Contraceptive use and needs among adolescent women aged 15–19: Regional and global estimates and projections from 1990 to 2030 from a Bayesian hierarchical modelling study

Expanding access to contraception and ensuring that need for family planning is satisfied are essential for achieving universal access to reproductive healthcare services, as called for in the 2030 Agenda for Sustainable Development. To quantify the gaps that remain in meeting needs among adolescents, this study provides a harmonised data set and global estimates and projections of family planning indicators for adolescents aged 15–19 years. We compiled a comprehensive dataset of family-planning indicators among women aged 15–19 from 754 nationally representative surveys. We used a Bayesian hierarchical model with country-specific annual trends to estimate contraceptive prevalence and unmet need for family planning, with 95% uncertainty intervals (UIs), for 185 countries, taking into account changes in proportions married or in a union and differences in sexual activity among unmarried women across countries. Among 300 million women aged 15–19 years in 2019, 29.8 million (95% UI 24.6–41.7) use any contraception, and 15.0 million (95% UI 12.1–29.2) have unmet need for family planning. Population growth and the postponement of marriage influence trends in the absolute number of adolescents using contraception or experiencing unmet need. Large gaps remain in meeting family-planning needs among adolescents. The proportion of the need satisfied by modern methods, Sustainable Development Goals (SDG) indicator 3.7.1, was 59.2% (95% UI 44.8–67.2) globally among adolescents, lower compared to 75.7% (95% UI 73.2%–78.0%) among all women age 15–49 years. It was less than one half of adolescents in need in Western Asia and Northern Africa (38.7%, 95%UI = 20.9–56.5), Central and Southern Asia (43.5%, 95%UI = 36.6–52.3), and sub-Saharan Africa (45.6%, 95%UI = 42.2–49.0). The main limitations of the study are: (i) the uncertainty surrounding estimates for countries with limited or biased data is large; and (ii) underreporting of contraceptive use and needs is likely, especially among unmarried adolescents.

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Currently married women with an unmet need for contraception in Eritrea: Profile and determinants

Canadian Studies in Population ◽

10.25336/p6gs4s ◽

2011 ◽

Vol 38 (1-2) ◽

pp. 61 ◽

Cited By ~ 11

Author(s):

Gebremariam Woldemicael ◽

Roderic Beaujot

Keyword(s):

Family Planning ◽

Contraceptive Use ◽

Economic Status ◽

Unmet Need ◽

Married Women ◽

Sub Saharan Africa ◽

The Status ◽

Sub Saharan ◽

Using Data ◽

Unmet Need For Contraception

Eritrea’s contraceptive prevalence rate is one of the lowest in sub-Saharan Africa and its fertility has only started to decline. Using data from the 2002 Eritrea Demographic and Health Survey (EDHS), this study examines the determinants of unmet need for family planning that is the discrepancy between fertility goals and actual contraceptive use. More than one-quarter of currently married women are estimated to have an unmet need, and this has remained unchanged since 1995. The most important reason for unmet need is lack of knowledge of methods or of a source of supply. Currently married women with higher parity, and low autonomy, low or medium household economic status, and who know no method of contraception or source of supply are identified as the most likely to have an unmet need. Addressing the unmet need for family planning entails not merely greater knowledge of or access to contraceptive services, but also the enhancement of the status of women.

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Estimating the levels and trends of family planning indicators in 436 sub-national areas across 26 countries in sub-Saharan Africa

10.1101/2021.03.03.21252829 ◽

2021 ◽

Author(s):

Joshua L Proctor ◽

Laina D. Mercer

Keyword(s):

Family Planning ◽

Universal Access ◽

Unmet Need ◽

Sub Saharan Africa ◽

Modern Contraceptive ◽

Model Based ◽

Administrative Unit ◽

Sub Saharan ◽

Demographic Subgroup ◽

Demographic Subgroups

Background: Scaling up access to safe, effective, and voluntary family planning (FP) services to achieve universal access for women and families will require increased commitment by countries and international organizations. On the way toward universal access, quantitative family planning goals have also been established by the United Nations through the sustainable development goals (SDGs). Here, we present a model-based framework that can help monitor progress toward these goals at the sub-national and demographic subgroup scale. Methods: We utilize 90 demographic health surveys for 26 countries that contain associated geographic position system data. We extract survey cluster level data to fit multiple small area estimation models that estimate FP indicators by administrative unit one and two regions as well as different demographic subgroups. Findings: We find significant variation of modern contraceptive prevalence rates (mCPR), unmet need, and demand satisfied by country, sub-national region, and demographic subgroup. Our model-based estimates show that on average for 436 administrative unit one regions, mCPR has increased at a rate of 0.75% per year and unmet need has decreased by 0.26% per year. There are also striking differences of FP indicators by demographic subgroup; for example, unmet need can be up to 40% different based on age and parity. Interpretation: We have developed a framework to help monitor progress, provide insights about the inequitable progress by region and demographic groups, and account for the sparsity of available data. These results and framework can help policy-makers better allocate and target interventions to help achieve family planning goals.

