Differences In Contraceptive Use Research Articles

Usual Source of Care and Contraceptive Use.

A high proportion of people in the United States at risk of unintended pregnancy also have limited primary care access. We pooled data for analyses from separate 2015-2017 and 2017-2019 waves of the National Survey of Family Growth. Multivariable logistic regression was used to estimate associations between the usual source of health care and self-reported use of a comprehensive range of contraceptive options, as well as alignment between patient preference and the current method. Compared with having a private doctor or Health Maintenance Organization, not having a usual source of care was associated with lower odds of using short-term hormonal methods (OR=0.54, 95% CI: 0.40-0.73, for an 11 percentage point lower rate); higher odds of using time-based methods (OR=1.47, 95% CI: 1.10-1.97, for a 6 percentage point higher rate); and higher odds of preferring a contraceptive method other than the one most recently used (OR=1.39, 95% CI: 1.01-1.90, for a 6 percentage point higher probability). Reliance on an emergency department as a usual source of care was not associated with contraceptive use or satisfaction with the method used. Reliance on urgent care was associated only with higher odds of using time-based methods (OR=1.60, 95% CI: 1.03-2.50, for a 7 percentage point higher rate). Clinic-based usual care was not associated with any differences in contraceptive use but was associated with preferring a contraceptive method other than the one most recently used (OR=1.65, 95% CI: 1.21-2.25, for an 8 percentage point higher probability). All sources of usual care can improve contraceptive access.

Contraceptive use in patients with gender dysphoria who were assigned female at birth receiving care at a specialty gender-affirming clinic

BackgroundThe Centers for Disease Control and Prevention (CDC) recommend that all patients, regardless of gender identity or sexual orientation, should be offered family planning and contraceptive options without assumptions of sexual behaviors and pregnancy risk. Current research on family planning services for lesbian, gay, bisexual, transgender, and queer or questioning patients is limited, but patients who are sexual or gender minorities are at increased risk for unintended pregnancy. ObjectivesThe objective of this study was to describe contraceptive use in patients assigned female at birth with gender dysphoria at a gender-affirming primary care clinic. MethodsA retrospective descriptive study was conducted. Patients were included if they were 18 to 44 years old, received care at University of New Mexico Truman Health Services in 2019, were diagnosed with gender dysphoria, and were assigned female at birth. Patients were excluded if they had never developed female reproductive organs. Data were collected from the electronic medical records. Potential differences in contraceptive use based on demographic characteristics, having a family planning discussion, and having a contraceptive use discussion were analyzed using chi-square analyses. Potential predictors of contraceptive use were identified using exploratory forward conditional logistic regression and univariate logistic regression analyses. ResultsA total of 163 patients were included; average age was 26.6 years; 71% identified as male, 5% identified as masculine, and 25% identified as nonbinary. Most patients (92%) were prescribed masculinizing therapy (testosterone). Forty-five (28%) patients had documented contraception use; the most common form was permanent contraception (76%). Most patients (68%) did not have any documented contraindications to contraception based on CDC US Medical Eligibility Criteria for contraceptive use. Of 113 patients with a documented sexual orientation, 45 patients (40%) reported having sex with persons who have a penis; only 13 (29%) of those patients had a documented form of contraception. Family planning discussions were documented for 82% of patients. Family planning discussions that specifically addressed contraception were documented in only 49% of patients. However, the odds of a patient having a documented use of contraception was 9.26 times higher when family planning discussions specifically addressed contraception. ConclusionDocumented contraception use was low in people assigned female at birth of childbearing age receiving care at a gender-affirming clinic. Due to increased risks of unintended pregnancy in this population and the teratogenic nature of testosterone, family planning discussion should also include discussions related to contraception, as this was associated with increased contraception use. Additional research is needed to address potential barriers to contraception use in this population.

Effectiveness of peer-led education intervention on contraceptive use, unmet need and demand among secondary school adolescents in Gedeo Zone, South Ethiopia. A study protocol for cluster randomized controlled trial

BackgroundSchool-based interventions are believed to increase contraceptive use and demand among adolescents. However, there is limited evidence on the effectiveness of peer education in promoting contraceptive use, unmet needs, and demand among adolescents aged 15–19 years. ObjectiveThe purpose of this study protocol will be to evaluate the effect of a peer-led educational intervention on increasing contraceptive use and demand among high school students in the Gedeo Zone of southern Ethiopia. MethodsA single-blind randomized controlled trial will be conducted in 6 randomly selected secondary schools in the Gedeo zone of southern Ethiopia. Two hundred twenty-four participants will be selected and randomly assigned to two groups: an intervention group and a control group. A peer-led educational intervention will be administered to the intervention group for six months. Pre-tested and validated questionnaires will be used to measure contraceptive use, unmet need and contraceptive demand. Generalized estimating equation (GEE) will be used to test the effectiveness of the interventions by examining whether there is any significant difference in contraceptive use, unmet needs, and contraceptive demands between the intervention and control groups. Trial registrationThis trail was registered under Clinical Trials.gov with identifier number PACTR202109586981531.

