ◽

...

Keyword(s):

Family Planning ◽

Ethnic Groups ◽

Young Women ◽

Health Surveys ◽

Urban Adolescents ◽

Contraceptive Use ◽

Unmet Need ◽

Health Concern ◽

Demographic And Health Surveys ◽

Modern Contraceptive

Abstract Background Despite improvements, adolescent fertility remains high in Africa. In Guinea, high fertility among adolescents and young women in urban areas remains a public health concern. This study aims to describe levels and trends in, and factors associated with using modern family planning (FP) methods among urban adolescents and young women in Guinea.Methods We used four Guinea Demographic and Health Surveys (DHS) conducted in 1999, 2005, 2012, and 2018. Among urban adolescents and young women (15–24 years), we examined trends over time in four key indicators: 1. Contraceptive use (% using any using any FP method among all and among those in need for FP), 2. Unmet need for FP (% not using any FP method among all and among those in need for FP) and 3.Modern contraceptive use (% of using modern FP methods and among those in need of FP), and 4. % using modern FP method (demand satisfied). We multivariable logistic regression to examine association between socio-demographic factors and modern FP use (indicator 2) on the most recent DHS dataset (2018).Results We found a statistically significant changes over the time period exmained in modern contracetive use (8.4% in 1999 to 12.8% in 2018, p < 0.01), demand satisfied (29.0% in 1999, 54.1% in 2018, p < 0.001), and halving of unmet need for FP (from 15.8% in 1999 to 8.6% in 2018, p < 0.001). The most important changes in these two indicators occurred between 1999 and 2005.. Compared to those 15–19 years, young women (20–24) more likely to use modern FP methods. Those living in Faranah and Kankan more likely to use modern FP method than those in Conakry. Middle and richer wealth quintile households were more likely to use modern FP compared to poorer. Married women compared to nevever married and those from the Peulh and Malinke ethnic groups compared to Soussou were less likely to use modern FP methods.Conclusion Despite some progress, efforts are still needed to improve FP method use among urban adolescent and you women. Future policies and intervention programs should emphasize on improving adolescents’ reproductive health knowledge and increasing awareness of FP method use. The focus should also be on adolescents aged 15–19 years, disparities of urban administrative regions, ethnic groups, and wealth index, especially the poor quintiles.

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The relationship between spatial access and modern contraceptive use: is proximity to a healthcare facility a determinant of use among women in Kinshasa, DRC?

Gates Open Research ◽

10.12688/gatesopenres.13229.1 ◽

2021 ◽

Vol 5 ◽

pp. 80

Author(s):

Saleh Babazadeh ◽

Julie Hearnandez ◽

Philip Anglewicz ◽

Jane Bertrand

Keyword(s):

Family Planning ◽

Contraceptive Use ◽

Unmet Need ◽

Modern Contraceptive ◽

Family Planning Services ◽

Spatial Access ◽

Modern Contraceptives ◽

Contraceptive Services ◽

Modern Contraceptive Use ◽

Sub Saharan

Background: Spatial access has a direct effect on health service utilization in many settings. Distance to health facility has proven to affect family planning (FP) service use in many Sub-Saharan countries. Studies show that women who reside closer to facilities offering family planning services are more likely to use modern contraceptives. However, researchers often test the theory of distance decay. This study analyzed the significance of proximity to family planning services, service availability, and quality of family planning services on modern contraceptive use in Kinshasa, Democratic Republic of the Congo. Methods: We used a pool of four rounds of facility- and population-based survey data in Kinshasa from PMA2020 between 2014 and 2016. We used GPS coordinates to calculate the distance between the health facilities and households. We tested if women who live closer to service delivery points with higher level of availability and quality are more likely to use modern contraceptives or less likely to have unmet need for contraceptive services. Results: 10,968 women were interviewed over four rounds of data collection. Our findings show that living closer to an SDP is not a determinant of modern contraceptive use or having unmet need for FP services. Lack of cognitive access, economic barriers, bypassing the closest facility, and sociocultural norms are strong barriers for women in Kinshasa to use modern contraceptives. Proximity to quality services did not necessarily result in increased FP use among women of reproductive age living in Kinshasa, thus suggesting that a bypass phenomenon may occur when obtaining modern contraceptive services. Conclusions: This study notes that barriers other than proximity to access may be substantial determinants of contraceptive use or unmet need. More research should be conducted that directly measures multidimensional components of access in order to interpret women’s contraceptive seeking behaviors in urban areas of Sub-Saharan Africa.

