Prevalence of child marriage and its impact on fertility outcomes in 34 sub-Saharan African countries

Abstract Background The issue of child marriage is a form of human rights violation among young women mainly in resource-constrained countries. Over the past decades, child marriage has gained attention as a threat to women’s health and autonomy. This study explores the prevalence of child marriage among women aged 20–24 years in sub-Saharan Africa countries and examines the association between child marriage and fertility outcomes. Methods Latest DHS data from 34 sub-Saharan African countries were used in this study. Sixty thousand two hundred and fifteen women aged 20–24 years were included from the surveys conducted 2008–2017. The outcome variables were childbirth within the first year of marriage (early fertility), first preceding birth interval less than 24 months (rapid repeat of childbirth), unintended pregnancy, lifetime pregnancy termination, the use of modern contraceptive methods, lifetime fertility and any childbirth. The main explanatory variable was child marriage (< 18 years) and the associations between child marriage and fertility outcomes were examined from the ever-married subsample to estimate odds ratios (ORs) and 95% CIs using binary logistic regression models. Results In the study population, the overall prevalence of women who experience child marriage was 54.0% while results showed large disparities across sub-Saharan African countries ranging from 16.5 to 81.7%. The prominent countries in child marriage were; Niger (81.7%), Chad (77.9%), Guinea (72.8%), Mali (69.0%) and Nigeria (64.0%). Furthermore, women who experience child marriage were 8.00 times as likely to have ≥3 number of children ever born (lifetime fertility), compared to women married at ≥18 years (OR = 8.00; 95%CI: 7.52, 8.46). Women who experience child marriage were 1.13 times as likely to use modern contraceptive methods, compared to adult marriage women (OR = 1.13; 95%CI: 1.09, 1.19). Those who married before the legal age were 1.27 times as likely to have lifetime terminated pregnancy, compared to women married at ≥18 years (OR = 1.27; 95%CI: 1.20, 1.34). Also women married at < 18 years were more likely to experience childbirth, compared to women married later (OR = 5.83; 95%CI: 5.45, 6.24). However, women married at < 18 years had a reduction in early childbirth and a rapid repeat of childbirth respectively. Conclusion Implementing policies and programmmes against child marriage would help to prevent adverse outcomes among women in sub-Saharan Africa. Also, social change programmes on child-marriage would help to reduce child marriage, encourage the use of modern contraceptive, which would minimize lifetime terminated pregnancy and also children ever born.

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Factors Influencing Contraceptive Use in Sub-Saharan Africa: A Systematic Review

International Quarterly of Community Health Education ◽

10.1177/0272684x16685254 ◽

2017 ◽

Vol 37 (2) ◽

pp. 79-91 ◽

Cited By ~ 46

Author(s):

Sarah R. Blackstone ◽

Ucheoma Nwaozuru ◽

Juliet Iwelunmor

Keyword(s):

Contraceptive Use ◽

Male Partner ◽

Sub Saharan Africa ◽

Modern Contraceptive ◽

African Countries ◽

Factors Influencing ◽

Contraceptive Side Effects ◽

Modern Contraceptive Use ◽

Negative Perceptions ◽

Sub Saharan

The purpose of this study was to systematically review the literature regarding factors influencing contraceptive use in sub-Saharan Africa between 2005 and 2015. A total of 58 studies from twelve Sub-Saharan African countries were reviewed. Keywords were grouped using the PEN-3 cultural model. Negative factors prohibiting or reducing contraceptive use were women’s misconceptions of contraceptive side–effects, male partner disapproval, and social/cultural norms surrounding fertility. Positive factors included education, employment, and communication with male partner. Increasing modern contraceptive use in Sub-Saharan Africa is a multi-faceted problem that will require community and systems wide interventions that aim to counteract negative perceptions and misinformation.

