The social context of adolescent women's use of modern contraceptives in Zimbabwe: a multilevel analysis.

Enock Ngome,Clifford Odimegwu

doi:10.1186/1742-4755-11-64

Enock Ngome, Clifford Odimegwu

Open Access

https://doi.org/10.1186/1742-4755-11-64

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Abstract

BackgroundEfforts aimed at reducing maternal mortality as per the Millennium Development Goal 5 (MDG 5) include reducing early childbearing through increased adolescent contraceptive use. Despite a substantial attempt to study factors influencing adolescent contraceptive use in Sub-Saharan Africa (SSA), few studies have explored the role of community level characteristics on adolescent modern contraceptive use. This study examines the influence of both individual, household and community variables in influencing adolescent contraceptive use in Zimbabwe. This study posits that community characteristics are more critical predictors of adolescent contraceptive use in Zimbabwe than other individual and household characteristics.MethodsData from the 2010/11 Zimbabwe Demographic Health Survey (ZDHS), supplemented by additional data from the Measure DHS consultants were used. A total weighted sample of 457 non-pregnant adolescent women aged 15 to 19 years who had their last sex within 12 months preceding the 2010/11 ZDHS was analysed. Univariate, bivariate and multilevel binary logistic regression analysis were performed using generalized linear mixed models (GLMM).ResultsThe odds of contraceptive use were higher for adolescent women with one or more children ever born (Odds Ratio (OR), 13.6) and for those ever married (OR, 2.5). Having medium and high access to media also increased the odds of using contraceptives (OR, 1.8; 2.1 respectively). At community level, the odds of modern contraceptive use decreased with an increase in the mean number of children ever borne per woman (OR, 0.071), an increase in the mean number of school years per women (OR, 0.4) and an increase in the proportion of women with at least secondary education (OR, 0.5). It however increased with an increase in the proportion of women experiencing at least one problem accessing health care (OR, 2.0). Individual and community level variables considered successfully explained the variation of adolescent contraceptive use across provinces.ConclusionsBoth individual and community characteristics were important predictors of adolescent contraceptive use in Zimbabwe. Reproductive program interventions aimed at increasing adolescent contraceptive use should take into account both individual and community factors. There is need for further research that examines other community characteristics influences that include political and cultural factors.

Highlights

The high rates of early childbearing among women in Sub-Saharan African (SSA) countries continue to be a public health concern
Excluded from the sample included those who reported being pregnant at the time of the Zimbabwe Demographic Health Survey (ZDHS) survey, who did not know the timing of their last sexual activity and those who had their last sex beyond 12 months preceding the survey
The following variables were used to indicate the socioeconomic development at community level; mean number of children ever borne per woman, mean number of years of school for women, proportion of females with at least secondary education, proportion of women with partners approving of use of contraception, contraceptive prevalence rate (CPR), proportion of women accessing antenatal care (ANC) at least once, proportion of women who delivered their last child in a health facility and provincial proportion of women participating in labour force

Summary

Introduction

The high rates of early childbearing among women in Sub-Saharan African (SSA) countries continue to be a public health concern. Childbearing impacts negatively on adolescent women through impairment of their health and that of their offspring [2]. It is associated with increased risk of adverse pregnancy outcomes and infant mortality [3,4,5]. Efforts aimed at reducing maternal mortality as per the Millennium Development Goal 5 (MDG 5) include reducing early childbearing through increased adolescent contraceptive use. This study examines the influence of both individual, household and community variables in influencing adolescent contraceptive use in Zimbabwe. This study posits that community characteristics are more critical predictors of adolescent contraceptive use in Zimbabwe than other individual and household characteristics

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