Abstract
BackgroundGlobal monitoring efforts have relied on national estimates of modern contraceptive prevalence rate (mCPR) for many low-income countries. However, most contraceptive delivery programs are implemented by health departments at lower administrative levels, reflecting a persisting gap between the availability of and need for subnational mCPR estimates.MethodsUsing woman-level data from multiple semi-annual national survey rounds conducted between 2013 and 2016 in five sub-Saharan African countries (Burkina Faso, Ethiopia, Ghana, Kenya, and Uganda) by the Performance, Monitoring and Accountability 2020 project, we propose a Bayesian Hierarchical Model with a standard set of covariates and temporally correlated random effects to estimate the level and trend of mCPR for first level administrative divisions in each country.ResultsThere is considerable narrowing of the uncertainty interval (UI) around the model-based estimates, compared to the estimates directly based on the survey data. We find substantial variations in the estimated subnational mCPRs. Uganda, for example, shows a gain in mCPR of 6.4% (95% UI: 4.5–8.3) based on model estimates of 20.9% (19.6–22.2) in mid-2014 and 27.3% (26.0–28.8) in mid-2016, with change across 10 regions ranging from − 0.6 points in Karamoja to 9.4 points in Central 2 region. The lower bound of the UIs of the change over four rounds was above 0 in 6 regions. Similar upward trends are observed for most regions in the other four countries, and there is noticeable within-country geographic variation.ConclusionsReliable subnational estimates of mCPR empower health departments in evidence-based policy making. Despite nationally increasing mCPRs, regional disparities exist within countries suggesting uneven contraceptive access. Raising investments in disadvantaged areas may be warranted to increase equity in access to modern contraceptive methods.
Highlights
Global monitoring efforts have relied on national estimates of modern contraceptive prevalence rate for many low-income countries
Data are collected at the woman, household, and facility levels by a network of resident enumerators stationed throughout the country
Ethiopia’s survey areas covered 11 regions in the country with a total of 24,237 Women of Reproductive Ages (WRA) interviewed across a subsample of 183 Enumeration Area (EA) consistently present in the four rounds
Summary
Global monitoring efforts have relied on national estimates of modern contraceptive prevalence rate (mCPR) for many low-income countries. Recent national estimates of modern contraceptive prevalence rates (mCPR) among all or married women of childbearing age are available for many low-income countries with a high level of precision (e.g. a margin of error of 2 percentage points) [9, 10]. These national survey-based estimates are not available at frequent intervals and largely depend on the availability of international funding. The lack of quality data and regular and frequent estimates of key indicators at the subnational level have hindered health and development authorities’ efforts to strengthen local systems’ delivery of contraception and other reproductive health care services. Ensuring that data and indicator estimates are available to subnational government units to inform their implementation is necessary for effective delivery of family planning to local communities
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