A hierarchical model of contraceptive use in urban and rural Bangladesh

Prevalence and factors associated with family planning during COVID-19 pandemic in Bangladesh: A cross-sectional study

Background and objectives

The COVID-19 pandemic has negatively impacted health systems worldwide, including in Bangladesh, limiting access to family planning information (FP) and services. Unfortunately, the evidence on the factors linked to such disruption is limited, and no study has addressed the link among Bangladeshis. This study aimed to examine the socioeconomic, demographic, and other critical factors linked to the use of FP in the studied areas during the COVID-19 pandemic.

Methods

The characteristics of the respondents were assessed using a cross-sectional questionnaire survey and descriptive statistics. The variables that were substantially linked with FP usage were identified using a Chi-square test. In addition, a multivariate logistic regression model was used to identify the parameters linked to FP in the study areas during the COVID-19 pandemic.

Results

The prevalence of FP use among currently married 15–49 years aged women was 36.03% suggesting a 23% (approximately) decrease compared to before pandemic data. Results also showed that 24.42% of the respondents were using oral contraceptive pills (OCP) which is lower than before pandemic data (61.7%). Multivariate regression analysis provided broader insight into the factors affecting FP use. Results showed that woman’s age, education level of the respondents, working status of the household head, locality, reading a newspaper, FP workers’ advice, currently using OCP, ever used OCP, husbands’ supportive attitude towards OCP use, duration of the marriage, ever pregnant, the number of children and dead child were significantly associated with FP use in the study areas during COVID-19 pandemic.

Conclusions

This study discusses unobserved factors that contributed to a reduction in FP use and identifies impediments to FP use in Bangladesh during the COVID-19 epidemic. This research further adds to our understanding of FP usage by revealing the scope of the COVID-19 pandemic’s impact on FP use in Bangladesh’s rural and urban areas.

Prevalence and determinants of unmet family planning needs among women of childbearing age in The Gambia: analysis of nationally representative data

Background: Family planning is imperative in the control of population growth by preventing unintended pregnancies and reducing other pregnancy-related risks. However, the effectiveness of family planning is constrained by unmet needs. This study determined the proportion and identify factors associated with unmet family planning needs among women of childbearing age in The Gambia. Methods: We utilized cross-sectional population-based Demographic and Health Survey (DHS) data from Gambian women aged 15-49 years in 2013. The outcome measured was the total unmet/met need for FP.  The sample comprised 10,233 women aged 15-49 years old. Chi-square test and multivariable logistic regression analysis were used. Results: Of the 10,233 eligible women recruited in the study, the mean age was 27.4±9.1 years while 67.5% were married. Overall, 17.6% of women reported unmet FP need, of whom 14.0% and 3.6% reported unmet birth spacing and birth limitation needs, respectively. The women's age, region, ethnicity, number of live children, number of household/family members, the optimal number of children, and husband/partners’ desire for the children were found as significant determinants of unmet FP needs. Furthermore, breastfeeding has been identified as the key reason for the non-use of FP in mothers. Conclusions: The study findings suggest a need to expand FP programs and related strategic communications especially for younger women in order to improve their contraceptive prevalence. Improving women empowerment and accessibility to FP will help to lessen the current trend towards rising unmet needs in The Gambia.

Prevalence and determinants of unmet family planning needs among women of childbearing age in The Gambia: analysis of nationally representative data

Background: Family planning is imperative in the control of population growth by preventing unintended pregnancies and reducing other pregnancy-related risks. However, the effectiveness of family planning is constrained by unmet needs. This study determined the proportion and identify factors associated with unmet family planning needs among women of childbearing age in The Gambia. Methods: We utilized cross-sectional population-based Demographic and Health Survey (DHS) data from Gambian women aged 15-49 years in 2013. The outcome measured was the total unmet/met need for FP.  The sample comprised 10,233 women aged 15-49 years old. Chi-square and multivariable logistic regression analysis were used. Results: Of the 10,233 eligible women recruited in the study, the mean age was 27.4±9.1 years while 67.5% were married. Overall, 17.6% of women reported unmet FP need, of whom 14.0% and 3.6% reported unmet birth spacing and birth limitation needs, respectively. The women's age, region, ethnicity, number of live children, number of household/family members, the optimal number of children, and husband/partners’ desire for the children were found as significant determinants of unmet FP needs. Furthermore, breastfeeding has been identified as the key reason for the non-use of FP in mothers. Conclusions: The study findings suggest a need to expand FP programs and related strategic communications especially for younger women in order to improve their contraceptive prevalence. Improving women empowerment and accessibility to FP will help to lessen the current trend towards rising unmet needs in The Gambia.

