From non-use to covert and overt use of contraception: Identifying community and individual factors informing Nigerian women’s degree of contraceptive empowerment

Abstract

Objective In Nigeria, unmet need for contraception is high despite improved access to modern contraception. To identify factors that support Nigerian women’s contraceptive decisions to achieve their reproductive goals, in the presence or absence of their partner’s support, we seek to identify individual/couple and community level determinants of a spectrum of contraceptive practices, from non-use to covert and overt use of contraception. Methods Data were drawn from a national probability survey conducted by Performance Monitoring and Accountability 2020 in Nigeria in 2017–2018. A sample of 12,948 women 15–49 years was included, 6433 of whom were in need of contraception at the time of the survey. We conducted bivariate and multivariate analysis to identify individual/couple and community level factors associated with covert use relative to non-use and to overt use of contraception. Results Altogether, 58.0% of women in need of contraception were non-users, 4.5% were covert users and 37.5% used contraception overtly. Covert users were more educated and wealthier than non-users, but less educated and less wealthy than overt users. Covert users were less likely to cohabitate with their partner compared to non-users [AOR = 4.60 (95%CI: 3.06–6.93)] and overt users [AOR = 5.01 (95%CI: 3.24–7.76)] and more likely to reside in urban areas. At the community level, covert users were more likely to live in communities with higher contraceptive prevalence and higher levels of female education relative to non-users. They were also more likely to live in communities with higher female employment [AOR = 1.62, (95%CI: 0.96–2.73)] compared to overt users. Conclusion By identifying individual and community level factors associated with the spectrum from non-use to covert use and overt use of contraception, this study highlights the importance of integrating individual and community interventions to support women’s realization of their reproductive goals.

Covert use of reversible contraceptive methods and its association with husband’s egalitarian gender attitude in India

“…Apart from husband's gender attitude and mobility, women's educational attainment, working status, parity, religion, place of residence, discordance in desire number of children are found to influence the covert contraceptive use. In India, spousal schooling and age gaps might also affect CCU as women tend to marry more educated or older men than themselves and they possibly internalized husband's high handedness in sexual and reproductive healthcare decisions, thinking the husband would make wiser decisions for them [1,2,33].…”

“…The independent variables were categorized into two parts. The first category included women's background characteristics, women's education, religion, caste, place of residence, and wealth [5,33,39] while the second category included couple-level variables. Religion, that was included in the first category, was divided into three categories: Hindu, Muslim, and Other.…”

Prevalence and factors associated with covert contraceptive use in Kenya: a cross-sectional study

“…However, covert use of contraceptives could highlight the discordance between women’s ability to decide on their sexual reproductive health and societal infringement of their right to choose. Previous studies in sub-Saharan Africa have shown that covert contraceptive use is associated with low levels of education [ 24 , 25 ], urban residence [ 24 , 26 ], richest wealth quintile [ 4 , 24 , 27 ] and polygamous marriage [ 24 ].…”

“…Covert contraceptive use is widespread in sub-Saharan Africa, with a prevalence of 2.6–53% [ 24 – 26 , 28 , 29 ]. In Kenya, previous studies based on the 2008/09 [ 24 ] and 2014 [ 1 ] demographic health survey (DHS), and in Nyanza region [ 30 ] found that 8.7, 7.8 and 9% of married women used contraceptives without their partners’ knowledge, but did not explore the associated factors.…”

Men’s Attitude Towards Contraception and Sexuality, Women’s Empowerment, and Demand Satisfied for Family Planning in India

“…Here we emphasize the potential role of women’s equality as a precondition for securing wellbeing and prosperity for populations, and its catalytic effect on contraceptive provision and use ( Slaymaker et al, 2020 ). To study how to overcome gender inequalities or to gain greater reproductive autonomy in restricted environments with high fertility prevalence, some studies have examined programmatic approaches to renegotiate gender relationships with promising evidence in a Mumbai slum ( Cislaghi et al, 2020 ), or the covert use of contraception among women in need of family planning in sub-Saharan Africa (SSA), where contraceptive use has been positively associated with working outside the home but negatively related to more years of schooling ( Gasca and Becker 2018 ; OlaOlorun, Anglewicz, and Moreau 2020 ). Women’s self-help groups (SHGs) is another mechanism associated with a significant impact on women’s economic, social, and political empowerment in South Asia and other developing countries ( Brody et al, 2017 ), although still with limited or no impact on psychological empowerment or on attitudes towards domestic violence and respect within households in India ( Kumar et al, 2021 ).…”