Pooled prevalence and determinants of informed choice of contraceptive methods among reproductive age women in Sub-Saharan Africa: A multilevel analysis

Abstract

BackgroundDespite the commitments of the government to minimize unintended pregnancy, abortion, and unmet need for contraceptives, as per our search of the literature, there is no study on the pooled prevalence and determinants of informed choice of contraceptive methods in sub-Saharan Africa. Therefore, this study aimed to assess the pooled prevalence and determinants of informed choice of contraceptive methods among reproductive-aged women in sub-Saharan Africa.MethodsThis study was based on the 32 Sub-Saharan African countries Demographic and Health Survey data. A total weighted sample of 65,487 women aged 15–49 was included in the study. The data were cleaned, weighted, and analyzed using STATA Version 14 software. Multilevel logistic regression modeling was used to identify determinants of an informed choice of contraceptive methods. Adjusted odds ratio (AOR) with 95% Confidence Interval (CI) and p-value < 0.05 were used to declare the significant determinants.ResultThe pooled prevalence of informed choice of contraceptive methods among reproductive age (15–49) women in sub-Saharan Africa was 49.47% (95%CI: 44.33, 54.62%) with I2 =99.5%, and variations in range of 19.42 to 78.42%. Women aged 25–34 years old (AOR = 1.26 95%CI: 1.21, 1.32) and 35–49 years (AOR = 1.33 95%CI: 1.27, 1.40), attending primary education (AOR = 1.26, 95% CI: 1.20, 1.32), secondary education (AOR = 1.50, 95% CI: 1.43, 1.58) and higher education (AOR = 2.01, 95% CI: 1.84, 2.19), having media exposure (AOR = 1.12, 95%CI: 1.07, 1.16), utilizing IUD (AOR = 1.98, 95%CI: 1.79, 2.19), injectable (AOR = 1.29, 95%CI: 1.23, 1.36) and implants (AOR = 1.70, 95%CI: 1.61, 1.79), survey year 2016–2020 (AOR = 1.38, 95%CI: 1.31, 1.44), women from lower middle (AOR = 1.25, 95%CI: 1.19, 1.31) and upper middle income level countries (AOR = 1.37, 95%CI: 1.23, 1.53) were associated with increased odds of informed choice of contraceptive methods. While, women who accessed contraceptives from private clinics (AOR = 0.64, 95%CI: 0.61, 0.67), pharmacies (AOR = 0.37, 95%CI: 0.35, 0.40), and others (AOR = 0.47, 95%CI: 0.43, 0.52), women in East Africa (AOR = 0.70, 95% CI: 0.67, 0.73), Central Africa (AOR = 0.52, 95% CI: 0.47, 0.57), and South Africa (AOR = 0.36, 95% CI: 0.32, 0.40) were associated with decreased odds of informed choice of contraceptive methods.ConclusionThe pooled prevalence of informed choice of contraceptive methods in Sub-Saharan Africa is low with high disparities among the countries. Enhancing maternal education and media exposure, providing greater concern for the source of contraceptive methods, and strengthening the economic status of the country are recommended to enhance informed choice of contraceptive methods.

Urban-rural inequalities and spatial arrangement of informed choice of family planning in Ethiopia: Further analysis of 2016 Ethiopian demographic health survey

“…Compared to the age group of 25 to 34 years being age group between 35 and 49 years is found decrease the gap in informed choice of family planning between rural and urban residents. Other studies also reported similar findings [ 30 , 32 – 34 ]. The possible reason behind this could be elder mothers from rural areas may also seek more information about the family planning method that could be delivered to them because they might experience side effects and discomforts in their prior utilization of family planning methods.…”

“…The reason for this could be the client flow at private health facilities are lower than at public health facilities so that informed choice of family planning can be practically achieved in private health facilities. Moreover, since private health facilities are commercial, they could have a good client handling approach including delivery of detailed information about the service and treatment they are providing to their clients [29][30][31]. It is better to expand private health facilities to rural areas as equal as the public health facilities to have informed choice services of FP.…”

Urban-rural inequalities and spatial arrangement of informed choice of FP in Ethiopia: further analysis of 2016 Ethiopian demographic health survey

“…In this study, being in the age group 35 to 49 year was signi cantly narrowed the urban and rural gap in the informed choice of family planning where as being in the age group 25 to 34 found to widen the urban -rural gap of family planning compared to age group 15 to 24 year. Other studies also reported similar ndings (23,(25)(26)(27). The possible reason behind this could be elder mothers from rural areas may also seek more information about the family planning method that could be delivered to them because they might experience side effects and discomforts in their prior utilization of family plaining methods.…”

“…The reason for this could be the client ow at private health facilities are lower than public health facilities so that informed choice of family planning can be practically achieved in private health facilities. Moreover, since private health facilities are commercial, they could have good client handling approach including delivery of detail information about the service and treatment they are providing to their clients (22)(23)(24). In this study, being in the age group 35 to 49 year was signi cantly narrowed the urban and rural gap in the informed choice of family planning where as being in the age group 25 to 34 found to widen the urban -rural gap of family planning compared to age group 15 to 24 year.…”

Access to quality contraceptive counselling among adolescent girls and young women in sub-Saharan Africa

“…There is a varied prevalence of informed contraceptive method choices across the globe [ 15 ]. Despite government objectives, a study conducted in 32 countries in SSA demonstrates that the prevalence of informed contraceptive method choice is low, with substantial country variations [ 16 ]. The low level of knowledge about contraceptive method choice in SSA is influenced by various factors, such as maternal age, residency, financial status, media exposure, internet use, marital status, education, occupational status, access to health facility, and access to contraceptives [ 17 – 19 ].…”