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The Relationship Between Spatial Access and Modern Contraceptive Use: Is Proximity to a Healthcare Facility a Determinant of Use Among Women in Kinshasa, DRC?

10.21203/rs.2.17656/v1 ◽

2019 ◽

Author(s):

Saleh Babazadeh ◽

Julie Hernandez ◽

Philip Anglewicz ◽

Jane T Bertrand

Keyword(s):

Family Planning ◽

Contraceptive Use ◽

Unmet Need ◽

Modern Contraceptive ◽

Family Planning Services ◽

Spatial Access ◽

Modern Contraceptives ◽

Contraceptive Services ◽

Modern Contraceptive Use ◽

Sub Saharan

Abstract Background: Spatial access has a direct effect on health service utilization in many settings. While, all elements of access are usually affected by service delivery points and client characteristics. Distance to facility has proven to affect family planning service use in many Sub-Saharan countries. Studies show that women who reside closer to facilities offering family planning services are more likely to use modern contraceptives. However, researchers often test the theory of distance decay to observe any association between an increased distance of health facilities and health service utilization. This study to analyze the significance of proximity to family planning services, as well as service availability and quality of family planning services in Kinshasa. Method: We used a pool of four rounds of facility- and population-based survey data in Kinshasa. We tested if women who live closer to service delivery points with higher level of availability and quality are more likely to use modern contraceptives or less likely to have unmet need for contraceptive services. Results: Our findings show that living closer to an SDP is not a determinant of modern contraceptive use or having unmet need for FP services. Discussion: Lack of cognitive access, economic barriers, bypassing the closest facility, and sociocultural norms are among the strong barriers for women in Kinshasa to use modern contraceptives. Our analysis shows that proximity to quality services does not necessarily result in increased FP use among women of reproductive age living in Kinshasa, thus suggesting that a bypass phenomenon may occur when obtaining modern contraceptive services. Conclusion: This study indicates that proximity to facilities does not necessarily equate proximity to methods, nor does it necessarily enable current users or women with an unmet need (potential contraceptive users) to easily obtain services for their method of choice. This study notes that other barriers to access may be substantial determinants of contraceptive use or unmet need. More research should be conducted that directly measures multidimensional components of access in order to interpret women’s contraceptive seeking behaviors in urban areas of Sub-Saharan Africa.

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Coverage and Determinants of Modern Contraceptive Use in Sub-saharan Africa: Further Analysis of Demographic and Health Surveys

10.21203/rs.3.rs-882664/v1 ◽

2021 ◽

Author(s):

Isaac Boadu

Keyword(s):

Family Planning ◽

Contraceptive Use ◽

Reproductive Age ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Modern Contraceptive ◽

Women Of Reproductive Age ◽

Modern Contraceptives ◽

Modern Contraceptive Use ◽

Sub Saharan

Abstract Background: The use of modern contraceptives (MC) in most African countries has been low despite the high fertility rate and unmet need for family planning. This study sought to determine the coverage and determinants of modern contraceptive use among women of reproductive age in Sub-Saharan Africa (SSA). Methods: Data for the study was obtained from the latest Demographic and Health Surveys (DHS) conducted between 1995-2020 across 37 SSA countries. Women of reproductive age (15-19 years) was the unit of analysis. Analyses of data was done using STATA version 16 for windows. A bivariate Rao Scott’s chi-square test of independence was done to determine factors associated with the use of modern contraceptives. Factors that showed significance (p<0.05) were included in a multilevel logistic regression to determine significant predictors of modern contraceptives. Clustering, stratification and sample weighting were accounted for in the analyses. Results: The overall prevalence of the use of MC was found to be 22.0%. This ranged from 3.5% in the Central Africa Republic to 49.7% in Namibia. The most common type of contraceptives used were injections (39.4%), condoms (17.5%) and implants (26.5%). Women were less likely to use contraceptive if they: had no education (aOR = 0.4, 95% CI: 0.38-0.44), had no children (aOR=0.27-0.42), not told of family planning at a health facility (aOR = 0.69, 95% CI: 0.67-0.71), not heard of family planning in the media (aOR = 0.77, 95% CI: 0.74-0.79) and being poor (aOR=0.76, 95%CI: 0.73-0.79). On the other hand, women were more likely to use modern contraceptive if they were between the age of 35-39 years (aOR=1.69, 95%CI: 0.73-0.79), married (aOR=2.66, 95%CI: 2.50-2.83), had seven or more children (aOR=1.27, 95%CI:1.17-0.38), had knowledge of any method of contraceptives (aOR=303.8, 95%CI: 89.9-1027.5) and when field worker visited and talked about family planning (aOR=1.53, 95%CI: 1.39-0.68).Conclusion: The study showed a low prevalence of modern contraceptive use in Sub-Sahara Africa. Findings from the study highlight the need to provide education to women to increase uptake of contraceptive use and also re-enforce contraceptive interventions to improve women’s health and well-being.