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

OBJECTIVE

The 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 METHOD

Multilevel 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.

RESULTS

There 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.

CONCLUSION

This 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 STATEMENT

An 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.

Regional variations of contraceptive use in Bangladesh: A disaggregate analysis by place of residence

This study advances current knowledge on contraceptive use in Bangladesh by providing new insights into the extent of regional variations in contraceptive use across rural and urban areas of Bangladesh. We examined the regional variations in contraceptive use among 15,699 currently married women ages 15-49 years using data from the 2014 Bangladesh Demographic and Health Survey (BDHS). Multivariate logistic regression models of contraceptive use were calibrated with sociodemographic attributes and cultural factors. Based on the aggregate sample (i.e., rural and urban combined), we found significant regional variations in contraceptive use across the administrative divisions in Bangladesh. Based on a disaggregate sample (i.e., rural and urban separately), we found that there were significant differences in divisional variations in contraceptive use in rural areas. In contrast, no significant variation in contraceptive use across divisions in urban areas of Bangladesh was found. More specifically, among women living in rural areas, the Rajshahi and Rangpur divisions had higher odds of contraceptive use than the Barisal division, whereas the Chittagong and Sylhet divisions had much lower odds of contraceptive use even after adjusting for selected sociodemographic attributes and cultural factors. A separate analysis of the divisional variations in usage of modern methods of contraception also revealed similar findings with only one exception. Findings of this study provide an evidence-based direction for adapting a pragmatic approach to reducing the divisional disparity of contraceptive use in rural areas of Bangladesh.

Identifying factors influencing contraceptive use in Bangladesh: evidence from BDHS 2014 data

Background

Birth control is the conscious control of the birth rate by methods which temporarily prevent conception by interfering with the normal process of ovulation, fertilization, and implantation. High contraceptive prevalence rate is always expected for controlling births for those countries that are experiencing high population growth rate. The factors that influence contraceptive prevalence are also important to know for policy implication purposes in Bangladesh. This study aims to explore the socio-economic, demographic and others key factors that influence the use of contraception in Bangladesh.

Methods

The contraception data are extracted from the 2014 Bangladesh Demographic and Health Survey (BDHS) data which were collected by using a two stage stratified random sampling technique that is a source of nested variability. The nested sources of variability must be incorporated in the model using random effects in order to model the actual parameter effects on contraceptive prevalence. A mixed effect logistic regression model has been implemented for the binary contraceptive data, where parameters are estimated through generalized estimating equation by assuming exchangeable correlation structure to explore and identify the factors that truly affect the use of contraception in Bangladesh.

Results

The prevalence of contraception use by currently married 15–49 years aged women or their husbands is 62.4%. Our study finds that administrative division, place of residence, religion, number of household members, woman’s age, occupation, body mass index, breastfeeding practice, husband’s education, wish for children, living status with wife, sexual activity in past year, women amenorrheic status, abstaining status, number of children born in last five years and total children ever died were significantly associated with contraception use in Bangladesh.

Conclusions

The odds of women experiencing the outcome of interest are not independent due to the nested structure of the data. As a result, a mixed effect model is implemented for the binary variable ‘contraceptive use’ to produce true estimates for the significant determinants of contraceptive use in Bangladesh. Knowing such true estimates is important for attaining future goals including increasing contraception use from 62 to 75% by 2020 by the Bangladesh government’s Health, Population & Nutrition Sector Development Program (HPNSDP).

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5098-1) contains supplementary material, which is available to authorized users.

