Sexual violence and unmet need for contraception among married and cohabiting women in sub-Saharan Africa: Evidence from demographic and health surveys

Abstract

Introduction Contraception plays a significant role in fertility regulation and determines the reproductive health rights of women. Studies in other parts of the world have found that sexual violence has negative effects on unmet need for contraception. There has not been any study on the association between these two phenomena in sub-Saharan Africa using current nationally-representative survey data. We investigated the association between sexual violence and unmet need for contraception among married and cohabiting women in sub-Saharan Africa. Materials and methods This study was based on secondary datasets from 26 sub-Saharan African countries’ Demographic and Health Surveys conducted between 2010 and 2018. A sample of 101,968 women in sexual unions (married and cohabiting) with complete information on sexual violence and all the variables of interest were included in the analyses. Both bivariate and multilevel logistic regression analyses were carried out to examine the association between sexual violence and unmet need for contraception. Other individual and contextual level socio-economic and demographic variables were considered as covariates. Crude odds ratios [cOR] and adjusted odds ratios [aOR] with their corresponding 95% confidence intervals [CI], signifying precision, were presented. Level of statistical significance was declared at p<0.05. Results The overall prevalence of sexual violence and unmet need for contraception in the 26 sub-Saharan African countries were 8.7% and 28.7% respectively. Experience of sexual violence within the last 12 months resulted in 10% increase in unmet need for contraception [OR = 1.10, CI = 1.03–1.14] and 5% increase in unmet need for contraception after controlling for individual and contextual level factors [aOR = 1.05, CI = 1.01–1.11]. With the individual level factors, women with 4 or more births [aOR = 4.85, CI = 4.41–5.33], those cohabiting [aOR = 1.43, CI = 1.37–1.47], those in female headed households [aOR = 1.22, CI = 1.18–1.27] and those who watched television at least once a week [aOR = 1.12, CI = 1.07–1.16] had higher odds of unmet need for family planning. However, those aged 30–34 [aOR = 0.56, CI = 0.52–0.61], those with secondary/higher level of education [AOR = 0.80, CI = 0.77–0.84], those who read newspaper less than once a week [aOR = 0.75, CI = 0.71–0.79] and those who listened to radio at least once a week [aOR = 0.94, CI = 0.90–0.97] had lower odds of unmet need for contraception. In terms of the contextual factors, women in rural areas [aOR = 0.87, CI = 0.84–0.91] and those in the richest wealth quintile households [aOR = 0.80, CI = 0.75–0.85] had lower odds of unmet need for contraception. Conclusion Our study has shown an association between sexual violence and unmet need for contraception in sub-Saharan Africa. Experiencing sexual violence increases the likelihood of unmet need for contraception in sub-Saharan Africa. It is also worthy to no...

Socio-demographic determinants of pregnancy termination among adolescent girls and young women in selected high fertility countries in sub-Saharan Africa

“…These obstacles include inadequate knowledge on family planning methods and where they can be accessed, low quality and limited availability of family planning services, and high cost of family planning methods, services, travel, and time. Other obstacles centre around fear of side effects, disapproval from partners and family members, and concerns about moral and social acceptability [ 2 , 5 , 6 ]. These obstacles are more prevalent in adolescent girls and young women (AGYW), and contribute significantly to the high unmet need for contraception among this cohort of women [ 2 , 6 ].…”

“…Other obstacles centre around fear of side effects, disapproval from partners and family members, and concerns about moral and social acceptability [ 2 , 5 , 6 ]. These obstacles are more prevalent in adolescent girls and young women (AGYW), and contribute significantly to the high unmet need for contraception among this cohort of women [ 2 , 6 ]. This may explain the approximately 80 million mistimed and unplanned pregnancies, which occur in low-and middle-income countries, and constitute 40% of all pregnancies [ 7 ].…”

“…These studies were done in countries with lower fertility rates compared to countries, which have higher fertility rates [ 11 ]. Despite evidence that women, particularly AGYW in countries with high fertility rates in SSA have high unmet need for contraception, leading to high unintended pregnancies and abortions [ 2 , 6 ], studies that have examined the determinants of pregnancy termination among AGYW in countries with high fertility rates in SSA are scanty. Moreover, there has not been any pooled analysis of nationally representative data on the determinants of pregnancy termination among AGYW in countries with high fertility rates in SSA.…”

Analysis of the Prevalence of the Preferred Methods of Contraception During the COVID 19 Lockdown in Uganda: A Multinomial Logistic Regression Study.

“…Globally unmet need for Family planning has always been a major public health concern over decades leading to mistimed and unwanted pregnancies and induced abortions. This is negatively associated with the social, economic and health issues of women and their families (Ahinkorah et al, 2020). Evidence suggests that the COVID 19 pandemic has disrupted access to all family planning information and services.…”

Decomposition of Factors Associated With Housing Material Inequality in Under-Five Deaths in Low and Middle-Income Countries

“…Studies have shown that infectious diseases, including acute respiratory infections, measles, malaria and diarrhoea are leading direct causes of U5D, while the indirect causes are most especially the socio-economic, environmental and behavioural factors (6). Difficulties associated with accessing fundamental lifesaving care such as the skill of birth attendant, postnatal care, adequate dietary intake, and vaccinations against common childhood diseases also predispose children to the risk of dying before the age of five years.…”