Abstract
BackgroundZambia’s fertility rate and unmet need for family planning are still high. This is in spite of the progress reported from 1992 to 2007 of the increase in contraceptive prevalence rate from 15% to 41% and use of modern methods of family planning from 9% to 33%. However, partner disapproval of family planning has been cited by many women in many countries including Zambia. Given the effectiveness of long-acting and permanent methods of family planning (ILAPMs) in fertility regulation, this paper sought to examine the relationship between contraceptive decision-making and use of ILAPMs among married women in Zambia.MethodsThis paper uses data from the 2007 Zambia Demographic and Health Survey. The analysis is based on married women (15–49) who reported using a method of family planning at the time of the survey. Out of the 7,146 women interviewed, only 1,630 women were valid for this analysis. Cross-tabulations and binary logistic regressions with Chi-square were used to analyse associations and the predictors of use of ILAPMs of contraception, respectively. A confidence interval of .95 was used in determining relationships between independent and dependent variables.ResultsTwo thirds of women made joint decisions regarding contraception and 29% of the women were using ILAPMs. Women who made joint contraceptive decisions are significantly more likely to use ILAPMs than women who did not involve their husband in contraceptive decisions. However, the most significant predictor is the wealth index. Women from rich households are more likely to use ILAPMs than women from medium rich and poor households. Results also show that women of North Western ethnicities and those from Region 3 had higher odds of using ILAPMs than Tonga women and women from Region 2, respectively.ConclusionJoint contraceptive decision-making between spouses is key to use of ILAPMs in Zambia. Our findings have also shown that the wealth index is actually the strongest factor determining use of these methods. As such, family planning programmes directed at increasing use of LAPMs ought to not only encourage spousal communication but should also consider rolling out interventions that incorporate economic empowerment.
Highlights
Zambia’s fertility rate and unmet need for family planning are still high
Joint contraceptive decision-making is an avenue for increasing effective contraceptive use and the last decade has seen an increase in family planning literature that is rich with pronouncements about the role of spousal communication as a mechanism for increasing joint decisions about contraceptive use [5,6,7,8,9,10]
Our analysis further revealed that level of exposure to family planning messages in the media in recent months appeared to be inconsequential on the odds of using ILAPMs of family planning just like hearing about family planning from a health worker within 12 months prior to the survey has no significance on use of long-acting contraceptives
Summary
Zambia’s fertility rate and unmet need for family planning are still high. Given the effectiveness of long-acting and permanent methods of family planning (ILAPMs) in fertility regulation, this paper sought to examine the relationship between contraceptive decision-making and use of ILAPMs among married women in Zambia. Even though women’s autonomy is critical, recent evidence suggests that 10% of women with unmet need for family planning have no access to contraception owing to opposition by partner/ husband [4]. This evidence suggests that there is need to include men in making contraceptive decisions. Joint contraceptive decision-making is an avenue for increasing effective contraceptive use and the last decade has seen an increase in family planning literature that is rich with pronouncements about the role of spousal communication as a mechanism for increasing joint decisions about contraceptive use [5,6,7,8,9,10]
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