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Unmet need for contraception among eligible women of urban slums in Chennai

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20214270 ◽

2021 ◽

Vol 8 (11) ◽

pp. 5352

Author(s):

Jayashree Kalva ◽

Arathi P. Rao ◽

Prakash Narayanan

Keyword(s):

Family Planning ◽

Post Partum ◽

Unmet Need ◽

Urban Slum ◽

Urban Slums ◽

Modern Contraceptive ◽

Cross Sectional ◽

Slum Dwellers ◽

Living Children ◽

Unmet Need For Contraception

Background: Unmet need for family planning is a crucial indicator to assess demand for family planning programme. It was reported that women from the world’s poorest countries have a high unmet need for contraception. Unmet need is particularly high among immigrants, urban slum dwellers, and women in the post-partum period. The objective of this study was to assess the unmet need and factors influencing the unmet need for contraception among urban slum dwellers in Chennai, South India.Methods: A community-based cross-sectional study of 375 married women was conducted among 50 urban slums of Chennai. Multistage random sampling was employed. About 6-9 women from each slum were interviewed. A semi-structured questionnaire was used to obtain data.Results: The mean age of the participants was 32.1±7.3 years. The total unmet need was 13.8%, which included 9.3% for limiting and 4.5% spacing. The major reasons for contraception non-use among women with unmet need were no preference to use modern contraceptives (30.8%) and preference to get sterilized soon (21.2%). Age, education, religion, and number of living children were the factors associated with unmet need.Conclusions: It was noted that unmet need reduced with age and increased number of living children. Though the unmet need is considerably low compared to other studies it is evident that women are still uncertain to use modern contraceptive methods for spacing and are more likely to undergo sterilization after their desired family size is achieved.

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Factors Associated With the Utilisation and Unmet Need for Modern Contraceptives Among Urban Women in Kenya: A Cross-Sectional Study

Frontiers in Global Women's Health ◽

10.3389/fgwh.2021.669760 ◽

2021 ◽

Vol 2 ◽

Author(s):

Catherine Akoth ◽

James Odhiambo Oguta ◽

O'Brien M. Kyololo ◽

Martin Nyamu ◽

Michael Ndung'u Ndirangu ◽

...

Keyword(s):

Family Planning ◽

Contraceptive Use ◽

Unmet Need ◽

Urban Women ◽

Household Wealth ◽

National Average ◽

Modern Contraceptive ◽

Factors Associated ◽

Modern Contraceptives ◽

Modern Contraceptive Use

Background: Family planning (FP) is a key intervention in improving maternal and child health. Hence, we assessed the factors associated with utilisation and unmet need for modern contraceptives among urban women in Kenya.Methods: The study used pooled data on 10,474 women 15–49 years from the seven rounds of the performance monitoring for accountability surveys collected between 2014 and 2018. The surveys were conducted in 11 of the 47 counties of Kenya using a multistage cluster design. Sample characteristics were described using frequencies and percentages while factors associated with utilisation and unmet need for modern contraceptives were assessed using multivariable logistic regressions.Results: The prevalence of modern contraceptives use and unmet need for FP among urban women in Kenya was 53.7% [95% confidence interval (CI) 52.1–55.3%] and 16.9% (15.8–18.1%), respectively. The use of modern contraceptive was associated with the county of residence, age, marital status, parity, education, household wealth quintile, exposure to media, and survey year. Teenagers, poorest urban women, women with no formal or primary level of education and those who seek services at a dispensary or health centres had higher odds of unmet need for FP while women who resided in Kitui and Nyamira counties had reduced odds of unmet need for FP. The odds of unmet need decreased with the survey year while that of modern contraceptive use had an inverse trend.Conclusion: Overall modern contraceptive use in urban areas is lower than the national average while the unmet need for FP is higher than national average, highlighting a potential urban-rural disparity in FP indicators in Kenya. Individual sociodemographic and socioeconomic and contextual factors are associated with the use of modern contraceptive and unmet need for FP among urban women in Kenya. Urban family planning policies and programmes in Kenya need to focus on strengthening urban healthcare systems to provide equal and accessible FP services, especially targeted towards teenagers and young women and those of low socioeconomic status.

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