Prevalence and determinants of unmet need for contraception among women in low and high-priority segments for family planning demand generation in Nigeria

Abstract

Background Studies have identified various determinants of unmet need for contraception. These determinants cut across individual, household, community, and health facility levels. Despite this evidence, there remains a lack of information regarding differentials in the prevalence and determinants of unmet need for contraception among women in the low-priority segments (such as women of advanced reproductive age and women living with disabilities) and high-priority segments (such as adolescents, young adults, and unmarried women) for family planning demand generation, hence this study. Methods The study design is cross-sectional. The study analyzed merged data from the individual, and persons recode of the 2018 Nigeria Demographic and Health Survey (NDHS). The samples analyzed are 5,147 women in the high-priority segment and 7,536 women in the low-priority segment. The outcome variable in the study was unmet need for contraception. The explanatory variables were selected at the individual, household, community, and facility levels. Statistical analyzes were performed using Stata 14. Three multilevel mixed-effects regression models were fitted. Model 1 was the empty model, while Model 2 included the sets of individual, household, and community variables. Model 3 controlled for the facility-level variables. Results Findings show a higher prevalence of unmet need for contraception among women in the family planning low-priority segment compared to women in the family planning high-priority segment. Religion and desired family size were the two individual characteristics that significantly predicted the unmet need for contraception among women in the two segments. Sexual autonomy was the only household characteristic that predicted unmet need for contraception in both segments. There were differences in the community characteristics that predicted unmet need for contraception among women in the two segments. Conclusion The prevalence of unmet need for contraception is not the same among women in low and high family planning priority segments. The determinants also differ among women in the two segments. Though, women in different family planning segments have the same contraceptive needs of avoiding pregnancy when not needed, however, getting the needs satisfied requires that existing programs be further examined to develop initiatives that will resonate with each segment of reproductive-age women.

Changes in unmet need for family planning among married women of reproductive age in Nigeria: A multilevel analysis of a ten-year DHS wave

“…This study also revealed regional disparities in the unmet need for family planning. This finding is consistent with previous findings [ 4 , 10 , 12 , 20 ]. Although difficult to explain, the disparities in region/geo-political zones might be mainly due to culture, socioeconomic inequalities, religion, lack of access to and attitudinal resistance to certain contraceptive methods in some regions/geo-political zones compared to others.…”

“…The study also revealed a negative relationship between women in the richest wealth category and unmet need for family planning. This finding is in line with previous studies [ 4 , 10 ] which report an inverse relationship between unmet need for family planning and high household wealth. Lack of access and cost of procuring contraceptive methods among other constraints, faced by the poor women compared to their richest counterparts might explain this relationship.…”

“…Islamic religion encourages polygamy and large family size and as such, unmet need for family planning tends to be higher. These findings were also reported in previous studies [ 4 , 8 , 11 , 16 ] but contradict what others [ 10 , 12 ] reported in Nigeria. This difference might be due to aggregation of the study population.…”

“…This study revealed that older women had lower odds of having unmet need for family planning than women aged 15–19 years. Several studies have documented an inverse association between maternal age and unmet need for family planning [ 4 , 10 ]. Lack of economic empowerment, cost and availability of family planning services, and preference for ineffective and short-term methods among women in the younger age group are possible reasons for the lower odds of unmet need for family planning.…”

“…However, other studies revealed a contrary result, as women with tertiary education had a lower odd of unmet need for family planning. Further explanations are rooted in the supposition that educated women do not have deep-rooted misconceptions about modern family planning methods, have positive attitudes towards modern contraception and well-informed about their benefits [ 10 ].…”