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USING COUPLES’ DISCORDANT REPORTS TO ESTIMATE FEMALE COVERT USE OF MODERN CONTRACEPTION IN SUB-SAHARAN AFRICA

Journal of Biosocial Science ◽

10.1017/s0021932017000256 ◽

2017 ◽

Vol 50 (3) ◽

pp. 326-346 ◽

Cited By ~ 6

Author(s):

Natalie C. Gasca ◽

Stan Becker

Keyword(s):

Contraceptive Use ◽

Modern Method ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Modern Contraceptive ◽

African Countries ◽

Couple Communication ◽

Significant Difference ◽

Contraceptive Prevalence ◽

Sub Saharan

SummarySubstantial numbers of married women use contraceptives without their partner’s knowledge in sub-Saharan Africa, but studies of female covert use across time are rare. This study investigates the levels, trends and correlates of covert use in nine countries and determines which contraceptive methods are more frequently used covertly by women. Data from monogamous couples in Demographic and Health Surveys were used from nine sub-Saharan African countries that had experienced an increase of 10 percentage points in current modern contraceptive use between an earlier (1991–2004) and later (2007–2011) survey. Covert use was indirectly estimated as the percentage of women who reported a female modern method whose husband did not report a modern method. The percentage of women using covertly increased in eight of the countries studied (significantly in three of them), yet when comparing across countries cross-sectionally, covert use was lower where contraceptive prevalence was higher. In general, women with more years of schooling and those with larger spousal schooling gaps had lower odds of covert use. There was no significant difference between covert and open injectable use, though more than half of both groups used this method in the later surveys. Encouraging couple communication about contraception, where the woman feels it is safe to do so, could be an important strategy to minimize covert use. Further research is needed to better identify the contraceptive prevalence and social context in which covert use declines within a country.

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Determinants of Modern Contraceptive Methods (MCM) discontinuation among childbearing age women in Kinshasa, Democratic Republic of Congo.

10.21203/rs.3.rs-215312/v1 ◽

2021 ◽

Author(s):

Nathalie Pemba ◽

Christophe Luhata ◽

Shahul H Ebrahim ◽

Dalau Nkamba Mukadi ◽

Lise Lombeya ◽

...

Keyword(s):

Democratic Republic ◽

Cox Regression ◽

Democratic Republic Of Congo ◽

Sub Saharan Africa ◽

Modern Contraceptive ◽

Contraceptive Methods ◽

Childbearing Age ◽

Republic Of Congo ◽

Contraceptive Discontinuation ◽

Sub Saharan

Abstract Background: Family planning (FP) is one of the main strategies to reduce maternal mortality in sub-Saharan Africa. However, only 8% of women use modern contraceptive methods in the Democratic Republic of Congo. It is estimated that at least 50% of women stop using Modern Contraceptive Methods (MCM) in sub-Saharan Africa. The objective of this study was to identify factors associated with MCM discontinuation in Kinshasa. Methods: A retrospective cohort study was conducted in Kinshasa from April through June 2019. Three hundred and eighty-seven women who attended 10 health facilities in 10 health zones of Kinshasa (one facility per health zone) were enrolled in the study. Predictors of modern contraceptive discontinuation were investigated, using Cox regression. Results: The proportion of MCM discontinuation was 21.4% (95% CI: 17.6-25.8); 60.2% for implants and 24.1% for contraceptive injections. Predictors for dicontinuation were: unemployement (Hz.R = 2.23; 95% CI: 1.35 - 3.70; p = 0.003); having no or only one child (Hz.R = 2.89; 95% CI : 1.43 - 5.85; p = 0.015); using a short-acting method (Hz.R = 4.61; 95% CI: 2.81 - 7.56; p <0.001); lack of sufficient explanations about MCM (Hz.R = 3.14; 95% CI: 1.93-5.11; p <0.001) and side effects (Hz.R = 2.93; 95% CI: 1.79 - 4.80; p = 0.001). Conclusion: MCM discontinuation was high among women in Kinshasa. While it is important to reinforce strategies to increase MCM uptake, it is also critical to increase its continuation.