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Improving Utilisation and awareness of Family Planning services in Adults of Reproductive age through Community Sensitization in Police Wing Village, Jinja District.

10.51168/sjhrafrica.v2i6.43 ◽

2021 ◽

Author(s):

◽

Rodgers Isiko

Keyword(s):

Family Planning ◽

Contraceptive Use ◽

Unmet Need ◽

Reproductive Age ◽

Sub Saharan Africa ◽

Project Implementation ◽

Number Of Children ◽

Planning Methods ◽

Sub Saharan ◽

Family Planning Methods

Background Family planning refers to a conscious effort by a couple to space the number of children they have through the use of contraceptive methods. According to WHO, an estimated 225 million women in developing countries, 24.2% of women of reproductive age have an unmet need for contraception. However, contraceptive use in sub-Saharan Africa is low at only 21%. The total fertility rate remains high for many countries in the region (4.6 in Kenya and Rwanda, 5.4 in Tanzania, 6.2 in Uganda, and 6.4 for Burundi). Methodology This was a community-based project implementation on increasing awareness and utilization of family planning methods in Police Wing village, Jinja district. Consent was gotten from the VHT, LC1, and DHO before mobilizing people to gather at the VHT’s home and her neighbour’s compound where we carried out the different educational sessions. Different team members got different roles to play as regards the health education session. One week later, we evaluated the progress of our project implementation through the administration of questionnaires to the same people we health educated. The questionnaire assessed the level of utilization, awareness, myths, misconception, and demography of the participants. Results 28% had heard about at least three family planning methods and 24.1% had at one time used family planning while 75.9% of the participants admitted not to have used it. The post-session assessment showed an increase from 28% to 93% in knowledge regarding the available methods of FP and an increase in the utilization of FP from 28% to 42%. Conclusion and recommendations Addressing the myths and misconceptions about FP by exposing them as a fallacy would help increase the uptake as evidenced by the will of the community to take up the different methods. Organize frequent health talks about FP in the community.

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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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Factors Affecting Unmet Need of Family Planning Among Married Tharu Women of Dang District, Nepal

International Journal of Reproductive Medicine ◽

10.1155/2018/9312687 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Chet Kant Bhusal ◽

Sigma Bhattarai

Keyword(s):

Family Planning ◽

Reproductive Health ◽

Strategic Behavior ◽

Universal Access ◽

Unmet Need ◽

Decisive Role ◽

Secondary Level ◽

Cross Sectional ◽

Factors Affecting ◽

Communication Program

Background. Increase in population plays a decisive role in providing universal access to reproductive health; however, there is very limited evidence about the reason of unmet need among marginalized and tribal communities such as Tharus. This study aimed to determine the factors affecting unmet need of family planning among married Tharu women of Dang, Nepal. Methods. Community-based cross-sectional household survey among 650 married Tharu women of age group 15-49 in October 2015 to April 2016 was conducted in Dang district, Nepal. Randomly 3 wards were selected from each Tulsipur municipality, Hekuli Village Development Committee, and Pawan Nagar VDC. Results. The mean age and parity were 30±7.31 and 2±0.69, respectively. Out of 650 women, 47% were using contraceptives. Westoff model was used for calculating total unmet need which is 49%, where unmet need for limiting and spacing was 27% and 22%, respectively. Hence after combining the current users and total unmet need, total demand for family planning was 96%. After adjustment, significant relation was observed between number of living sons ≥ 1 and unmet need of family planning (OR= 0.4; CI=0.2-0.8, p=0.01 ), similarly for women education; lower secondary level (OR=0.3; CI=0.1-0.6, p=0.01) and secondary (OR=0.1; CI=0.03-0.4, p=0.01); husband education, lower secondary level (OR=0.3; CI=0.1-0.6, p=0.01) and secondary (OR=0.4; CI= 0.2-0.9, p=0.04); and husband occupation, wage labor (OR=0.6; CI=0.4-0.99, p=0.05). In addition, having very good knowledge about method was also significantly associated (OR=0.49; CI= 0.2-0.97, p= 0.04). Conclusion. Unmet need of family planning was significantly higher among less than secondary educated women. It is also predisposed by spouse education, partner’s occupation, and number of living sons. This study concerns the need for all stake holders to focus on strategic behavior communication program regarding reproductive health.

