Married women's decision-making autonomy on modern contraceptive use and its associated factors in high fertile sub-Saharan Africa countries: a multi-level analysis of Demographic and Health Surveys

BACKGROUND

For better maternal and child health, women's independence on reproductive health issues is crucial; however, couples are restricted from discussing openly with their partner. Regarding this, information about women's decision-making autonomy is low in the world, including Sub-Saharan Africa; therefore, this study was aimed to assess married women's decision-making autonomy on modern contraceptive utilization in high fertility SSA countries.

METHODS

Data for this study was obtained from the most recent (2010-2018) Demographic and Health Surveys. A total of weighted sample of 14,575 married reproductive age women was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of decision-making autonomy on modern contraceptive utilization. Finally, the Adjusted Odds Ratio (AOR) with 95% confidence interval was used to declare as statistical significance.

RESULTS

Overall prevalence of married women decision-making autonomy on modern contraceptive utilization in the high fertile SSA countries is 25.28% (95% CI:18.32%, 32.24%). The factors significantly associated with the decision-making autonomy on modern contraceptive utilization were women's age 25-34 years (AOR = 1.88, 95% CI = 1.84-1.93) and 35-49 years (AOR = 1.90, 95% CI = 1.82-1.92), had media exposure (AOR = 1.13, 95% CI = 1.00- 1.28), Number of alive children, 1-2 (AOR = 2.35, 95% CI = 1.38-4.01), 3-4 (AOR = 2.98, 95% CI = 1.74-5.10), [Formula: see text] 5 (AOR = 2. 82, 95% CI = 1.63-4.86), educational status; primary education (AOR = 1.93, 95% CI = 1.77-2.83), Secondary and higher (AOR = 2.11, 95% CI = 1.78-2.89), Community media exposure (AOR = 1.80, 95% CI = 1.38-2.34), Community level poverty, (AOR = 1.43, 95% CI = 1.09-1.86) and resides in rural (AOR = 0.67, 95% CI = 0.64-0.71).

CONCLUSION

Women's decision-making autonomy on modern contraception utilization in this study was low. Therefore, the government should promote women's autonomy on contraceptive use as an essential component of SRH rights through mass media, with particular attention for, women living in the poorest communities, and those residing in rural settings of the country. Moreover, health professionals should counsel the women about the benefits of using modern contraceptive to help them managing their number of children.

Prevalence of married women's decision-making autonomy on contraceptive use and its associated factors in high fertility regions of Ethiopia: a multilevel analysis using EDHS 2016 data

BACKGROUND

Women's independence in reproductive health is crucial to the health of mothers and children. Couples are, however, restricted from discussing their relationship openly. Regarding this, information about women's decision-making autonomy is low in developing countries including Ethiopia. Therefore, this study was aimed to assess married women's decision-making autonomy on contraceptive use in high fertility regions of Ethiopia.

METHODS

The study was based on secondary data analysis of the Ethiopian Demographic and Health Survey 2016 data. A total weighted sample of 1157 reproductive age women was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of decision making autonomy on contraceptive use. Statistical significance was determined using Adjusted Odds Ratio (AOR) with 95% confidence interval.

RESULTS

Overall prevalence of decision making autonomy on contraceptive use was observed to be 17.2% (15.1, 19.5). Women's age 25-34 (AOR = 3.19; 95% CI:1.55, 6.54), and 35-49 (AOR = 3.59; 95% CI: 1.5, 8.36), secondary and above educational level (AOR = 3.38; 95% CI: 1.07, 10.67), being married before 18 years (AOR = 0.42; 95% CI:0.26, 0.68), being Muslim in religion (AOR = 0.47; 95% CI: 0.23, 0.98), women being in urban area (AOR = 2.73; 95% CI: 1.97, 6.35), and community media exposure (AOR = 1.85; 95% CI: 1.15, 2.48) were associated with decision making autonomy on contraceptive use.

CONCLUSION

Women's decision-making autonomy on contraceptive use in this study was low. Age of mothers, educational status of mothers, age at first marriage, residence, religion, and community media exposure were significant factors. Therefore, the government should promote women's autonomy on contraceptive use as an essential component of reproductive health rights through mass media, educating, with particular attention for, youth women, and women living in rural settings.