Low-income women and use of prescribed contraceptives in the context of full health insurance coverage in France, 2019

ObjectiveMajor socioeconomic differences in contraceptive use are observed in high-income countries. Cost is often cited as a main factor to explain these differences but other barriers may also exist. Our aim was to compare prescribed contraceptive use among low-income and non-low-income women in a national context of full health insurance coverage. Study designIn the French national health insurance database, we selected all women (14.8 million) aged 15–49 years living in France in 2019. We compared the prevalence of use of each prescribed contraceptive between low-income and non-low-income women: oral contraceptives, copper intrauterine devices (IUDs), the levonorgestrel intrauterine system (LNG-IUS), and implants. ResultsIn the study population, 11% had a low income. Fewer low-income women used prescribed contraceptives than non-low-income women (36% vs. 46%, p < 0.001). When using a contraceptive, low-income women used a different method: at 20–24 years old, they used less oral contraceptives (60% vs. 77%, p < 0.001) and more implants (22% vs. 9%, p < 0.001), while at 40–44 years, they used less levonorgestrel intrauterine systems (18% vs. 30%, p < 0.001). ConclusionsEven in a national context of free access to medical care for low-income women, they use less and different prescribed contraceptives than non-low-income women. These results could reflect barriers other than financial cost to the use of prescribed contraceptives by low-income women. ImplicationsFinancial barriers need to be removed in order to increase contraceptive use. However, this may not be sufficient and further research should explore barriers that low-income women may encounter in accessing and choosing their contraception.

Effectiveness of peer-led education interventions on contraceptive use, unmet need, and demand among adolescent girls in Gedeo Zone, South Ethiopia. A cluster randomized controlled trial

ABSTRACT Background Peer-led education interventions are assumed to be an effective means of increasing contraceptive utilization and demand in adolescents. However evidence is lacking on whether peer-led education is effective in promoting the demand for and use of contraceptives in adolescent girls, especially in resource-limited settings. Objective The present study evaluated the effectiveness of peer-led education interventions in improving contraceptive use, unmet needs, and demand among sexually active secondary school adolescent girls in Gedeo Zone, South Ethiopia. Methods A single-blinded cluster randomised controlled trial study was performed in six randomly selected secondary schools in the Gedeo Zone, southern Ethiopia. A total of 224 participants were recruited and randomly assigned to the intervention and control groups. The intervention group received peer-led education intervention for six months. A pre-tested and validated questionnaire was used to measure contraceptive use, unmet need, and contraceptive demand. A generalised estimating equation (GEE) model was used to examine the effectiveness of the intervention. Result After six months of intervention, the Differences-in-difference in contraceptive use, unmet need, and contraceptive demand between the intervention and control groups were 25.1%, 7.4%, and 17.7%, respectively. There was a statistically significant difference in contraceptive use [AOR = 8.7, 95% CI: (3.66, 20.83), unmet need for contraceptives [AOR = 6.2, 95% CI: (1.61, 24.36)] and contraceptive demand [AOR = 6.1, 95% CI: (2.43, 15.11)] between the intervention and control groups. Conclusions School-based peer education intervention effectively improved contraceptive use and unmet needs in a low-resource setting and created demand in sexually active adolescent girls. These results support the potential utility of this approach in similar settings for the promotion of contraception use and demand.

