Contraceptive use in Eswatini: do contextual influences matter?

Abstract

This study sought to investigate the determinants of current use of modern contraceptives beyond the individual level in Eswatini (formerly Swaziland). Previous studies have overlooked the role of community characteristics such as socioeconomic development, women’s empowerment and fertility norms in shaping contraceptive use. Hierarchical structured subsample data of 4112 sexually experienced women from the 2007 Eswatini Demographic Health Survey were analysed using multilevel logistic regression to identify factors contributing to community/cluster variations in women’s current use of modern contraceptives. Less than half (44.2%) of the sexually active women were using modern contraceptive methods in 2007. At the community level, the odds of contraceptive use decreased for rural women (AOR = 0.82, 95% CI: 0.68–0.98) and among women residing in communities with high-fertility norms (AOR = 0.77, 95% CI: 0.66–0.89). After adjusting for both individual- and community-level factors, no community-level variables considered for the study were significantly associated with contraceptive use. The findings highlight in all four models, from the empty to full model, that there is a small and decreasing significant variation in women’s contraceptive use across communities (MOR, 1.37–1.17). In 2007, the findings suggest individual rather than community factors account for some contextual variability in contraceptive use. The study proposes the use of ethnographic techniques to unravel community factors that promote modern contraceptive use in Eswatini.

Systematic review of multilevel models involving contextual characteristics in African demographic research

“…The findings further show that the community's access to mass media was associated with increased odds of antenatal service utilization (Ononokpono et al, 2013). A study conducted in Eswatini indicated at the bivariate level that women living in communities with lower levels of media exposure had reduced rates of contraceptive use (Odimegwu & Chemhaka, 2021). In Ethiopia, communities with higher electronic media possession had an increased likelihood of family planning use compared to communities with lower reports of electronic media possession (Alemayehu et al, 2020).…”

“…However, after controlling for individual factors, the contextual factors were insignificantly associated with contraceptive use. This shows that contextual factors may have important implications for contraceptive use (Odimegwu & Chemhaka, 2021). The beliefs and myths in communities play a vital role in influencing reproductive health outcomes in different parts of Sub-Saharan Africa.…”

“…Not only does region and place of residence influence the health-seeking behaviours of mothers but also impact their reproductive health. Women residing in rural areas have higher fertility compared to those in urban areas (Odimegwu & Chemhaka, 2021). Women residing in urban areas have a higher likelihood of using modern contraceptives than those in rural areas (Zegeye et al 2021).…”

“…A study conducted in Zimbabwe indicated that residing in communities with a higher mean number of children ever born per woman reduced modern contraceptive use among adolescent women (Ngome & Odimegwu, 2014). In Eswatini, women living in communities with high fertility norms whose ideal number of children was four had a significantly lower likelihood of using contraceptives (Odimegwu & Chemhaka, 2021). However, after controlling for individual factors, the contextual factors were insignificantly associated with contraceptive use.…”

Women’s post-abortion contraceptive use: Are predictors the same for immediate and future uptake of contraception? Evidence from Ghana

“…Using the 2017 GMHS, we investigate the factors that account for women’s immediate and subsequent or future use of contraception following abortion, considering socio-demographic, reproductive, partner-related, and facility-level factors. Several studies have investigated factors associated with contraceptive use among women in reproductive ages [ 14 – 18 ] but, abortion seekers have unique characteristics that put them at risk of experiencing multiple abortions. Abortion seekers in Ghana are younger, reside in urban areas, have a higher socio-economic status, and have no child or few children [ 19 ].…”