Factors associated with short birth interval among reproductive-age women in East Africa

BACKGROUND

Child and maternal mortality continue as a major public health concern in East African countries. Optimal birth interval is a key strategy to curve the huge burden of maternal, neonatal, infant, and child mortality. To reduce the incidence of adverse pregnancy outcomes, the World Health Organization recommends a minimum of 33 months between two consecutive births. Even though short birth interval is most common in many East African countries, as to our search of literature there is limited study published on factors associated with short birth interval. Therefore, this study investigated factors associated with short birth intervals among women in East Africa.

OBJECTIVE

To identify factors associated with short birth intervals among reproductive-age women in East Africa based on the most recent demographic and health survey data.

DESIGN

A community-based cross-sectional study was conducted based on the most recent demographic and health survey data of 12 East African countries. A two-stage stratified cluster sampling technique was employed to recruit the study participants.

METHODS AND ANALYSIS

A total weighted sample of 105,782 reproductive-age women who had two or more births were included. A multilevel binary logistic regression model was fitted to identify factors associated with short birth interval. Four nested models were fitted and a model with the lowest deviance value (-2log-likelihood ratio) was chosen. In the multivariable multilevel binary logistic regression analysis, the adjusted odds ratio with the 95% confidence interval was reported to declare the statistical significance and strength of association between short birth interval and independent variables.

RESULTS

The prevalence of short birth interval in East Africa was 16.99% (95% confidence interval: 16.76%, 17.21%). Women aged 25-34 years, who completed their primary education, and did not perceive the distance to the health facility as a major problem had lower odds of short birth interval. On the contrary, women who belonged to the poorest household, made their own decisions with their husbands/partners or by their husbands or parents alone, lived in households headed by men, had unmet family planning needs, and were multiparous had higher odds of having short birth interval.

CONCLUSION

Nearly one-fifth of births in East Africa had short birth interval. Therefore, it is essential to promote family planning coverage, improve maternal education, and empower women to decrease the incidence of short birth intervals and their effects.

Women’s and male partners’ socio-demographic and economic characteristics associated with contraceptive decision making in Nigeria

Background

Women’s ability to make contraceptive decision can determine their contraceptive use which can improve their reproductive health and career. Improvement in such ability can increase contraceptive prevalence in Nigeria. However, factors that promote contraceptive decision-making among women are scarcely studied. This study examined factors associated with women’s individual or joint contraceptive decision-making in Nigeria.

Methods

Secondary (cross-sectional) data were analysed. The data were extracted from the individual recode file of the 2018 Nigeria Demographic and Health Survey (DHS). Partnered women (i.e., currently married or living with a partner) aged 15–49 years and currently using contraceptives before the survey were considered. They constituted 4,823 in total. Their data were analysed using frequency and percentage distributions of variables, Chi-square tests of independence and multinominal logistic regression.

Results

Findings reveal that 23% (1,125) of women made their own contraceptive decision, nearly 67% (3,213) were joint decision makers, and 10% (491) stated that their male partners had decided for them. The probability of solely making contraceptive decision and being a joint decision maker (relative to being a male partner’s decision) was higher among women above 29 years and aged 30–34 years (than women aged 15–24 years) respectively as well as among the employed (than the unemployed) and among those from Yoruba ethnic group (than their counterparts from Hausa/Fulani/Kanuri/Beri Beri) respectively. The probability of being responsible for contraceptive decision (than being the male partner’s decision) was higher among women from the Igbo group and women whose male partners desired more children (than those with the same number of desired children) respectively. The probability of being the main decision maker (relative to being the male partner) was lower among women in the poorer (RRR = 0.39; 95%CI = 0.21–0.73; p = 0.01), middle (RRR = 0.47; 95%CI = 0.25–0.90; p = 0.02) and richest (RRR = 0.41; 95%CI = 0.20–0.82; p = 0.01) groups respectively, than the poorest women. The probability of being a joint decision maker was higher among women with secondary education (than the uneducated), practised Christianity (than the Muslims/ others), and among those residing in the North West region (than those in North East) respectively. However, the probability of being a joint decision-maker was lower among women whose partners desire more children and those who did not know their partners’ desires.

