Unmet Need for Family Planning Among Married Women in Zambia: Lessons from the 2018 Demographic and Health Survey

Namukoko, Harriet; Likwa, Rosemary Ndonyo; Hamoonga, Twaambo Euphemia; Phiri, Million

doi:10.21203/rs.3.rs-690859/v1

Cited by 4 publications

(12 citation statements)

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“…Our analysis revealed that geographical residence (rural vs urban), age of woman, socioeconomic status, number of children ever born to a woman (parity), employment status and partner’s age constituted factors significantly associated with unmet need for family planning. These findings are largely consistent with other studies (22, 30-31) including a Zambian study which analysed unmet need for family planning using the 2018 DHS data (30). From a review of literature predictors of contraceptive uptake and unmet need for family planning are similar for HIV positive and HIV negative women.…”

Section: Discussionsupporting

confidence: 90%

“…Our study findings also suggest that the more children a woman has the higher the chances they have an unmet need for family planning. This is in line with study findings from Zambia (30) Ethiopia (45-46) and Kenya (47) including a multi-country study that analysed nineteen DHS survey data from Sub-Sahara Africa (48). It is probable that with higher parity, women will have attained the desired number of children hence a greater need for limiting and in the context of limited access to contraceptive services the unmet need is potentially high.…”

Section: Discussionsupporting

confidence: 88%

“…While education has been shown to be a significant predictor of contraceptive uptake, and conversely of unmet need for family planning among women in other studies (33-34, 49), our findings did not demonstrate any association. It is however consistent with a study in Zambia that used the 2018 DHS data and involved all married women (not merely those with an HIV positive result) (30). The mechanism for this phenomenon (lack of association with education) is unclear although it points to the importance of emphasizing family planning specific education and counselling irrespective of a woman’s education level.…”

Section: Discussionsupporting

confidence: 87%

“…Evidently, similar to our findings, studies in Tigray (32) and Dire Dawa (33) in Ethiopia, Nigeria (34) and India (35) found that women living with HIV residing in rural areas were more likely to have unmet need for family planning than their counterparts from the urban areas. The probable explanation for this phenomenon is that women in rural areas have lower exposure to information and limited access to sexual and reproductive health services than their urban counterparts, as reported in surveys in Zambia and elsewhere (30,31). Furthermore, in the Zambia country context, women in rural areas are arguably impacted more than their urban counterparts by other barriers to uptake of family planning services such as some deeply engrained cultural practices that propagate hesitancy to contraceptives and those that affect the autonomy of women to make reproductive choices.…”

mentioning

confidence: 99%

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Trends and predictors of unmet need for family planning among women living with HIV in Zambia: implications for elimination of Mother to Child Transmission of HIV

Lungu

Chewe

2022

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Introduction Prevention of Mother To Child Transmission (PMTCT) of HIV is one of the key strategies towards HIV epidemic control. Despite considerable progress in PMTCT of HIV over the past decade in Zambia, the country is yet to reach global and national target for elimination of Mother To Child Transmission of HIV. Avoidance of unintended pregnancy among women living with HIV provides is one of the cost-effective interventions in a comprehensive PMTCT of HIV approach. This study therefore aimed at ascertaining trends in and predictors of unmet need for family planning among women living with HIV in Zambia Methods The study employed a repeated cross sectional (RCS) study design, using data from the three (3) most recent consecutive rounds of the Zambia Demographic and Health Survey (ZDHS) conducted in 2007, 2013/2014 and 2018. The study used data from a total of 34,204 women aged 15-49 years from the three survey points, 2007, 2013/14 and 2018, among whom 4,985 were HIV positive, with a final sample size constituting 2,675 married women living with HIV. We used descriptive statistics and logistic regression analyses to respectively ascertain trends in and predictors of unmet need for family planning among married women living with HIV. Results Over the three survey points, unmet need for family planning among married women living with HIV has hardly declined, registering 22% in both the 2007 and 2018. Residence, age of women, household wealth, woman’s parity, employment, and age of spouse emerged as significant predictors of unmet need for family planning among women living with HIV in Zambia Conclusion Preventing one HIV infection in a child is averting lifetime costs of HIV treatment and associated healthcare costs. There is need to consider optimization of PMTCT interventions including shaping programming regarding prong 2 in a way that it responds to main causes of mother to child transmission of HIV in Zambia. Among other aspects, policy and practice needs to strengthen SRH/HIV integration and better target rural residents, younger women, those with high parity and consider positive male engagement to reduce unmet need for family planning among women living with HIV.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 87%

mentioning

confidence: 99%

See 2 more Smart Citations

Trends and predictors of unmet need for family planning among women living with HIV in Zambia: implications for elimination of Mother to Child Transmission of HIV

Lungu

Chewe

2022

Preprint

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“…The prevalence rate of teenage pregnancy among adolescents aged 15-19 in Africa is 18.8% while that of sub-Saharan Africa (SSA) is around 19.3% [3]. The drivers of teenage pregnancy are several and multifaceted and these include poverty, inadequate education and employment opportunities, gender inequalities, rural residence, poor access and low use of contraceptives and inadequate sexual and reproductive health (SRH) information among others [3][4][5][6]. Marital status is another major factor associated with teenage pregnancies.…”