P076Contraceptive use by females with chronic medical conditions in a large integrated healthcare system

<h3>Objectives</h3> Females with chronic medical conditions (CMCs) face greater risk of pregnancy complications yet have higher risk of unplanned pregnancy than healthy females. To identify opportunities to optimize care, we investigated differences in contraceptive use among those with CMCs vs. those without these conditions within Kaiser Permanente Mid-Atlantic States (KPMAS). <h3>Methods</h3> We conducted a retrospective cohort study using electronic medical record data. We included females aged 15–44 enrolled within KPMAS between January 1, 2021 and December 31, 2021 without hysterectomy or bilateral oophorectomy. We defined CMCs using the US Medical Eligibility Criteria for Contraceptive Use and identified contraception through ICD-10 and CPT codes for intrauterine device (IUD), implant, female sterilization, and injectables; and pharmacy dispensing data for pills, patches, and rings. Controlling for sociodemographic differences, we used multinomial logistic regression to determine the odds of using each tier of contraception vs. none of the specified tiers for those with CMCs versus those without. <h3>Results</h3> Of 128,340 patients, 13,672 (10.7%) had CMCs with hypertension, diabetes, and sickle cell disease most common. 44% of those with CMCs used one of the specified methods versus 40% of those without (OR, 1.19; 95% CI, 1.15–1.23). Those with CMCs were more likely to be >35yo, Black, and have Medicaid (p<0.01) and to use female sterilization (aOR 1.79, 95% CI 1.66-1.93) or long-acting reversible contraception (aOR 1.32, 95% CI 1.26-1.39). <h3>Conclusions</h3> In our diverse cohort, females with CMCs were more likely to use effective contraception than their healthy counterparts, although there may be room for improvement given their unique health risks.

Gender differentials of contraceptive knowledge and use among youth - evidence from demographic and health survey data in selected African countries.

Improving family planning demand and uptake has both social and economic benefits, including increasing education attainment, reducing poverty and increased participation in the labour force. Also, contraceptive use remains a key driver in Africa to facilitate demographic transition and the demographic dividend. However, numerous challenges have prevented the take-up of contraception across the continent. This is more so the case among African youth that present the lowest levels of contraceptive use in sub-Saharan Africa. Therefore, the objective of this research was to examine gender differences in contraceptive use and knowledge of sexually active young people (15-24 years) in sub-Saharan African countries. This study used data from nine countries in sub-Saharan Africa through the Demographic and Health Surveys (DHSs) of Benin, Democratic Republic of Congo, Lesotho, Namibia, Niger, Rwanda, Senegal, South Africa and Zimbabwe. Data analysis entailed frequency distributions and cross-tabulations to describe the gender-differentiated levels of contraceptive use and knowledge among youth. Additionally, logistic regression showed the gender-specific predictors of contraceptive use for African youth. Our findings present the gender-specific predictors of contraceptive use and will contribute to policy and programme formulation for African countries and organisations that promote contraceptive use.

Contraception claims by medication for opioid use disorder prescription status among insured women with opioid use disorder, United States, 2018

Objective(s)To understand how contraception method use differed between women prescribed and not prescribed medications for opioid use disorder (MOUD) among commercially-insured and Medicaid-insured women. Study DesignIBM Watson Health MarketScan Commercial Claims and Encounters database and the Multi-State Medicaid database were used to calculate the (1) crude prevalence, and (2) adjusted odds ratios (adjusted for demographic characteristics) of using long-acting reversible or short-acting hormonal contraception methods or female sterilization compared with none of these methods (no method) in 2018 by MOUD status among women with OUD, aged 20 to 49 years, with continuous health insurance coverage through commercial insurance or Medicaid for ≥6 years. Claims data was used to define contraception use. Fisher exact test or χ2 test with a P-value ≤ 0.0001, based on the Holm-Bonferroni method, and 95% confidence intervals were used to determine statistically significant differences for prevalence estimates and adjusted odds ratios, respectively. ResultsOnly 41% of commercially-insured and Medicaid-insured women with OUD were prescribed MOUD. Medicaid-insured women with OUD prescribed MOUD had a significantly lower crude prevalence of using no method (71.1% vs 79.0%) and higher odds of using female sterilization (aOR, 1.33; 95% CI: 1.06–1.67 vs no method) than those not prescribed MOUD. Among commercially-insured women there were no differences in contraceptive use by MOUD status and 66% used no method. ConclusionsAmong women with ≥ 6 years of continuous insurance coverage, contraceptive use differed by MOUD status and insurance. Prescribing MOUD for women with OUD can be improved to ensure quality care. ImplicationsOnly two in five women with OUD had evidence of being prescribed MOUD, and majority did not use prescription contraception or female sterilization. Our findings support opportunities to improve prescribing for MOUD and integrate contraception and MOUD services to improve clinical care among women with OUD.

Differentials in Contraceptive Use Among Selected Minority Ethnic Groups in Nigeria.