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Determinants of Modern Contraceptive Utilization Among Married Women in Sub-saharan Africa: Multilevel Analysis Using Recent Demographic and Health Survey

10.21203/rs.3.rs-699121/v1 ◽

2021 ◽

Author(s):

Zemenu Tadesse Tesema ◽

Getayeneh Antehunegn Tesema ◽

Moges Muluneh Boke ◽

Temesgen Yihunie Akalu

Keyword(s):

Health Survey ◽

Married Women ◽

Sub Saharan Africa ◽

Modern Contraceptive ◽

African Countries ◽

Wealth Status ◽

Modern Contraception ◽

Pooled Prevalence ◽

Contraceptive Utilization ◽

Sub Saharan

Abstract Background: Family planning is a low-cost, high-impact public health and development strategy to improve child and maternal health. However, there is a lack of evidence on modern contraceptive use and determinants in sub-Saharan Africa. Hence, this study was aimed at determining the pooled prevalence and determinants of modern contraceptive utilization in Sub-Saharan Africa. Methods: Thirty-six sub-Saharan African countries' demographic and health survey (DHS) data were used for pooled analysis. A total weighted sample of 322,525 married women were included. Cross tabulations and summary statistics were done using STATA version 14 software. The pooled prevalence of modern contraceptive utilization with a 95% Confidence Interval (CI) was reported. Four models were fitted to select the best-fitted model using Likelihood Ratio (LLR) and Deviance test. Finally, the model with the highest LLR and the smallest deviance was selected as a best fitted model. Results: The pooled estimate of modern contraception use in sub–Saharan African countries was 18.36% [95% CI: 18.24, 18.48], with highest in Lesotho (59.79%) and the lowest in Chad (5.04%). The odds of modern contraception utilization among women living in East Africa was (AOR=1.47 (1.40, 1.54)), urban (AOR=1.18 (1.14, 1.24)), women primary and secondary and above educational level (AOR=1.49 (1.44, 1.55)), and (AOR=1.66 (1.58, 1.74)), respectively. Moreover, husband primary (AOR=1.38 (1.33, 1.42)), middle (AOR=1.17, (1.14, 1.21)), rich wealth status (AOR=1.29 (1.25, 1.34)), media exposure (AOR=1.25 (1.22, 1.29)), and postnatal care (PNC) utilization (AOR=1.25 (1.22, 1.29)) had higher odds of modern contraceptive utilization compared with their counter parts. Furthermore, deliver at health facility (AOR=1.74 (1.69, 1.79)) and birth order 2-4 (AOR=1.36 (1.31, 1.41)) had higher odds of modern contraceptive utilization. On the otherhand, women living in Central (AOR=0.23 (0.22, 0.24)), Western regions (AOR=0.46 (0.40, 0.54)), women decided with husband (AOR=0.90 (0.87, 0.93)), and husband alone (AOR=0.73 (0.71, 0.75)) were decreased the odds of modern contraceptive utilization. Conclusion: The uptake of modern contraception in sub-Saharan Africa is low. Modern contraceptive utilization is affected by different factors. More attention need to be given to rural residents, illiterate women, and communities with low wealth status.

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Determinants of Modern Contraceptive Utilization Among Married Women in sub-Saharan Africa; Multilevel Analysis of Recent Demographic and Health Survey

10.21203/rs.3.rs-628571/v1 ◽

2021 ◽

Author(s):

Zemenu Tadesse Tesema ◽

Getayeneh Antehunegn Tesema ◽

Moges Muluneh Boke ◽

Temesgen Yihunie Akalu

Keyword(s):