Joint modeling of correlated binary outcomes: The case of contraceptive use and HIV knowledge in Bangladesh

Recent advances in statistical methods enable the study of correlation among outcomes through joint modeling, thereby addressing spillover effects. By joint modeling, we refer to simultaneously analyzing two or more different response variables emanating from the same individual. Using the 2011 Bangladesh Demographic and Health Survey, we jointly address spillover effects between contraceptive use (CUC) and knowledge of HIV and other sexually transmitted diseases. Jointly modeling these two outcomes is appropriate because certain types of contraceptive use contribute to the prevention of HIV and STDs and the knowledge and awareness of HIV and STDs typically lead to protection during sexual intercourse. In particular, we compared the differences as they pertained to the interpretive advantage of modeling the spillover effects of joint modeling HIV and CUC as opposed to addressing them separately. We also identified risk factors that determine contraceptive use and knowledge of HIV and STDs among women in Bangladesh. We found that by jointly modeling the correlation between HIV knowledge and contraceptive use, the importance of education decreased. The HIV prevention program had a spillover effect on CUC: what seemed to be impacted by education can be partially contributed to one's exposure to HIV knowledge. The joint model revealed a less significant impact of covariates as opposed to both separate models and standard models. Additionally, we found a spillover effect that would have otherwise been undiscovered if we did not jointly model. These findings further suggested that the simultaneous impact of correlated outcomes can be adequately addressed for the commonality between different responses and deflate, which is otherwise overestimated when examined separately.

Scaling up contraceptives use in the division with lowest contraceptives use in Bangladesh: sources, methods, and determinants

BACKGROUND

Total fertility rate (TFR) is high and at a static level for the last two decades in Bangladesh. Reduction of fertility by increasing contraceptives use could reduce maternal and neonatal mortality. To achieve the targeted contraceptive prevalence rate (CPR) of Family Planning 2020 (FP2020) Initiative, it is important to increase CPR in all regions of the country. However, it is lower in Sylhet Division compared to other divisions in Bangladesh. This study looked into the methods, source and determinants of contraceptives use in this division.

METHODS

Data from the Bangladesh Demographic and Health Survey 2014 (BDHS 2014) were analyzed. After reporting the sources of obtaining contraceptives and choice of methods, distributions of contraceptives use were reported by selected characteristics. Logistic regression was applied to calculate the odds ratios.

RESULTS

A total of 599 women were analyzed. CPR was lower in rural areas compared to urban areas, 45.4% and 58.5%, respectively. The majority of the women received services from governmental sectors. The birth control pill was the most common contraceptive method. The proportion of women using long-acting permanent methods was low (<10%) in both urban and rural areas. In the multivariate analyses, number of alive children (adjusted odds ratio (AOR) of ≥5 children: 1.6, 95% confidence interval (CI): 1.1-2.2), presence of a male child (AOR: 1.7; 95% CI: 1.1-2.6), higher education level of the husband (AOR: 1.7; 95% CI: 1.1-2.6), receiving a visit from a family planning worker (AOR: 2.4; 95% CI: 1.6-3.4) and membership in a non-governmental organization (AOR:1.4, 95% CI: 1.1-1.8) were positively associated with contraceptives use in Sylhet after controlling for age, education level and other contextual factors. Conversely, rural women had the lower likelihood of using contraceptives (AOR: 0.6; 95% CI: 0.4-0.8) than urban women. Women's education level and religion were not statistically significant.

CONCLUSIONS

A comprehensive strategy is required for this division to address multiple factors which simultaneously influence contraceptives use. In addition to more awareness programs to increase contraceptives use, providing contraceptive distribution services through family planning workers, involving women with non-governmental organizations and prioritizing rural areas could increase contraceptives use in Sylhet Division.

WOMEN'S EMPOWERMENT AND FAMILY PLANNING: A REVIEW OF THE LITERATURE

This paper reviews the literature examining the relationship between women's empowerment and contraceptive use, unmet need for contraception and related family planning topics in developing countries. Searches were conducted using PubMed, Popline and Web of Science search engines in May 2013 to examine literature published between January 1990 and December 2012. Among the 46 articles included in the review, the majority were conducted in South Asia (n=24). Household decision-making (n=21) and mobility (n=17) were the most commonly examined domains of women's empowerment. Findings show that the relationship between empowerment and family planning is complex, with mixed positive and null associations. Consistently positive associations between empowerment and family planning outcomes were found for most family planning outcomes but those investigations represented fewer than two-fifths of the analyses. Current use of contraception was the most commonly studied family planning outcome, examined in more than half the analyses, but reviewed articles showed inconsistent findings. This review provides the first critical synthesis of the literature and assesses existing evidence between women's empowerment and family planning use.

Women's household decision-making autonomy and contraceptive behavior among Bangladeshi women

BACKGROUND

Women's autonomy is a potentially important but less studied indicator of using contraception among women as well as ability to control their fertility. This study explores women's decision-making autonomy as a potential indicator of the use of contraception in Bangladesh.