Ethnicity is one of the critical factors that shape contraceptive use in Nigeria. While there are growing disparities in contraceptive uptake among women of reproductive age in the three major ethnic groups (Hausa, Igbo and Yoruba), not much is known about differentials in contraceptive use among the minority ethnic groups. This study examined differentials in contraceptive use among a sample of 1,072 respondents comprising the Ebira (352), Igala (358) and Okun (361) ethnic groups in Nigeria. Questionnaire was administered to respondents proportionately in the selected minority ethnic groups with six key informant interviews and 12 focus group discussions to generate quantitative and qualitative data among ever-married women. Quantitative data were analyzed at bivariable and multivariable levels. The qualitative data were content-analyzed. Differentials in contraception are shaped by ethnic affiliations and socio-demographic characteristics of couples. The use of modern contraceptives was low among the Ebira (25.7%) and Igala (24.1%) ethnic groups, but high among Okun (67%) women of reproductive age. The odd of using a modern contraceptive is significantly higher among the Okun women (UOR = 5.618, 95% CI 4.068–7.759) than the Ebira and Igala. There is no significant difference between the Ebira and Igala minority ethnic groups on modern contraceptive use. Ethnicity as a factor is not a stand-alone predictor of the use of modern contraception among the study groups, other socio-economic variables such as residence, religion, income and marital status were significant predictors of modern contraceptive use among minority ethnic groups. We suggest introducing reproductive health intervention programmes targeted at sensitizing the minority ethnic groups on effective modern contraceptive use while addressing their specific modern contraceptive need in Nigeria.

Determinants of intention to use family planning methods in the four emerging regions of Ethiopia: an ideation score based assessment

BackgroundIdeation refers to the ideas and views that people hold; it has been identified as an important explanation for differences in contraceptive use within and across countries. This study aimed to identify ideational factors that influence intention to use family planning (FP) methods among women of reproductive age (WRA) in the four emerging regions of Ethiopia.MethodsA quantitative cross-sectional survey of 2891 WRA was carried out in the four emerging regions of Ethiopia. A multistage, stratified systematic random sampling technique was employed to select the study participants. Data were collected by trained enumerators, using tablets equipped with Open Data Kit. To assess the impact of ideation on intention to use FP, the research team used 41 items distributed across five broad ideational factors: contraception awareness, self-efficacy, rejection of myth and rumor, intra-family discussion and family support. Confirmatory factor analysis was employed to test the fit of these items into the five ideational factors. A multiple binary logistic regression analysis was employed to assess the combined effect of these ideational factors with different sociodemographic variables on intention to use contraceptive methods. In all the statistical analysis, a p-value < 0.05 was considered statistically significant.ResultsDifferent proportions of women in the four regions intended to use contraceptives in the future: 74.9% in Benishangul-Gumuz, 50.1% in Gambela, 21.8% in Afar, and 20.1% in Somali. The proportion of women who intended to use contraceptives varied with ideation scores. The multiple binary logistic regression revealed that self-efficacy was an important ideational factor of intention to use contraception in all four regions. Rejection of myth and rumor was also an important factor in all regions except in Somali. Contraception awareness and family support were significant predictors of intention to use contraception in the Afar region only. Intra-family discussion was not found significant in any region.ConclusionsRegional/district health offices should focus on increasing self-efficacy for FP use. Demystifying rumors would contribute to improved intention to use FP among women in Afar, Benishangul-Gumuz, and Gambela regions. Raising contraception awareness and encouraging family support would improve intention to use FP in Afar region.

Identifying inequity in family planning: The Track20 equity tool

Background: With increases in contraceptive use in most countries in the world, within country inequities persist. Equity in family planning does not mean an equal level of contraceptive use among all groups; differences in use of contraception could reflect variation in cultural beliefs and values and therefore not inequity. Methods: Focusing on demand satisfied for modern methods and five dimensions (age, education, geography, parity, and wealth), we map inequities within 15 sub-Saharan African countries and across time. We create a “Concentration of Inequity” to highlight the intersectionality of inequities in family planning and allows for more data informed programming. Results: Inequities exist in all countries included in this analysis, though the range varies substantially. Over 85% of the countries included in this analysis had at least 1 subgroup in the population with demand satisfied 30% or more below the national level of demand satisfied. To help visualize inequities and stimulate discussion, we create an online tool to display multiple aspects of inequity. Conclusions: Using demand satisfied with modern methods to measure inequity for family planning allows us to focus attention on women with desire to delay or limit childbearing. Studying the intersections of demographic factors is fundamental for a deeper understanding of family planning equity.