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DESIRE FOR MORE CHILDREN, CONTRACEPTIVE USE AND UNMET NEED FOR FAMILY PLANNING IN A REMOTE AREA OF BALI, INDONESIA

Journal of Biosocial Science ◽

10.1017/s0021932010000052 ◽

2010 ◽

Vol 42 (4) ◽

pp. 549-562 ◽

Cited By ~ 14

Author(s):

MELLISSA WITHERS ◽

MEGUMI KANO ◽

GDE NGURAH INDRAGUNA PINATIH

Keyword(s):

Family Planning ◽

Health Services ◽

Contraceptive Use ◽

Unmet Need ◽

Multivariate Logistic Regression Analysis ◽

Reproductive Age ◽

Access To Health Services ◽

The Past ◽

Access To Health ◽

Living Children

SummaryExploring fertility preferences in relation to contraceptive use can increase the understanding of future reproductive behaviour and unmet family planning needs. This knowledge can help assist women in meeting their reproductive goals. The influences on the desire for more children and current contraceptive use were examined among 1528 married women of reproductive age in an isolated community in Bali, Indonesia, using multivariate logistic regression analysis. Women who were younger, had fewer living children, had given birth in the past year and had regular access to health services were more likely to desire children. Being older, having fewer living children, not having regular access to health services, having given birth in the past year and having the desire for more children were associated with a lower likelihood of using contraception. Women with regular access to health care are more likely to desire more children, probably because they are confident in their ability to have successful birth outcomes. However, specialized clinics or family planning outreach workers may be required to reduce barriers to service utilization among some groups. The findings of this study identify key target populations for family planning, including older women and postpartum women – groups that may not perceive themselves to be at risk for unintended pregnancy. Meeting unmet need for family planning among these groups could help women meet their fertility goals, as well as reduce maternal morbidity and mortality.

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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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Post-abortion fertility desires, contraceptive uptake and unmet need for family planning: voices of post-abortion care clients in Tanzania

Journal of Biosocial Science ◽

10.1017/s0021932020000607 ◽

2020 ◽

pp. 1-16

Author(s):

Colin Baynes ◽

Erick Yegon ◽

Grace Lusiola ◽

Japhet Achola ◽

Rehema Kahando

Keyword(s):

Family Planning ◽

Contraceptive Use ◽

Unmet Need ◽

Pregnancy Intentions ◽

Middle Income ◽

Fertility Desires ◽

Abortion Care ◽

Post Abortion Care ◽

Post Abortion ◽

Contraceptive Uptake

Abstract Post-abortion care (PAC) integrates elements of care that are vital for women’s survival after abortion complications with intervention components that aid women in controlling their fertility, and provides an optimal window of opportunity to help women meet their family planning goals. Yet, incorporating quality family planning services remains a shortcoming of PAC services, particularly in low- and middle-income countries. This paper presents evidence from a mixed method study conducted in Tanzania that aimed at explaining factors that contribute to this challenge. Analysis of data obtained through client exit interviews quantified the level of unmet need for contraception among PAC clients and isolated the factors associated with post-abortion contraceptive uptake. Qualitative data analysis of interviews with a subset of these women explored the multi-level context in which post-abortion pregnancy intentions and contraceptive behaviours are formed. Approximately 30% of women interviewed (N=412) could recall receiving counselling on post-abortion family planning. Nearly two-thirds reported a desire to either space or limit childbearing. Of those who desired to space or limited childbearing, approximately 20% received a contraceptive method before discharge from PAC. The factors significantly associated with post-abortion contraceptive acceptance were completion of primary school, prior use of contraception, receipt of PAC at lower level facilities and recall of post-abortion family planning counselling. Qualitative analysis revealed different layers of contextual influences that shaped women’s fertility desires and contraceptive decision-making during PAC: individual (PAC client), spousal/partner-related, health service-related and societal. While results lend support to the concept that there are opportunities for services to address unmet need for post-abortion family planning, they also attest to the synergistic influences of individual, spousal, organizational and societal factors that influence whether they can be realized during PAC. Several strategies to do so emerged saliently from this analysis. These emphasize customized counselling to enable client–provider communication about fertility preferences, structural intervention aimed at empowering women to assert those objectives in family and health care settings, availability of information and services on post-abortion fertility and contraceptive eligibility in PAC settings and interventions to facilitate constructive spousal communication on family planning and contraceptive use, after abortion and in general.

