Determinants of modern contraceptive utilization among married women in sub-Saharan Africa: multilevel analysis using recent demographic and health survey

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 aimed at determining the pooled prevalence and determinants of modern contraceptive utilization among married women of 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. 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. Multilevel regression analysis was used to identify the determinants of modern contraceptive use among married women. Four models were fitted to select the best-fitted model using the Likelihood Ratio (LLR) and Deviance test. Finally, the model with the highest LLR and the smallest deviance was selected as the 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 were high among women living in East Africa [AOR = 1.47 (1.40, 1.54)], urban areas [AOR = 1.18 (1.14, 1.24)], and women with primary [AOR = 1.49 (1.44, 1.55)] and secondary and above educational level [AOR = 1.66 (1.58, 1.74)]. Moreover, husbands with primary educational level [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 other hand, women living in Central [AOR = 0.23 (0.22, 0.24)], Western regions [AOR = 0.46 (0.40, 0.54)], women who decided with husband [AOR = 0.90 (0.87, 0.93)], and decisions by husband alone [AOR = 0.73 (0.71, 0.75)] 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 needs to be given to rural residents, illiterate women, and communities with low wealth status.

A multivariate decomposition analysis of modern contraceptive utilization among married women in the emerging region of Ethiopia (2000–2019)

“…The decrease in the proportion of women who were not educated and in primary school showed a significant contribution to increasing modern contraceptive utilization. This finding is in line with studies conducted in Ethiopia 23 , Ghana 18 , Liberia 20 , Senegal 21 , East Africa 16 , Sub-Saharan Africa 22 , and Africa 25 . Ensuring inclusive and equitable education is one of the key sustainable development goals and is emphasized by global, regional, and local organizations 33 .…”

“…The use of modern contraceptives is related to many factors. This includes; age 15 , 16 , marital status 16 – 18 , religion 16 , 19 , 20 , residence 21 , 22 , educational status 16 , 20 – 25 , wealth index 16 , 21 , 22 , 25 , media exposure 22 , discussion on family planning with a partner 18 , 19 , 26 – 28 , knowledge on modern contraceptive methods 15 , 23 , 29 , ever use of a modern contraceptive method 17 , 19 , number of alive children 20 – 22 , and the desired number of children 15 , 21 , 23 .…”

Determinants of contraceptive continuation among women in sub-Saharan Africa

“…Contraceptive usage has been a public health intervention for couples to have children by choice [ 4 ]. Potentially, it can reduce poverty and hunger in countries with high fertility [ 2 ].…”

The determinants of postpartum contraceptive use in Nigeria

“…In Nigeria, family planning and contraceptive use remain markedly low (estimated at 17%) compared to other sub-Saharan countries. For instance, Lesotho (59%), Namibia (56%) and other counties in the region have reported significant higher contraceptive prevalent rates ( 4 , 5 ). These findings highlight the substantial disparity in contraceptive use between Nigeria and these neighboring countries, indicating the need for improved access to and awareness of contraceptives in Nigeria to enhance family planning and reproductive health.…”