Married Women ◽

Sub Saharan Africa ◽

Modern Contraceptive ◽

African Countries ◽

Wealth Status ◽

Modern Contraception ◽

Pooled Prevalence ◽

Contraception Use ◽

Contraceptive Utilization ◽

Sub Saharan

Abstract Background Family planning is a low-cost, high-impact public health and development strategy. Planned pregnancies are essential for both the child and mother’s health. However, there is a lack of evidence on modern contraceptive use and determinants in sub-Saharan Africa, hence this study aimed to determine the pooled prevalence and determinants of modern contraceptive utilization across Sub-Saharan Africa. Methods Thirty-six sub-Saharan African countries' demographic and health survey (DHS) data were used for pooled analysis. A total weighted sample of 322,525 married women was included in the study. Cross tabulations and summary statistics were done using STATA version 14 software. The pooled prevalence of modern contraceptive utilization with a 95% Confidence Interval (CI) was reported for sub- Saharan Africa countries. Four models were fitted to select the best-fitted model for the data using Likelihood Ratio (LLR) and Deviance. Model III was selected because of its highest LLR and Smallest deviance. Results The pooled estimate of modern contraception use in sub–Saharan African countries were 18.36% [95% CI: 18.24, 18.48], with highest in Lesotho (59.79%) and the lowest in Chad (5.04%). The odds of modern contraception utilization were increased; women living in East Africa (AOR = 1.47 (1.40, 1.54)), urban (AOR = 1.18 (1.14, 1.24)), women primary and secondary and above educational level (AOR = 1.49 (1.44, 1.55)), and (AOR = 1.66 (1.58, 1.74)) respectively, husband primary and secondary and above educational level (AOR = 1.38 (1.33, 1.42)) and (AOR = 1.38 (1.36, 1.47)), wealth status middle and rich (AOR = 1.17, (1.14, 1.21)) and (AOR = 1.29 (1.25, 1.34)) respectively, media exposure (AOR = 1.25 (1.22, 1.29)), Postnatal care(PNC) utilization (AOR = 1.25 (1.22, 1.29)), deliver at health facility (AOR = 1.74 (1.69, 1.79)), and birth order 2–4 and 5+ (AOR = 1.36 (1.31, 1.41)) and (AOR = 1.35 (1.28, 1.43)) whereas the odds of contraception use were decreased among women living in Central, and Western regions (AOR = 0.23 (0.22, 0.24)), and (AOR = 0.46 (0.40, 0.54)) respectively, women decided with husband and husband alone (AOR = 0.90 (0.87, 0.93)) and (AOR = 0.73 (0.71, 0.75)). Conclusion The uptake of modern contraception in sub-Saharan Africa is low compared to other developing region. Therefore, family planning program activities need to give attention to the rural resident, illiterate women and low wealth status community.

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Beyond counting intended pregnancies among young women to understanding their associated factors in sub-Saharan Africa

International Health ◽

10.1093/inthealth/ihab056 ◽

2021 ◽

Author(s):

Luchuo Engelbert Bain ◽

Bright Opoku Ahinkorah ◽

Abdul-Aziz Seidu ◽

Eugene Budu ◽

Joshua Okyere ◽

...

Keyword(s):

Young Women ◽

Formal Education ◽

Binary Logistic Regression ◽

Wealth Quintile ◽

Cross Sectional Study ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

African Countries ◽

Cross Sectional ◽

Sub Saharan

Abstract Background In this article we report the prevalence and determinants of intended or wanted pregnancies among young women 15–24 y of age in selected sub-Saharan African countries. Methods This cross-sectional study used pooled data from current Demographic and Health Surveys conducted between 1 January 2010 and 31 December 2019 in 29 countries in sub-Saharan Africa (SSA). The sample size comprised 14 257 young women (15–24 y of age). Multivariable binary logistic regression models were used to present the results as adjusted odds ratios. Results The prevalence of intended pregnancies was 67.7%, with the highest and lowest prevalence in Gambia (89.9%) and Namibia (37.7%), respectively. Intended pregnancy was lower among young women who had knowledge of modern contraceptives, those with a secondary/higher education and those with four or more births. Lower odds of intended pregnancy were observed among young women in the richer wealth quintile and those who lived in southern Africa. Conclusions To reduce intended pregnancies in sub-Saharan African countries such as Gambia, Burkina Faso and Nigeria, there is a need for government and non-governmental organisations to recalibrate current and past interventions such as investment in increasing formal education for women and poverty alleviation programmes, as well as augmenting job creation, including skill-building. These interventions have to be sensitive to the cultural realities of each setting, especially with regards to early marriages and womanhood.

