Trends in Contraceptive Prevalence in Sub-Saharan Africa: The Roles of Family Planning Programs and Education

Abstract

Background: Since 1960, contraceptive use has risen rapidly in Asia and Latin America reaching prevalence levels among married women of 61 and 69 percent, respectively, by 2015. In contrast prevalence in sub-Saharan Africa reached only 25 percent in 2015. Some countries in Africa have experienced very rapid increases (e.g. Ethiopia, Malawi, Rwanda), while others (e.g. Nigeria) have seen little change. This study examines the causes of these different trends which remain controversial. Methods: The analysis focuses on trends from 1990 to 2015 in 24 sub-Saharan Africa. Countries. Country-level regression analysis (OLS and fixed effects models) are used to estimate the separate impact on prevalence of family planning programs and socioeconomic variables (women's educational attainment, GNI/cap (PPP), percent urban and child mortality). The quality and scope of the government's public family planning program is measured with a new index developed by Bongaarts and Hardee. Findings: First, women's educational attainment and program score are the main determinants of levels of contraceptive prevalence in sub-Saharan countries. Second, the very rapid increases in prevalence in several countries since the 1990s are mainly due to the rapid strengthening of family planning programs and not to an acceleration of education levels. Third, the improvements in family planning programs are directly traceable to increases in government actions including stronger commitment from political leaders and increased funding. Interpretation: Voluntary family programs can increase contraceptive prevalence at all levels of female education. The best programs with prevalence impacts above 30% (relative to no program effort) are found in Zimbabwe, Malawi, Kenya, Rwanda, Zambia and Ethiopia. Without family planning programs prevalence remains low even when education levels have risen substantially. Funding: William and Flora Hewlett Foundation Declaration of Interest: We declare no competing interests.