Factors associated with modern contraceptive use among women with no fertility intention in sub-Saharan Africa: evidence from cross-sectional surveys of 29 countries

Bright Opoku Ahinkorah,Eugene Budu,Yaa Boahemaa Gyasi Aderoju,Ebenezer Agbaglo,Abdul-Aziz Seidu,Francis Arthur-Holmes,Collins Adu,Richard Gyan Aboagye,Anita Gracious Archer

doi:10.1186/s40834-021-00165-6

Abstract

BackgroundIn sub-Saharan Africa, the majority of women of reproductive age who want to avoid pregnancy do not use any method of contraception. This study sought to determine the factors associated with modern contraceptive use among women with no fertility intention in sub-Saharan Africa.MethodsThis study used data from the Demographic and Health Surveys of 29 countries in sub-Saharan Africa. A total of 87,554 women aged 15–49 with no fertility intention and who had completed information on all the variables of interest were considered in this study. Using a multilevel logistic regression analysis, four models were used to examine the individual and contextual factors associated with modern contraceptive use. The results were presented as adjusted odds ratios (aOR), with their respective confidence intervals (CIs). Statistical significance was set at p< 0.05.ResultsThe prevalence of modern contraceptive use was 29.6%. With the individual-level factors, women aged 45–49 had lower odds of using modern contraceptives (aOR = 0.33, 95% CI = 0.28, 0.39). Women who had their first sex at age 15–19 (aOR = 1.12, 95% CI = 1.07, 1.17), those with higher education (aOR = 1.93, 95% CI = 1.75, 2.13), and women who were exposed to newspaper (aOR = 1.15, 95% CI = 1.10, 1.20) and radio (aOR = 1.21, 95% CI = 1.17, 1.26) had higher odds of modern contraceptive use. In terms of the contextual factors, women living in urban areas (aOR = 1.06, 95% CI = 1.02, 1.11), women in the richest wealth quintile (aOR = 1.55, 95% CI = 1.43, 1.67), and those in communities with medium literacy level (aOR = 1.11, 95% CI = 1.06, 1.16) and medium community socio-economic status (aOR = 1.17, 95% CI = 1.10, 1.23) had higher odds of modern contraceptive use. Across the geographic regions in sub-Saharan Africa, women in Southern Africa had higher odds of modern contraceptive use (aOR = 5.29, 95% CI = 4.86, 5.76).ConclusionThere is a relatively low prevalence of modern contraceptive use among women with no fertility intention in sub-Saharan Africa, with cross-country variations. Women’s age, age at first sex, level of education, mass media exposure, place of residence, community literacy level and community socio-economic status were found to be associated with modern contraceptive use. It is, therefore, important for policy makers to consider these factors when designing and implementing programmes or policies to increase contraceptive use among women who have no intention to give birth. Also, policymakers and other key stakeholders should intensify mass education programmes to address disparities in modern contraceptive use among women.

Highlights

In sub-Saharan Africa, the majority of women of reproductive age who want to avoid pregnancy do not use any method of contraception
Women who had their first sex at age 15–19, those with higher education, and women who were exposed to newspaper and radio had higher odds of modern contraceptive use
In terms of the contextual factors, women living in urban areas, women in the richest wealth quintile, and those in communities with medium literacy level and medium community socio-economic status had higher odds of modern contraceptive use

Summary

Introduction

In sub-Saharan Africa, the majority of women of reproductive age who want to avoid pregnancy do not use any method of contraception. Provision of modern contraception to women who want to avoid pregnancy could cause a reduction in maternal deaths from 308, 000 to 84,000 and newborn mortality from 2.7 million to 538,000 per year respectively [3] These reductions in unintended pregnancies, and maternal and newborn mortalities can lead to the attainment of the target 3.1 and 3.2 of the SDG 3 which seek to reduce the global maternal mortality ratio to less than 70 per 100,000 live births and end all preventable deaths under 5 years of age by 2030 respectively [1]. In low-and middle-income countries, 214 million women who wanted to avoid pregnancy in 2019 were not using any method of contraception [2]

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Conclusion