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ACCESS TO CONTRACEPTIVE METHODS AND PREVALENCE OF USE

Journal of Biosocial Science ◽

10.1017/s0021932012000715 ◽

2012 ◽

Vol 45 (6) ◽

pp. 761-778 ◽

Cited By ~ 27

Author(s):

JOHN ROSS ◽

KAREN HARDEE

Keyword(s):

Survey Data ◽

Time Trends ◽

Contraceptive Use ◽

Modern Contraceptive ◽

Contraceptive Methods ◽

Multiple Methods ◽

African Countries ◽

Total Prevalence ◽

Cross Tabulation ◽

Sub Saharan

SummarySurvey data on contraceptive use for about 80 countries are related to measures of contraceptive access, by method, from 1999 to 2009. Cross-tabulation and correlational methods are employed, with geographic comparisons and time trends. Total prevalence of use for five modern contraceptive methods correlates well to a variety of access measures. Greater access is also accompanied by a better balance among methods for both access and use. Sub-Saharan African countries show similar patterns though at lower levels. Improved access to multiple methods is consistently associated with higher levels of contraceptive use.

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The unmet needs for modern family planning methods among postpartum women in Sub-Saharan Africa: a systematic review of the literature

Reproductive Health ◽

10.1186/s12978-021-01089-9 ◽

2021 ◽

Vol 18 (1) ◽

Cited By ~ 1

Author(s):

Jumaine Gahungu ◽

Mariam Vahdaninia ◽

Pramod R. Regmi

Keyword(s):

Systematic Review ◽

Family Planning ◽

Unmet Needs ◽

Unmet Need ◽

Reproductive Age ◽

Sub Saharan Africa ◽

Modern Contraceptive ◽

Contraceptive Methods ◽

Factors Affecting ◽

Sub Saharan

Abstract Background Sub-Saharan Africa has the highest fertility rate in the world, with the highest unmet need for family planning (FP). Yet, there is a lack of knowledge about the determinants for non-utilisation of modern contraceptive methods among women of reproductive age. This systematic review of literature assessed factors affecting the unmet need and reasons for non-utilisation of modern contraceptive methods during the postpartum period in Sub-Saharan African women. Methods An online literature search was conducted in several databases: MEDLINE, Cochrane Review, PubMed, Elsevier's Science Direct and Web of Science. The search was completed by hand searching. Data were extracted and summarised using the Arksey and O’Malley methodology. Results In total, 19 studies were included; one qualitative study, seventeen quantitative, and one used a mixed-methods approach. Studies were conducted in Ethiopia (n = 11), Nigeria (n = 3), Kenya (n = 2), Malawi (n = 2) and Uganda (n = 1). Factors affecting the unmet need for modern contraceptive methods were described at three levels: (a) individual; (b) household; and (c) healthcare facility level. Reasons for non-use of FP included: fear of side effects; husband’s disapproval; the absence of menses; abstinence; and low perception of risk of pregnancy. Conclusion Unmet needs in postpartum FP in women from Sub-Saharan Africa were associated with health-system and socio-demographic determinants. We suggest that there is a need to improve the awareness of modern contraceptive methods through effective interventions. Further research is needed for under-studied countries in this continent.

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Prevalence of anemia and its associated factors among married women in 19 sub-Saharan African countries

Archives of Public Health ◽

10.1186/s13690-021-00733-x ◽

2021 ◽

Vol 79 (1) ◽

Author(s):

Betregiorgis Zegeye ◽

Felix Emeka Anyiam ◽

Bright Opoku Ahinkorah ◽

Edward Kwabena Ameyaw ◽

Eugene Budu ◽

...

