Abstract
Background: Around 80% of the African population lives in urban areas, and a rapid urbanization is observed in almost all countries. Urban poverty has been linked to several sexual and reproductive health risks, including high levels of unintended pregnancies. We aim to investigate wealth inequalities in demand for family planning satisfied with modern methods (mDFPS) among women living in urban areas from African countries.Methods: We used data from 43 national health surveys carried out since 2010 to assess wealth inequalities in mDFPS. mDFPS and the share of modern contraceptive use were stratified by groups of household wealth. We also assessed the ecological relationship between the proportion of urban population living in informal settlements and both mDFPS and inequalities in coverage.Results: mDFPS among urban women ranged from 27% (95% CI: 23–31%) in Chad to 87% (95% CI: 84–89%) in Eswatini. We found significant inequalities in mDFPS with lower coverage among the poorest women in most countries. In North Africa, inequalities in mDFPS were identified only in Sudan, where coverage ranged between 7% (95% CI: 3–15%) among the poorest and 52% (95% CI: 49–56%) among the wealthiest. The largest gap in the Eastern and Southern African was found in Angola; 6% (95% CI: 3–11%) among the poorest and 46% (95% CI: 41–51%) among the wealthiest. In West and Central Africa, large gaps were found for almost all countries, especially in Central African Republic, where mDFPS was 11% (95% CI: 7–18%) among the poorest and 47% (95% CI: 41–53%) among the wealthiest. Inequalities by type of method were also observed for urban poor, with an overall pattern of lower use of long-acting and permanent methods. Our ecological analyses showed that the higher the proportion of the population living in informal settlements, the lower the mDFPS and the higher the inequalities.Conclusion: Our results rise the need for more focus on the urban-poorer women by public policies and programs. Future interventions developed by national governments and international organizations should consider the interconnection between urbanization, poverty, and reproductive health.
Highlights
Population growth and dynamics pose many challenges to the achievement of the sustainable development agenda, in low and middle-income contexts [1]
In West and Central Africa, large gaps were found for almost all countries, especially in Central African Republic, where mDFPS was 11% among the poorest and 47% among the wealthiest
Countries in North Africa presented a high coverage of mDFPS (>70%), except for Sudan, where only 42.8% of urban women had their need for family planning satisfied by modern methods (Table 1)
Summary
Population growth and dynamics pose many challenges to the achievement of the sustainable development agenda, in low and middle-income contexts [1]. Despite the higher access to health care and availability of services generally found in urban areas, key maternal, and child health indicators for the urban poor present undesirably low coverage—similar to what is found for the rural poor populations [7,8,9]. Specific programs like the Urban Reproductive Health Initiative have resulted in increased access to modern contraceptives for women living in urban areas of Kenya, Nigeria, and Senegal [13, 17], most policies and programs have failed to address the sexual and reproductive health needs of the most vulnerable urban populations [10]. We aim to investigate wealth inequalities in demand for family planning satisfied with modern methods (mDFPS) among women living in urban areas from African countries
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