Pattern of contraceptive use, determinants and fertility intentions among tribal women in Kerala, India: a cross-sectional study

ObjectivesTo assess the pattern of contraceptive use and its determinants, knowledge regarding contraceptives including oral contraceptive pills and fertility intentions among tribal women in the reproductive age group.DesignCommunity-based cross-sectional study.SettingCommunity...

International Migration and Modern Contraceptive Use: A Research Note on African Migrants to France.

This research note presents a multisited analysis of migration and contraceptive use by standardizing and integrating a sample of African migrants in France from six West and Central African countries in the Trajectoires et Origines survey with a sample of women living in the same six African countries in the Demographic and Health Surveys. Descriptive analyses indicate that the contraceptive use of migrants more closely aligns with that of native French women than with that of women from origin countries. In particular, migrants report dramatically higher use of long-acting reversible contraceptives and short-acting hormonal methods and lower use of traditional methods than do women in the countries of origin. Although migrants differ from women in the countries of origin on observed characteristics, including education and family background, reweighting women in the origin countries to resemble migrants on these characteristics does little to explain differences in contraceptive use between the groups. Given that contraceptive use is an important proximate determinant of fertility, our results suggest that contraceptive use should feature more prominently in the dominant demographic paradigms of migrant fertility.

Contraceptive Use and Missed Opportunities for Family Planning Discussions in Women Living with Human Immunodeficiency Virus at an HIV Clinic.

The objective of this study was to examine contraception use and family planning discussions (FPD) in female people living with HIV (PLWH). A retrospective cohort study was conducted. Female PLWH were included if they were 18-44 years and received care in 2019 at an HIV clinic. 74 patients met inclusion; mean age was 35 years, 53% were white. All patients were prescribed antiretroviral therapy. 48.6% of patients had documented FPD. 64.9% of patients were using contraception; sterilization was most common (41.7%). Only five patients had a contraindication to hormonal contraception. No differences in contraception use were observed based on age, race, HIV viral load, number of visits, or past pregnancies. However, patients with documented FPD were more likely to use contraception (OR 4.55; 95% CI 1.35-15.29). Routine FPD and contraception use in female PLWH were low. Rates of sterilization were high in female PLWH. Providing quality family planning services is critical to increase contraception use and selection of the most appropriate contraception form.

Sexting and sexual behaviour in Australian adolescents.

Previous studies have tried to determine the relationship between sexting and risky behaviour to discover whether sexting fits into a deviance or normalcy discourse. This study investigated the relationship between sexting and sexual risk behaviours, contraception use and gender. The design was a cross-sectional analysis of data from the sixth National Survey of Secondary Student and Adolescent Sexual Health, collected in 2018. There were 8263 Australian adolescents (aged 14-18years). Participants were fairly evenly split by gender, and 73% identified as heterosexual. Participants were asked a series of questions about their engagement in sexting, sexual behaviour and sexual health behaviours. A total of 52% of participants had sent a sext in the previous 2months, with most being text-based sexts. Sexters were 3.29times more likely to have engaged in anal or vaginal intercourse, and 2.88times more likely to have gotten pregnant than non-sexters. Sexters (M =2.76) had significantly more partners than non-sexters (M =2.35), t (3763)=-10.99, P X 2 (1)=0.38, P =0.535, or contraceptive use based on sexting status. Sexters are more likely to have engaged in sexual intercourse and have more partners than non-sexters. Sexting is not strongly associated with other risky behaviours. Evidence for differences between sexters and non-sexters in protecting against STIs and pregnancy was not found, as there were no significant differences in contraceptive use.

Contraceptive Use Among Adolescents With and Without Disabilities

PurposeThe aim of this study is to assess contraceptive use at last intercourse among adolescent girls with and without disabilities. MethodsData were from the 2015 and 2017 Oregon Healthy Teens survey, a state-wide representative sample of 11th grade students. Among respondents at risk for unplanned pregnancy (n = 3,702), we estimated the prevalence of contraceptive method used at last intercourse—including intrauterine device, implant, Depo-Provera, oral contraceptive pills, patch, ring, condoms, withdrawal, and emergency contraception—by disability status. We used multivariable Poisson regression to measure the association between disability status and use of any contraceptive. ResultsGirls with disabilities were more likely to report having had intercourse compared to girls without disabilities (49.2% vs. 37.4%). Girls with disabilities were less likely to use oral contraceptive pills (32.8% vs. 36.6%) or condoms (51.9% vs. 59.7%) compared to their non-disabled peers. After adjusting for demographic factors, 92.3% of girls with disabilities reported using any contraceptive method compared to 94.7% of girls without a disability (adjusted prevalence difference −2.6%, 95% CI −.26%, −4.9%; adjusted prevalence ratio .97, 95% CI .95–1.00, p = .03). ConclusionsWe observed high levels of contraceptive use among Oregon high school girls. Still, girls with disabilities were slightly less likely to report contraceptive use compared to their non-disabled peers. Given the high proportion of teens with disabilities who are sexually active, the magnitude of the difference in contraceptive use could be of concern on a national scale and further research is warranted.

