BackgroundIn sub-Saharan Africa, few studies have stressed the importance of spatial heterogeneity analysis in modern contraceptive use and the relationships with high-risk births.ObjectiveThis paper aims to analyse the association between modern contraceptive use, distribution of birth risk, and under-five child mortality at both national and regional levels in Burkina Faso.DesignThe last three Demographic and Health Surveys – conducted in Burkina Faso in 1998, 2003, and 2010 – enabled descriptions of differentials, trends, and associations between modern contraceptive use, total fertility rates (TFR), and factors associated with high-risk births and under-five child mortality. Multivariate models, adjusted by covariates of cultural and socio-economic background and contact with health system, were used to investigate the relationship between birth risk factors and modern contraceptive prevalence rates (mCPR).ResultsOverall, Burkina Faso's modern contraception level remains low (15.4% in 2010), despite significant increases during the last decade. However, there are substantial variations in mCPR by region, and health facility contact was positively associated with mCPR increase. Women's fertility history and cultural and socio-economic background were also significant factors in predicting use of modern contraception. Low modern contraceptive use is associated with higher birth risks and increased child mortality. This association is stronger in the Sahel, Est, and Sud-Ouest regions. Even though all factors in high-risk births were associated with under-five mortality, it should be stressed that short birth spacing ranked as the highest risk in relation to mortality of children.ConclusionsProgrammes that target sub-national differentials and leverage women's health system contacts to inform women about family planning opportunities may be effective in improving coverage, quality, and equity of modern contraceptive use. Improving the demand satisfied for modern contraception may result in a reduction in the percentage of women experiencing high-risk births and may also reduce child mortality.
The paper proposes to clarify whether fertility decline in Burkina Faso between 2003 and 2015 is explained by the differential distributions (composition effect and response effect) with focus on socioeconomic status (women’s education, women’s occupation and poverty). Using data from 2003 demographic and health survey (DHS) and 2015 demographic and health module of the Multisectoral Continuous Survey, we applied an extension of Blinder-Oaxaca decomposition approach to quantify the percentage of fertility decline attributable to distribution of the socio-economic status (composition effect) and the percentage attributable to women’s fertility behavior (response effect) attributable to socio-economic status. We find the fertility decline is mainly explain to changes in the distribution of women according the different factors. Indeed, the composition effect represents 88% and only 12% for the response effect. Moreover, composition effect for socio-economic factors is estimated to 85.13% and the response effect is estimated to 34.23%. These results suggest (i) to encourage girl’s education by enrolling them in school but particularly by ensuring that they go at least to secondary school; (ii) create a minimum package of services for the promotion of modern methods of contraception, particularly for women working in agriculture and trade sector as well as those from poor households and living in rural areas; (iii) promote domestic work to allow more women to be interested.
The Population Council would like to thank all the organisations and individuals who contributed to the success of this study. We wish to first thank Marie Stopes International (MSI) for their support during the study. Secondly, we would like to thank public sector and MSI service providers and MSI facility staff for their collaboration during the data collection exercise. Finally, the Council also wishes to thank the clients who cooperated and provided information to make the study possible.
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