Spatial variation in the non-use of modern contraception and its predictors in Bangladesh

Abstract

This study aimed to investigate spatial variations in the non-use of modern contraception in Bangladesh and identify associated individual, household, and community-level factors. The analysis utilized data from 16,135 women, extracted from the 2017/18 Bangladesh Demographic and Health Survey. The study's main outcome was the prevalence of non-use of modern contraception (yes or no), while the explanatory variables included factors at the individual, household, and community level. To assess geographical heterogeneity in non-use of modern contraception, Moran's I statistics were applied. Additionally, the Gettis-Ord Gi* was calculated to measure spatial autocorrelation differences across various study locations. The relationship between non-use of modern contraception and location was further explored using a geographically weighted regression model at the cluster level. The results indicated that 42.8% (95% CI 41.6–43.8) of respondents reported non-use of modern contraception in Bangladesh, with significant variation across geographical locations (p < 0.001). Hot spots of high non-use were predominantly identified in the Sylhet, Barishal, and some areas of the Chattogram divisions, while cold spots of low use were concentrated in the Rangpur, Mymensingh, and some areas Rajshahi divisions. Notably, the likelihood of non-use was highest among women and partners with low levels of education. The analysis of other risk factors, such as partner occupation, community-level illiteracy, and poverty, revealed varying effects on non-use of modern contraception across different locations (clusters) within the country. The study's findings underscore the importance of targeted, area-specific policies and programs aimed at promoting knowledge and uptake of modern contraception in Bangladesh.

Association between women's empowerment and modern contraception uptake in Bangladesh: Evidence from Bangladesh Demographic and Health survey

“…The possible explanation for these counterintuitive ndings could involve cultural or relational factors, where a lack of shared decision-making may be associated with lower communication or support regarding reproductive health choices. These factors could also account for the regional and urban-rural differences observed in this study, which align with ndings from previous studies in Bangladesh [3,20,29]. It may also re ect a need for increased spousal involvement and support in family planning decisions [33].…”

“…Empowered women often demonstrate increased decisionmaking autonomy [25], access to information and education, economic independence [26], proactive healthcare-seeking behavior [27], and effective negotiation skills within relationships [28]. This study also identi ed a signi cant association of these factors with the uptake of modern contraception, aligning with previous studies conducted in Bangladesh and other LMICs [3,20,29]. These factors collectively contribute to women's capacity to make informed choices about their reproductive health, including access to modern contraceptive methods [30][31][32].…”

“…In terms of the individual decision-making components of women's empowerment, those who reported joint decision-making with their husbands on areas such as access to healthcare, large household purchases, and visits to family or relatives consistently exhibited a higher likelihood of using modern contraceptive methods compared to women whose husbands or other relatives made decisions. This suggests that collaborative decision-making in these signi cant life domains may foster an environment where reproductive health choices are more actively considered and embraced [20]. Surprisingly, in contrast to women whose husbands or other relatives made decisions on the individual components of women's empowerment, those who reported sole decision-making indicated a reduced odds of using modern contraceptive methods [3].…”

“…However, the extent of this association remains largely unexplored in Bangladesh and available literature in LMICs has reported con icting associations [8,12,[16][17][18][19]. Moreover, existing studies predominantly consider socio-demographic and regional factors, inadequately addressing women's empowerment [3,5,11,12,19,20]. Thus, we conducted this study to explore the association between women's empowerment and the uptake of modern contraception while adjusting for covariates.…”