How the Community Shapes Unmet Need for Modern Contraception: An Analysis of 44 Demographic and Health Surveys

Abstract

Unmet need for modern contraception is a major public health concern in resource-constrained countries. Recent research supports the application of social-ecological theories to explain how characteristics of a woman's community shape modern contraception use. However, this research focuses largely on individual countries and uses a limited number of community-level effects. We fitted three random-effects logistic regression models to examine associations between 13 community-level variables and the odds of reporting unmet need, unmet need for spacing, and unmet need for limiting for all parous, female respondents in 44 DHS surveys collected in 2010-2015 (n=528,101). Community variables explain significant variance in unmet need between communities. Associations between community variables and unmet need differ by urban and rural residence. The results highlight several commonalities in how the community shapes unmet need across resource-constrained settings and may help in designing structural-level interventions.

Age disparities in unmet need for contraception among all sexually active women in Colombia: an analysis of the 2015 Demographic Health Survey

“…In this study, the household wealth index, education level, and health service affiliation regime explain some differences in unmet needs among age groups. These findings are consistent with previous research in which the unmet need and non-use of contraceptives are associated with social determinants as such as education level (6,28,29), the variables of access to health services (30,32), household wealth index (6,28,29), and community-level variables related with social norms, inequalities gender, and economic prosperity (50). In this study, the prevalence of estimated unmet need is higher in the subsidized regime, among those lacking affiliation to the health system, and the Atlantic and Orinoquia-Amazonia regions.…”

“…Consequently, challenges remain for the national provision of family planning services that contribute to the fulfillment of the SDGs, the Montevideo Conference, and national public policies. The provision of services must adjust to the needs and preferences of people according to their present conditions (43) and the cultural and social context (5,42,50). Beyond access to essential services, such as family planning, Colombia, like other countries, requires an approach that promotes equity (i.e., that reaches the most vulnerable populations) and prioritizes and designs policy guidelines with the participation of society.…”

The role of empowerment in the use of modern contraceptives among women in need of family planning in Burkina Faso: A multilevel analysis

“…Speci cally, higher levels of women's rights and opportunities increased modern contraceptive use, while higher levels of violence and discrimination had the opposite effects. These ndings are supported by previous evidence that traditional gender norms that support higher ideal number of children, early marriage, domestic violence or female unemployment reduced women's ability to meet their family planning needs [34][35][36]. Also, promoting women's education, autonomy, HIV knowledge, and contact with family planning health workers were shown to increase modern contraceptive use among women [34,35,37].…”

Individual and community-level factors associated with unmet need for contraception among reproductive-age women in Ethiopia; a multi-level analysis of 2016 Ethiopia Demographic and Health Survey

“…So, all of these articles are subject to an atomistic or ecological fallacy [17,21,22,[29][30][31][32][33][34][35][36][37][38][39]. The factors associated with the unmet need to FP are area-specific which requires a different approach of analysis at a different level [8,24,[40][41][42][43][44][45][46]. So, this study took into account those different levels of analysis and aimed to assess individual and community-level factors associated with unmet need for contraception among reproductive-age women in Ethiopia (EDHS 2016 dataset, 2019).…”