METHODS

This cross-sectional study utilizes data from the Bangladesh Demographic Health Survey (BDHS) 2007. Information of 8456 currently married and non-pregnant women aged 15-40 years are analyzed to meet up the objective of this study.

RESULTS

The mean age of the respondents is 27.19 years and majority of the respondents are from rural areas (62.7%) and also Muslim (90.2%). A large number of women (26.1%) and their husbands (29.0%) have no education and 27.2% respondents were working at the time of interview. The mean number of living children is 2.14. 48.9% of the respondents are currently using a modern method of contraception. More than one-third women are not involved in their household decision-making. Results of this study indicate that household decision-making autonomy is significantly associated with current use of modern contraception, future intention to use contraception and discuss contraception with husband. This measure of women's autonomy provides additional independent explanatory power of contraceptive behavior net of some other socio-demographic variables.

CONCLUSION

This study argues in favor of increasing women's autonomy to increase contraception using rate in this population.

Socioeconomic factors associated with contraceptive use and method choice in urban slums of Bangladesh

This article explores the socioeconomic factors affecting contraceptive use and method choice among women of urban slums using the nationally representative 2006 Bangladesh Urban Health Survey. Both bivariate and multivariate statistical analyses were applied to examine the relationship between a set of sociodemographic factors and the dependent variables. Overall, the contraceptive prevalence rate was 58.1%, of which 53.2% were modern methods. Women's age, access to TV, number of unions, nongovernmental organization membership, working status of women, number of living children, child mortality, and wealth index were important determinants of contraceptive use and method preference. Sex composition of surviving children and women's education were the most important determinants of contraceptive use and method choice. Programs should be strengthened to provide nonclinical modern methods free of cost among the slum dwellers. Doorstep delivery services of modern contraceptive methods may raise the contraceptive prevalence rate among the slum dwellers in Bangladesh.

Socio-demographic factors influence contraception use among female students of the University of Novi Sad (Serbia)

OBJECTIVES

To identify some of the socio-demographic factors that influence the use of contraception among female university students and to gain a deeper insight into their contraceptive behaviour.

METHODS

The study encompassed 597 randomly chosen, sexually active, second- and third-year female students of the University of Novi Sad (Serbia). The questionnaire, specially designed for the purpose of this investigation, covered a number of socio-demographic factors that could presumably influence the contraceptive behaviour of the polled students.

RESULTS

Statistically significant differences among the respondents with respect to contraception use appeared to be: mother's education, presence of an elder sibling in the family, motivation for engaging in sexual intercourse, talking with friends, as well as self-assessment of the knowledge about contraception.

CONCLUSION

The identified socio-demographic factors that influence the contraceptive behaviour of female students should allow to devise appropriate strategies for the promotion of the use of contraception by this young population.

Rural and urban Midwestern United States contraception practices

To address a paucity of demographic data on rural United States contraception practices, 370 randomly selected menstruating women, age 13-55 years, living in rural and urban Illinois and Missouri answered interview questions. Women with relatively few children and living in urban areas were likely to practice contraception more than those with relatively few children and living in rural areas, p < 0.01. In Illinois, more rural (23%) than urban (2%) women chose sterilization, p < 0.01. Single status was more frequent in Chicago (41%) and rural Missouri (32%) than in rural Illinois (19%), p < 0.002, and extant research links single status with risk for HIV and other sexually transmitted diseases (STDs). Condom use did not differ significantly by locale, p > 0.05. Urban-rural differences in contraception practices may be a function of life style choices (e.g. urban women may practice contraception to postpone having children, whereas rural women may practice contraception to prevent having more children after families are complete). Results do not strongly support that locale differences in contraception practices are a function of concern about contracting STDs.

Dimensions of women's autonomy and the influence on maternal health care utilization in a north Indian city

The dimensions of women's autonomy and their relationship to maternal health care utilization were investigated in a probability sample of 300 women in Varanasi, India. We examined the determinants of women's autonomy in three areas: control over finances, decision-making power, and freedom of movement. After we control for age, education, household structure, and other factors, women with closer ties to natal kin were more likely to have greater autonomy in each of these three areas. Further analyses demonstrated that women with greater freedom of movement obtained higher levels of antenatal care and were more likely to use safe delivery care. The influence of women's autonomy on the use of health care appears to be as important as other known determinants such as education.