Individual, community and service environment factors associated with modern contraceptive use in five Sub-Saharan African countries: A multilevel, multinomial analysis using geographically linked data from PMA2020

Abstract

The importance of the family planning service environment and community-level factors on contraceptive use has long been studied. Few studies, however, have been able to link individual and health facility data from surveys that are nationally representative, concurrently fielded, and geographically linked. Data from Performance Monitoring and Accountability 2020 address these limitations. To assess the relative influences of the service delivery environment and community, household, and individual factors on a woman’s likelihood of using a modern contraceptive in five geographically and culturally diverse sub-Saharan African countries. Nationally representative, cross-sectional data from PMA2020 were linked at the household and service delivery level. Country-specific and pooled multilevel multinomial logistic models, comparing non-users, short- and long-acting method users were used. The variables elected for inclusion in our multivariate analyses were guided by the conceptual framework to profile the different levels of influences on individual use of modern contraception. Average marginal effects were calculated to improve interpretability. We find that the effect of contextual factors varies widely but that being visited by a health worker who spoke about family planning in the past 12 months was consistently and positively associated with individual use of short-acting and long-acting contraception. Characteristics of the nearest health facility did not generally exercise their own independent influences on a woman’s use of contraception, except in the case of Burkina Faso, where the average distance between individuals and the nearest family planning provider was significantly greater than other countries. Inclusion of country fixed effects in the pooled models and the relevance of covariates at different levels in the country-specific models demonstrate that there is significant variation across countries in how community, individual, and service delivery environment factors influence contraceptive use and method choice. Context must be taken into account when designing family planning programs.

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

“…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]. In patriarchal societies, violence and discrimination are used to maintain women in a socially disadvantaged position and legitimize their subordinate position [38].…”

Trends in and predictors of pregnancy termination among 15–24 year-old women in Nigeria: a multi-level analysis of demographic and health surveys 2003–2018

“…Currently married women aged 15–24 years, those living with a partner or previously married and not living with a partner were more likely to terminate pregnancy than never-married women. This could be linked to social desirability bias as never-married 15–24 year old women may be reluctant to report pregnancy termination due to social stigma surrounding non-marital sexual activity or use of contraceptive [ 46 ]. However, this is inconsistent with the findings of previous school-based studies in Nigeria [ 16 , 18 ] and facility-based studies among older women in Ethiopia [ 23 ], Burkina Faso [ 47 ] and Ghana [ 22 ], which found that unmarried youth are more likely to terminate a pregnancy than their married counterparts.…”

Young people’s experiences in accessing sexual and reproductive health services in sub-Saharan Africa from 1994 to 2019 - A content analysis

“…The review brought out three major categories of barriers that deter young people from SRH services patronage: barriers of service-accessibility that discourage or prevent them from accessing SRH services; barriers of service-utilization that young people experience from the time they entered the SRH services facility till they exit and that of service-quality which are encountered at the time of receiving service. [67,68].…”