Keyword(s):

Associated Factors ◽

Wealth Index ◽

Married Women ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Modern Contraceptive ◽

African Countries ◽

Factors Associated ◽

Sub Saharan ◽

Prevalence Of Anemia

Abstract Background Sub-Saharan Africa (SSA) remains the region with the highest burden of anemia globally. Since anemia has both health and non-health-related consequences, its reduction is one of the Sustainable Development Goals. Therefore, this study aimed to examine the prevalence of anemia and its associated factors among married women in SSA. Methods Using Stata version-14 software, the analysis was done on 89,029 married women from the Demographic and Health Surveys of 19 countries in SSA. Pearson Chi-Square test and Binary logistic regression analyses were used to examine the factors associated with anemia. The results were presented using adjusted Odds Ratio (aOR) at a 95% Confidence Interval (CI). A p-value less than or equal to 0.05 (p ≤ 0.05) was considered statistically significant. Results The pooled analysis showed that 49.7% of married women were anemic. Of these, 1.04% and 15.05% were severely and moderately anemic respectively, and the rest 33.61% were mildly anemic. Husband education (primary school-aOR = 0.84, 95% CI; 0.71–0.99), wealth index (middle-aOR = 0.81, 95% CI; 0.68–0.96, richer-aOR = 0.69, 95% CI; 0.57–0.84, richest-aOR = 0.68, 95% CI; 0.51–0.91), modern contraceptive use (yes-aOR = 0.68, 95% CI; 0.56–0.81) and religion (Muslim-aOR = 1.27, 95% CI; 1.11–1.46, others-aOR = 0.73, 95% CI; 0.59–0.90) were factors associated with anemia among married women. Conclusion The findings show that nearly half of the married women are affected by anemia. Enhancing partners’ educational levels, and economic empowerment of women, strengthening family planning services, and working with religious leaders to reduce the perception and religious beliefs related to food restrictions can be the main focus to reduce the burden of anemia among married women in SSA.

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Individual- and country-level correlates of female permanent contraception use in sub-Saharan Africa

PLoS ONE ◽

10.1371/journal.pone.0243316 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243316

Author(s):

Babayemi O. Olakunde ◽

Jennifer R. Pharr ◽

Lung-Chang Chien ◽

Rebecca D. Benfield ◽

Francisco S. Sy

Keyword(s):

Household Wealth ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Modern Contraceptive ◽

Contraceptive Methods ◽

Factors Associated ◽

Country Level ◽

Permanent Contraception ◽

Sub Saharan ◽

Living Children

Background Female permanent contraception is a cost-effective contraceptive method that can help clients with the desire to limit childbearing achieve their reproductive intention. However, despite its benefits, the use of FPC remains low in sub-Saharan Africa (SSA), and limited studies have examined the correlates of its uptake. In this study, we assessed the individual- and country-level factors associated with the use of FPC among married or in-union women using modern contraceptive methods to limit childbearing in SSA. Methods This study was a secondary data analysis of individual- and country-level data obtained from the Demographic and Health Surveys (DHS) Program and three open data repositories. The study included 29,777 married or in-union women aged 15–49 years using modern contraceptive methods to limit childbearing from DHS conducted in 33 sub-Sahara African countries between 2010 and 2018. We performed descriptive statistics and fitted multilevel logistic regression models to determine the predisposing, enabling, and need factors associated with the use of FPC. Results Approximately 13% of the women used FPC. About 20% of the variance in the odds of using FPC was attributable to between-country differences. In the full model, the significant individual-level factors associated with the use of FPC compared with other modern contraceptive methods were: age (odds ratio [OR] = 1.10; 95%CI = 1.08–1.12), living children (OR = 1.11, 95%CI = 1.04–1.16), high household wealth (OR = 1.39, 95%CI = 1.18–1.64), rural residence (OR = 0.83, 95% CI = 0.71–0.97), joint contraceptive decision with partner (OR = 1.68, 95% = 1.43–1.99), contraceptive decision by partner and others (OR = 2.46, 95% = 1.97–3.07), and the number of living children less than the ideal number of children (OR = 1.40, 95%CI = 1.21–1.62). The significantly associated country-level factors were births attended by skilled health providers (OR = 1.03, 95%CI = 1.00–1.05) and density of medical doctors (OR = 1.37, 95%CI = 1.01–1.85). Conclusions Our results suggest that both individual- and country-level factors affect uptake of FPC in SSA. Increasing geographic, economic, and psychosocial access to FPC may improve its uptake in SSA.

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