Section: Introductionmentioning

confidence: 99%

A multilevel analysis of trends and predictors associated with teenage pregnancy in Zambia (2001–2018)

et al. 2023

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Background Teenage pregnancy remains a major social and public health challenge in developing countries especially sub-Saharan Africa (SSA) where prevalence rates are still increasing. Even if considerable effort has been made over the years to study determining factors of teenage pregnancy in SSA, few studies have looked at the trends and associated factors over a longer period. Furthermore, no known study has focussed on both individual and contextual factors influencing teenage pregnancy in Zambia. This study, thus sought to fill this gap in knowledge by simultaneously investigating trends of teenage pregnancy as well as its individual and contextual determining factors. Methods A total pooled weighted sample of 10,010 teenagers (in the age group 15–19) from four waves of the Zambia Demographic and Health Surveys were extracted. Using bivariate analysis, we investigated the trends of teenage pregnancy between 2001 and 2018. Separate multilevel logistic regression models were fitted on pooled teenage pregnancy data in relation to several individual and contextual level factors. Both fixed and random effects were produced. Bayesian parameter estimates were produced using lme4 package in R statistical programming environment. Results Results of the trends of teenage pregnancy in Zambia have shown an overall decrease of 2% between 2001 and 2018. Almost all the socioeconomic and demographic variables were consistently associated with teenage pregnancy (p < 0.001) in a bivariate analysis across the four survey. In multilevel analysis, the odds of being pregnant were higher for teenagers who were employed (aOR = 1.21, 95% CI: 1.02–1.42), married (aOR = 7.71, 95% CI: 6.31–9.52) and those with knowledge of ovulation period (aOR = 1.58, 95% CI: 1.34–1.90). On the other hand, belonging to households in high wealth quintiles, being literate, exposure to mass-media family planning messages and delayed sexual debut were associated with decreased odds of teenage pregnancy. Conclusion The study shows that teenage pregnancy remains a social and public health challenge in Zambia as the country has seen little decrease in the prevalence over the years under consideration. Factors associated with teenage pregnancy include marital status, and employment, knowledge of ovulation period, wealth quintile, sexual debut and exposure to mass-media family planning messaging. Concerted effort must be made to improve literacy levels, reduce poverty and enhance sexual health promotion through the mass media in view of cultural norms, which may prevent parents and children from discussion sexual education topics thus exacerbate the vice.

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Individual and Community-level factors associated with early marriage in Zambia: a mixed effect analysis

et al. 2023

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Background Child marriage has long been a public health concern around the world, because it has the potential to deprive adolescent girls of their sexual reproductive health rights and limits their ability to reach their full potential in life. The prevalence of child marriage has been consistently higher in sub-Saharan Africa than elsewhere. However, fewer studies have explored the influence of both individual and community-level influences on early marriage in sub-Saharan Africa. This study, therefore, examined individual and community-level factors associated with child marriages in Zambia. Methods Data came from the Zambia Demographic and Health Surveys (ZDHS) conducted in 2007, 2013–14 and 2018. A pooled weighted sample of 9990 women aged 20–29 years was used in the analysis. Stata software version 17 was used to perform statistical analysis, taking into account complex survey design. The association between individual- and community- level factors and early marital behavior was assessed using multilevel logistic regression models. Results The prevalence of child marriage among women aged 20–29 was 44.4 percent (95% CI: 42.1, 46.7) in 2018, declining from 51.5 percent (95% CI: 48.9, 54.0) in 2007. Women with secondary or higher level of education [aOR = 0.36, 95% CI = 0.26–0.49] and [aOR = 0.07, 95% CI = 0.03–0.18] and those whose age at first birth was (15–19 year) or (20–29 years) were associated with less likelihood of experiencing child marriage. Communities with a high percentage of women who gave birth at a young age [aOR = 1.36, 95% CI = 1.15–1.62] were more likely to experience child marriage. Individual and community-level characteristics accounted for 35% of the overall variations in communities' likelihood of experiencing early marriage. Even after controlling for both individual and community-level influences, the intra-class correlation revealed that around 4.5 percent of the overall variations remained unexplained. Conclusion Prevalence of child marriage has reduced over the years but is still high in Zambia. Both individual and community- level factors influenced child marriage in Zambia. There is a need to strengthen strategies that keep girls in school to delay their exposure to early sexual debut and child marriage. Designing of reproductive health interventions in the country should consider integration of community factors such as economic insecurity and access to reproductive health information.

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Unmet Need for Family Planning Among Married Women in Zambia: Lessons from the 2018 Demographic and Health Survey

Cited by 4 publications

References 6 publications

Trends and predictors of unmet need for family planning among women living with HIV in Zambia: implications for elimination of Mother to Child Transmission of HIV

Trends and predictors of unmet need for family planning among women living with HIV in Zambia: implications for elimination of Mother to Child Transmission of HIV

A multilevel analysis of trends and predictors associated with teenage pregnancy in Zambia (2001–2018)

Individual and Community-level factors associated with early marriage in Zambia: a mixed effect analysis

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