Multilevel analysis of factors associated with unmet need for family planning among Malawian women

Abstract

Background Malawi has a high fertility rate which is also characterized by a relatively high prevalence of unmet need for contraception. However, little is known about the influence of individual- and community- level characteristics on unmet need in Malawi. This study examined the individual- and community- level factors associated with unmet need for family planning (FP) among Malawian women. Methods Data from the 2015–16 Malawi demographic and health survey were used to analyze 15, 931 women. The association between individual- and community- level factors and unmet need was assessed using multilevel binary logistic regression models. Results The prevalence of total unmet need was 21.0%. Women aged ≥35 years were more likely to have total unmet need [adjusted odds ratio (aOR) = 1.19, 95% confidence interval (CI) = 1.04–1.35] compared with those aged 15–24 years. Women who were married [aOR = 0.41, 95% CI = 0.35–0.48], and those employed [aOR = 0.78, 95% CI = 0.71–0.85] were associated with less likelihood of having total unmet need compared with unmarried, and unemployed women, respectively. At community-level, women from communities with a high percentage of women from rich households [aOR = 0.81, 95% CI = 0.67–0.96], and those from communities with a middle and high percentage of educated women [aOR = 0.86, 95% CI = 0.76–0.96 and aOR = 0.81, 95% CI = 0.70–0.93, respectively] were less likely to have total unmet need for FP compared with those from communities with low percentages of rich and educated women, respectively. The proportional change in variance showed that about 36.0% of total variations in the odds of unmet need across the communities were explained by both individual- and community-level factors. Moreover, the intraclass correlation showed that about 3.0% of the total variation remained unexplained even after controlling for both individual- and community-level factors. Conclusion Both individual- and community- level factors influenced unmet need for FP in Malawi. Public health practitioners should conduct community profiling and consider individual and community factors when designing FP programs.

Magnitude and associated factors of unmet need for family planning among rural women in Ethiopia: a multilevel cross-sectional analysis

“…54 In this regard, a systematic metaanalysis conducted in Ethiopia revealed that the odds of unmet need for FP were 2.3 times higher among women with age at first marriage <18 years than women marriage at 18 years and above. 60 Similar to a study conducted in Malawi, 10 this study found that unmet need for FP was greater among women who cited the distance to a health facility as a problem. This finding suggests improving geographical access to health facilities decreases unmet need for FP.…”

“…This is consistent with a study conducted in Malawi. 10 The result of our study further reveals that women who live in communities with high media exposure had decreased odds of unmet need for FP compared with women in low-media exposure communities. This Open access might be due to educated women having higher odds of understanding health messages and experiencing demand for FP services.…”

“…11 In this regard, the previous study implies that married women had 59% lower odds of unmet need for FP compared with never married women. 10 Therefore, having large proportions of women who are married in our study may reduce the odds of unmet need for FP. However, the magnitude of unmet need for FP in this study was higher than studies conducted in Ethiopia, 14 18 Burkina Faso, 9 Malawi, 10 Cameroon 36 and Nigeria.…”

“…This finding is supported by the study conducted in Malawi. 10 The possible explanation for this association might be because women who were working can have a good income so they may be able to afford private health facilities compared with their counterparts. 52 Moreover, women who were working would have a great deal of trust and decisionmaking ability on health services including FP.…”

“…[6][7][8] In developing countries, 225 million women had unmet need for modern FP methods in 2014, and 230 million women experienced unmet need for modern FP methods in 2019. 6 7 The prevalence of unmet need for FP among reproductive age group women was 18.3% (15.1% for spacing and 3.2% for limiting) in Burkina Faso, 9 21.0% (12.6% for spacing and 8.4% for limiting) in Malawi, 10 46.6% (31.1% for spacing and 15.5% for limiting) in Cameroon 11 and 38. 9% (27.5% for spacing and 12.2% for limiting) in Ghana.…”