Contemporary Use of Traditional Contraception in sub‐Saharan Africa

Rossier, Clémentine; Corker, Jamaica

doi:10.1111/padr.12008

Cited by 38 publications

(42 citation statements)

References 47 publications

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“…Without this important mechanism of postpartum infecundability, there would have been a much greater divergence of the fertility rate between the richest and poorest. As Rossier and Corker [24] pointed out, natural methods of fertility regulation play an important role in sub-Saharan Africa, and in this paper we show that postpartum abstinence and breastfeeding are vital methods for the poorest, in particular, in regulating fertility.…”

Section: Discussionsupporting

confidence: 55%

“…However, the poorest did not see these gains, hence the rising inequality the total fertility rate between the richest and poorest. Rossier et al [24] have noted the smaller role of modern contraceptive use in determining observed fertility of the poorest. Applying Bongaarts’ model, and putting exposure, contraceptive use, abortion, postpartum abstinence, and amenorrhea (breastfeeding) side-by-side, our descriptive data analysis also highlights the modest role of modern contraceptive use in determining observed fertility of the poorest.…”

Section: Discussionmentioning

confidence: 99%

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Inequality in total fertility rates and the proximate determinants of fertility in 21 sub-Saharan African countries

Finlay

Mejía‐Guevara

Akachi³

2018

PLoS ONE

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In this paper, we examine the inequality in the dynamics of the total fertility rate within 21 sub-Saharan African countries by wealth quintiles. We also examine the associated inequality within each country in the proximate determinants of fertility–marriage, contraception, and breastfeeding. Applying Bongaarts’ proximate determinants of fertility framework, for 14/21 countries we analyze, we find that those in the richest wealth quintiles have had a more rapid decline in fertility rates than those in the poorest wealth quintiles. The rapid decline for those in the richest wealth quintiles is attributable to delayed marriage and modest increases in contraceptive use. Although the poorest lag in fertility decline, postpartum abstinence and breastfeeding are the most important factors for them for fertility regulation. Further encouraging maternal health programs that focus on natural methods of fertility regulation will work in favor of the poorest in sub-Saharan Africa in moving through the demographic transition.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Inequality in total fertility rates and the proximate determinants of fertility in 21 sub-Saharan African countries

Finlay

Mejía‐Guevara

Akachi³

2018

PLoS ONE

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“…Although important gains have been achieved in reducing unmet need for family planning, increasing contraceptive prevalence, and preventing unintended pregnancies [7,[9][10][11][12], those gains have been slow [13,14], and important obstacles persist in SSA. Recent studies indicate that low socioeconomic status; financial barriers; limitations in access to information, services and supplies; and cultural norms and societal pressure on women to bear children, represent the major barriers for family planning and contraceptive uptake within the region [15].…”

Section: Viewpoints Research Theme 3: Gender Norms and Healthmentioning

confidence: 99%

Association of collective attitudes and contraceptive practice in nine sub-Saharan African countries