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Women’s Membership in Health Insurance and Correlation with Contraception Use in Indonesia

Global Journal of Health Science ◽

10.5539/gjhs.v9n2p85 ◽

2016 ◽

Vol 9 (2) ◽

pp. 85

Author(s):

Misnaniarti Misnaniarti

Keyword(s):

Health Insurance ◽

Family Planning ◽

Contraceptive Use ◽

Multinomial Logistic Regression ◽

Family Planning Services ◽

Chi Square ◽

Data Set ◽

Number Of Children ◽

Contraception Use

BACKGROUND & PURPOSE: One important effort in reducing the Maternal Mortality Rate is integration of Family Planning services into Health Insurance policy. This is giving affordability in health service financing through providing contraceptive accordance with established policy. The purpose of this study is to examine women’s participation in health insurance and correlations to contraception use.MATERIAL & METHODS: The study used the 2012 Indonesian Demographic and Health Survey data-set. Samples were women aged 15 to 49 years, of married status or living together (n=33,465). The dependent variable was contraception used for three categories: Using Long Term Contraceptive, using non-Long Term Contraceptive, and not using any kind of contraception. Data analysis used Chi-square and multinomial logistic regression with complex sample.RESULTS: 10.6% of women were found to have used a Long Term Contraception method. Health insurance membership has correlations to contraceptive use (OR=1.241 and 0.964, p<0.05, CI 95%), with confounder variables of age (p<0.05, OR=1.428 and 0.648), education (p<0.05, OR=1.402 and 1.064), work status (p<0.05, OR=1.151 and 0.966), parity (p<0.05, OR=3.114 and 1.685), perception of ideal number of children (p<0.05, OR=2.057 and 1.682), husband’s education (p<0.05, OR=0.166 and 0.920), husband's work (p<0.05, OR=1.247 and 2.469), and role of media (p<0.05, OR=1.255 and 1.084).CONCLUSION & RECOMMENDATIONS: This study was empirical evidence in Indonesia that health insurance factors have a significant correlation to Long Term Contraceptive use in women. It is recommended for government to maintain and improve policies that integrate Family Planning services into National Health Insurance.

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WOMEN’S EMPOWERMENT, HOUSEHOLD STATUS AND CONTRACEPTION USE IN GHANA

Journal of Biosocial Science ◽

10.1017/s0021932016000377 ◽

2016 ◽

Vol 49 (4) ◽

pp. 423-434 ◽

Cited By ~ 14

Author(s):

Sarah R. Blackstone

Keyword(s):

Decision Making ◽

Contraceptive Use ◽

Household Head ◽

Unmet Need ◽

Women's Empowerment ◽

Sub Saharan Africa ◽

Wife Beating ◽

Women’S Empowerment ◽

Contraception Use ◽

Unmet Need For Contraception

SummaryGender inequality is often cited as a barrier to improving women’s sexual and reproductive health outcomes, including contraceptive use, in low- and middle-income countries such as those in sub-Saharan Africa. To date there is limited, recent, evidence available regarding women’s empowerment, household status and contraceptive use in Ghana. The objective of this study was to investigate whether women’s empowerment and status in the household were associated with contraceptive use and unmet need for contraception using the 2014 Ghana Demographic and Health Survey. The study sample consisted of 1828 women aged 15–49. Women’s empowerment was measured based on two composite indexes created by the DHS: attitudes towards intimate partner violence and decision-making. Women’s status in the home was measured using indicators of work status, relationship to household head, control over monetary earnings and land ownership. Decision-making was found to be positively associated with contraceptive use and not having unmet need for contraception. Women who justified wife beating in one or more instances were less likely to use contraception, and more likely to have unmet need for contraception. Current or past employment and higher levels of male partner education were associated with contraceptive use. This study indicates that women’s empowerment and household status are influential for contraceptive indicators. Future interventions aimed at improving contraceptive uptake and use should promote women’s empowerment, i.e. decision-making, self-worth and education.

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