Limited detraditionalization of intimacy: Growing socioeconomic differences in contraceptive use at first intercourse in Italy.

This paper investigates links between social inequality and reproductive behavior. It complements the extensive research on the stratification of young adults' life chances in education and the labor market by considering changes over time in the stratification of contraceptive use at first intercourse by parental background. We seek to understand detraditionalization trends in young people's sexually intimate behavior by investigating whether these trends were driven by particular social groups and how they were supported by policy initiatives. We study Italy from 1950 to 2006, which shows strong regional and socioeconomic disparities, and comparatively slow changes in religiosity and gender norms. Data from the "Survey on Italians' Sexual Behavior" (2006) and macro indicators on family planning centers are used. The findings show a steep increase in contraceptive use at first sexual intercourse over time, stratified by parental background, but only for condom use. We did not find that family planning centers intervened in these relationships.

Understanding the needs and use of sexual and reproductive health services among Thai women: a descriptive cross-sectional study in Sweden.

A cross-sectional study using postal questionnaire to all Thai-born women (age 23-60) in Stockholm, residing in Sweden since 2014. The response rate was 52.3% (n= 266). Bivariate and multivariate logistic regression analyses were used. The majority reported a significant need for information related to SRH services. Most of the women using contraception (70%) bought their contraceptives in Thailand. In total, 60% of the women had been HIV-tested at some point in their lives; the majority were tested in Thailand. Women who had been HIV-tested in Thailand were more likely to also have been tested in Sweden. Significant differences in contraception use, participation in contraceptive counselling and having had an HIV test were found between groups of younger and older women. Our findings imply that age is an important factor to understand women's need and use of SRH services in Sweden versus Thailand. Furthermore, women's lack of knowledge and reported need for SRH information needs to be considered when making policies and strategies to increase access to SRH services.

Sexual orientation-related differences in contraceptive use: A brief report based on a cohort of adolescent and young women

ObjectivesTo examine contraceptive methods used by adolescent/young adult women of diverse sexual orientations. Study designWe collected data from 12,902 females, born 1982–1995, from the longitudinal Growing Up Today Study. ResultsCompared to heterosexuals, lesbians were half as likely to use contraceptives; other sexual minority subgroups (e.g., bisexuals) were more likely to use contraceptives, particularly long-acting reversible contraceptives. ConclusionsMany sexual minority women use contraception throughout adolescence/young adulthood, though use is low among lesbians. ImplicationsWith limited contraception use, lesbians miss opportunities for care and need to be brought into the healthcare system in other ways.

Variation in contraceptive prevalence rates in Tanzania: A multilevel analysis of individual and regional determinants

ObjectiveThe aim of this study was to answer two key questions: (1) what are the individual and regional determinants of contraceptive use; and (2) what are the effect(s) of individual and regional variables on regional differences in contraceptive use? Data and methodMultilevel logistic regression was applied on data from the Tanzania Demographic and Health Survey (TDHS) 2010 that allowed us to investigate simultaneously the individual and the regional determinants of contraceptive use and its regional variation. ResultsThere was significant variation in contraceptive use, both between population groups as well as between regions. A higher number of children ever born, urban residence, and a non-manual occupation are characteristics associated with higher odds of a woman using contraceptives. Women who talk about family planning with community-based distribution workers and clinic staff also have higher odds of using contraceptives. The regional differences in the shares of women with a secondary education or above explain a significant portion of the regional variance in contraceptive use. Having secondary education and above is related to lower contraceptive use. ConclusionThis study constitutes a first step towards gaining a better understanding of the macro-level effects on decision-making processes regarding contraceptive use. The regional educational level explains a significant portion of the regional variance in contraceptive use. Implication statementAn advantage of our study over other studies in Tanzania is that we extended the determinants of contraceptive use to include not only individual-level factors, but also regional-level factors.