Mejía‐Guevara

Cislaghi

Weber

et al. 2020

Journal of Global Health

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Background There is ample evidence that gender norms affect contraceptive practice; however, data are mostly qualitative with limited geographical scope. We investigated that association quantitatively using collective community-level attitudes towards premarital sex and wife-beating as proxies for gender norms. Methods Data came from nationally representative Demographic and Health Surveys (2005-2009) for women of reproductive age (15-49 years) in nine sub-Saharan African countries. Using multilevel logistic models, controlling for individual covariates and community-level indicators of women' s empowerment, we assessed the community-level association of gender norms regarding premarital sex and wife-beating with individual contraception uptake and demand satisfied among fecund sexually active women. Norms were approximated as 'collective attitudinal norms' from female/male residents (aged 15-49 years) from the same community. We assessed the magnitude and significance of the community-level effects and attributed variance across communities. The same analysis was replicated for each country. Results In a fully-adjusted model with a pooled sample of 24 404 adolescent women, the odds of contraception use increased with a 1 standard deviation (SD) increase in the variation of collective permissive attitudes towards premarital sex of female (odds ratio (OR) = 1.08, 95% confidence interval (CI) = 1.02-1.15) and male (OR = 1.11, 95% CI = 1.05-1.17) peers (15-24 years), while odds of contraceptive use declined by 10% (OR = 0.90, 95% CI = 0.85-0.96) with collective accepting attitudes towards wife-beating of women aged 15-49 years. Similar results were found in separate models that controlled for adults' permissive attitudes towards premarital sex. The community-level attributed variance (V 2 = 1.62, 95% CI = 1.45-1.80) represented 33% (intra-class correlation (ICC) = 33.0, 95% CI = 30.0-35.4) of the total variation of contraception use, and attitudes towards premarital sex and violence jointly explained nearly 26% of that V 2 variance. The community-level shared of attributed variation of contraceptive use varied significantly across countries, from 3.5% in Swaziland (ICC = 3.5, 95% CI = 0.8-13.7) to 60.2% in Nigeria (OR = 60.2, 95% CI = 56.0-64.2). Conclusions Overall, significant positive associations of collective permissive attitudes of both adolescent and adult women towards premarital sex were found for use of, and demand for, contraception, whereas collective accepting attitudes towards wife-beating were negatively associated with the use and demand for contraception. Ours is the first study to define quantitatively the influence of proxies for gender norms at the community level on women' s family planning decisions. These findings offer new insights for understanding the role of sex-related attitudes and norms as important factors in shaping contraceptive practices and improving the effectiveness of family planning policies by targeting individuals as well as their groups of influence. Electronic supplementar...

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“…Some researchers have suggested using sexual activity rather than marriage to indicate exposure to pregnancy and that differences across countries and over time in sexual activity should be included in the proximate determinants framework (Stover, 1998;Brown, 2000). In parts of sub-Saharan Africa, sexual inactivity played a role alongside traditional contraceptive methods in the onset of the fertility transition (Rossier & Corker, 2017).…”

Section: Introductionmentioning

confidence: 99%

Sexual activity by marital status and age: a comparative perspective

2019

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This paper presents an analysis of trends in sexual activity by marital status and age, and their associations with contraceptive use. Understanding levels of, and trends in, sexual activity is important for assessing the needs for family planning services and for analysing commonly used family planning indicators. Data were taken from 220 Demographic and Health Surveys (DHSs) and 62 Multiple Indicator Cluster Surveys (MICSs) to provide insights into sexual activity by marital status and age in a total of 94 countries in different regions of the world. The results show the sensitivity of the indicator with respect to the definition of currently sexually active, based on the timing of last sexual intercourse (during the last 4 weeks, 3 months, or 1 year). Substantial diversity in sexual activity by marital status and age was demonstrated across countries. The proportion of married women reporting recent sexual activity (sexual intercourse during the last 4 weeks) ranged from 50% to 90%. The proportion of unmarried women reporting recent sexual activity did not exceed 50% in any of the 94 countries with available data, but showed substantial regional differences: it appeared to be rare in Asia and extremely varied within Africa, Europe and Latin America and the Caribbean. Among married women, sexual activity did not vary much by age group, while for unmarried women, there was an inverted U-pattern by age, with the youngest age group (15–19 years old) having the lowest proportion sexually active. The proportion of women who reported currently using contraception and reported not being sexually active varied by the contraceptive method used and was overall much greater among unmarried women. The evidence presented in this paper can be used to improve family planning policies and programmes to serve the diverse needs, for example regarding method choice and service provision, of unmarried women.

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Contemporary Use of Traditional Contraception in sub‐Saharan Africa

Cited by 38 publications

References 47 publications

Inequality in total fertility rates and the proximate determinants of fertility in 21 sub-Saharan African countries

Inequality in total fertility rates and the proximate determinants of fertility in 21 sub-Saharan African countries

Association of collective attitudes and contraceptive practice in nine sub-Saharan African countries

Sexual activity by marital status and age: a comparative perspective

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