Individual and community level socioeconomic inequalities in contraceptive use in 10 Newly Independent States: a multilevel cross-sectional analysis

Abstract

IntroductionLittle is known regarding the association between socioeconomic factors and contraceptive use in the Newly Independent States (NIS), countries that have experienced profound changes in reproductive health services during the transition from socialism to a market economy.MethodsUsing 2005–2006 data from Demographic Health Surveys (Armenia, Azerbaijan, and Moldova) and Multiple Indicator Cluster Surveys (Belarus, Georgia, Kazakhstan, Kyrgyzstan, Tajikistan, Ukraine, and Uzbekistan), we examined associations between individual and community socioeconomic status with current modern contraceptive use (MCU) among N = 55,204 women aged 15–49 married or in a union. Individual socioeconomic status was measured using quintiles of wealth index and education level (higher than secondary school, secondary school or less). Community socioeconomic status was measured as the percentage of households in the poorest quintile of the nationals household wealth index (0%, 0–25%, or greater than 25%). We used multilevel logistic regression to estimate associations adjusted for age, number of children, urban/rural, and socioeconomic variables.ResultsMCU varied by country from 14% (in Azerbaijan) to 62% (in Belarus). Overall, women living in the poorest communities were less likely than those in the richest to use modern contraceptives (adjusted odds ratio (aOR) = 0.82, 95% Confidence Interval = 0.76, 0.89). Similarly, there was an increasing odds of MCU with increasing individual-level wealth. Women with a lower level of education also had lower odds of MCU than those with a higher level of education (aOR = .75, 95%CI = 0.71, 0.79). In country-specific analyses, community-level socioeconomic inequalities were apparent in 4 of 10 countries; in contrast, inequalities by individual-level wealth were apparent in 7 countries and by education in 8 countries. All countries in which community-level socioeconomic status was associated with MCU were in Central Asia, whereas at the individual-level inequalities of the largest magnitude were found in the Caucasus. There were no distinct patterns found in Eastern European countries.ConclusionsCommunity-level socioeconomic inequalities in MCU were most pronounced in Central Asian countries, whereas individual-level socioeconomic inequalities in MCU were most pronounced in the Caucasus. It is important to consider multilevel contextual determinants of modern contraceptive use in the development of reproductive health and family planning programs.

How the Community Shapes Unmet Need for Modern Contraception: An Analysis of 44 Demographic and Health Surveys

“…In the combined sample, there may be a correlation between a community's wealth and access, supporting the findings of previous studies (Elfstrom and Stephenson ; Janevic et al. ). In urban areas, where fertility preferences are lower and health care infrastructure is presumably more robust, this relationship may hold.…”

“…The presence of a significant association in urban communities and a lack of a significant association in rural communities may point to issues of availability and health care infrastructure in concert with the traditionally inverse relationship between fertility norms and urbanization (Kulu 2013). In the combined sample, there may be a correlation between a community's wealth and access, supporting the findings of previous studies Janevic et al 2012). In urban areas, where fertility preferences are lower and health care infrastructure is presumably more robust, this relationship may hold.…”

A Multilevel Logit Estimation of Factors Associated With Modern Contraception in Urban Nigeria

“…For example, Dereuddre et al (2016) found that country-level gender equality was positively associated with modern contraceptive use among European women. Also, Janevic et al (2012) found that among women living in 10 European and Asian countries, women who live in poor communities were less likely to report modern contraceptive use compared to those who live in wealthier communities. Stephenson et al (2007) found that among women in six sub-Saharan African countries, there were significant associations between modern contraceptive use and community factors such as level of female education, average household wealth, dominant religion, approval of family planning, and level of annual rainfall in the community.…”

“…In the last decade, however, there has been a surge in studies assessing contextual effects on health behaviors. Researchers have found that the characteristics of a community influence the practice of health behaviors including modern contraceptive use (Dereuddre, Van de Velde, & Brackle, 2016;Janevic, Pallas, Ismayilova, & Bradley, 2012;Kaggwa, Diop, & Storey, 2008;Stephenson, Baschieri, Clements, Hennink, & Madise, 2007). For example, Dereuddre et al (2016) found that country-level gender equality was positively associated with modern contraceptive use among European women.…”

Socioeconomic and religious differentials in contraceptive uptake in western Ethiopia: a mixed-methods phenomenological study

“…Studies conducted in some countries reported that socioeconomic status [3–7] and religion [8–12] influence contraceptive use rate of mothers in reproductive age, while this has been explored less in Ethiopia. In some religions, children are looked as a blessing and a gift from Almighty (God/Allah) and it is sinful to prevent pregnancies.…”