Factors associated with modern contraceptive use among women with no fertility intention in sub-Saharan Africa: evidence from cross-sectional surveys of 29 countries

Abstract

Background In sub-Saharan Africa, the majority of women of reproductive age who want to avoid pregnancy do not use any method of contraception. This study sought to determine the factors associated with modern contraceptive use among women with no fertility intention in sub-Saharan Africa. Methods This study used data from the Demographic and Health Surveys of 29 countries in sub-Saharan Africa. A total of 87,554 women aged 15–49 with no fertility intention and who had completed information on all the variables of interest were considered in this study. Using a multilevel logistic regression analysis, four models were used to examine the individual and contextual factors associated with modern contraceptive use. The results were presented as adjusted odds ratios (aOR), with their respective confidence intervals (CIs). Statistical significance was set at p< 0.05. Results The prevalence of modern contraceptive use was 29.6%. With the individual-level factors, women aged 45–49 had lower odds of using modern contraceptives (aOR = 0.33, 95% CI = 0.28, 0.39). Women who had their first sex at age 15–19 (aOR = 1.12, 95% CI = 1.07, 1.17), those with higher education (aOR = 1.93, 95% CI = 1.75, 2.13), and women who were exposed to newspaper (aOR = 1.15, 95% CI = 1.10, 1.20) and radio (aOR = 1.21, 95% CI = 1.17, 1.26) had higher odds of modern contraceptive use. In terms of the contextual factors, women living in urban areas (aOR = 1.06, 95% CI = 1.02, 1.11), women in the richest wealth quintile (aOR = 1.55, 95% CI = 1.43, 1.67), and those in communities with medium literacy level (aOR = 1.11, 95% CI = 1.06, 1.16) and medium community socio-economic status (aOR = 1.17, 95% CI = 1.10, 1.23) had higher odds of modern contraceptive use. Across the geographic regions in sub-Saharan Africa, women in Southern Africa had higher odds of modern contraceptive use (aOR = 5.29, 95% CI = 4.86, 5.76). Conclusion There is a relatively low prevalence of modern contraceptive use among women with no fertility intention in sub-Saharan Africa, with cross-country variations. Women’s age, age at first sex, level of education, mass media exposure, place of residence, community literacy level and community socio-economic status were found to be associated with modern contraceptive use. It is, therefore, important for policy makers to consider these factors when designing and implementing programmes or policies to increase contraceptive use among women who have no intention to give birth. Also, policymakers and other key stakeholders should intensify mass education programmes to address disparities in modern contraceptive use among women.

Modern Contraceptive Utilization and Associated Factors Among Married Women in Liberia: Evidence from the 2019 Liberia Demographic and Health Survey

“…15 The contraceptive prevalence rate among married women in sub-Saharan Africa increased from 14.7% in 2000 to 27.9% in 2019 and 29.6% in 2021. 16,17 In the past decades, studies in developing countries have shown that contraceptive use is influenced by various factors; these factors include demographic characteristics, religious beliefs, knowledge of contraception, education of couples, gender preference among children, the quality of the Contraception among women, limited choice of methods, and fear or experience of side-effects. 6,11,[18][19][20][21][22][23][24] The unmet need for modern contraception is high in Liberia.…”

“…27 Modern contraceptive is an important and cost-effective public health intervention to reduce maternal mortality and avert unintended pregnancies, especially in developing countries. 13,17,28 However, mCPR was low in most of the developing countries, including Liberia. 7,27,29 To increase the level of contraceptive use, it is necessary to understand factors that significantly influence contraceptive use.…”

Factors associated with non-use of modern contraceptives among sexually active women in Ethiopia: a multi-level mixed effect analysis of 2016 Ethiopian Demographic and Health Survey

“…Sub-Saharan Africa will account for the majority of global population growth in the coming decades, while many other regions will begin to see population decline. Between 2019 and 2050, the global population is expected to grow by almost two billion people, with 1.05 billion (52%) of that growth occurring in Sub-Saharan African countries [ 1 ]. Ethiopia is the most populous country in Sub-Saharan Africa, with a population of 112 million people and a fertility rate of 4.6 children per woman.…”

Disentangling rural-urban modern contraceptive utilization disparity among sexually active women of reproductive age in Sierra Leone: a Blinder-Oaxaca decomposition analysis

“…Additionally, evidence from studies done in Sub Saharan Africa, western Africa, D.R Congo and Nigeria reported that urban women use modern contraception more frequently than rural women (1,15,16), and rural fertility is significantly higher than urban fertility (1).…”

“…A study conducted in Sierra Leone using the 2013 demographic health survey (DHS) data found that living in an urban area was associated with increased odds of modern contraceptive utilization among married or in-union women when compared to living in rural areas (14). Additionally, evidence from studies done in Sub Saharan Africa, western Africa, D.R Congo and Nigeria reported that urban women use modern contraception more frequently than rural women (1, 15, 16), and rural fertility is significantly higher than urban fertility (1).…”