Conclusions

Women’s age, highest level of education, employment status, wealth index, ethnicity, religion, region of residence and male partners’ desire for children are associated with contraceptive decision making respectively. There is a need for reproductive empowerment interventions in Nigeria that devise effective ways of improving contraceptive decision-making power of partnered women aged 15–24 years, unemployed, in the poorer and richest groups, from the Hausa/Fulani/Kanuri/Beri Beri ethnic group, practising Islam/ other religions, have the same fertility desire as their partners and those who do not know their male partner’s desire for children respectively. Women whose partners desire more children should be empowered to participate effectively in contraceptive decision making.

Prevalence of Contraceptive Non-use Due to Husbands/Partners Influence Among Married Women in Ethiopia: A Multilevel Analysis Using Demographic and Health Survey 2016 Data

Background

In Ethiopia women with their husbands/partners are the decision-makers for contraceptives non-use suffered either due to the consequence of unintended pregnancy or due to the indirect impact of the secret use of contraceptives from their husbands/partners. Despite this challenge, there is a dearth of evidence about the magnitude of husbands/partners' decision-makers on contraceptives n non-used in Ethiopia.

Objective

This study was aimed to assess the magnitude of husbands'/partners decisions on contraceptive non-use and associated factors among married and non-contraceptive user reproductive-age women in Ethiopia.

Methods

The study was conducted based on Ethiopian demographic and health survey 2016 data which was a cross-sectional survey from 18 January 2016 to 27 June 2016. A total weighted sample size of 5,458 married and non-contraceptive user reproductive-age women were taken. A multilevel logistic regression model was used because of the data nature hierarchical, and variables with p ≤ 2 in the bivariable multilevel analysis were taken to multivariable multilevel analysis. Adjusted odds ratio with 95% CI was used to declare both the direction and strength of association and variables with p < 0.05 were considered statistically significant with the outcome variable.

Results

Husband decision-making power on contraceptive non-use was 10.44% [9.65–11.28%]. Husband's educational level higher (adjusted odds ratio (AOR = 2.6; CI 1.4–4.7), being Muslim, protestant, and others in religion (AOR = 2.4; CI 1.7–3.5), (AOR = 2.1; CI 1.4–3.1), (AOR = 4.5; CI 2.3–8.5), respectively, media exposure (AOR = 1.4; CI 1.0–1.8), husband wants more children (AOR = 3.7; CI 2.8–4.8), husband desire did not know (AOR = 1.4; CI 1.1–1.9), information about family planning (AOR = 0.6; CI 0.4–0.8), visited by field worker (AOR = 0.7; CI 0.5–0.9), visited health facility (AOR = 0.6; CI 0.4–0.7), and community husband education high (AOR = 1.6; CI 1.1–2.4) were statistically significant with husband decision making power on contraceptive non-use.

Conclusion

In Ethiopia 1 out of 10 married and non-pregnant women is influenced by their husband/partner's decision-making power of non-use contraceptives. Husband's educational level high, religion (Muslim, protestant, and others), media exposure, husband's desire for children (husband wants more and does not know), and community husband education were variables positively associated with the outcome variable; whereas having information about family planning, visited by field worker, and visited health facility were negatively associated husband decision making power for non-use contraceptive in Ethiopia.

Determinants of contraceptive decision making among married women in Sub-Saharan Africa from the recent Demographic and Health Survey data

BACKGROUND

Different evidence suggested that couples often disagree about the desirability of pregnancy and the use of contraceptives. Increased women's decision-making on contraceptives is identified as a key solution that can change the prevailing fertility and contraceptive utilization pattern in SSA. Therefore, this study aimed to determine determinants of contraceptive decision-making among married women in Sub-Saharan Africa.

METHODS

The data source of this study was the standard demographic and health survey datasets of 33 Sub-Saharan Africa countries. Reproductive age group women aged (15-49 years) currently married who are not pregnant and are current users of contraceptive preceding three years the survey was included from the individual record (IR file) file between 2010 and 2018. Since the outcome variable is composed of polychotomous categorical having multiple-choice, the Multinomial logistic regression (MNLR) model was applied.

RESULTS

A total of 76,516 married women were included in this study. Maternal age 20-35 and 36-49 years were more likely to had decision making on contraceptive use in both women-only and joint (women and husband/partner category (referance = husband/partner) (RRR = 1.2; 95% CI = 1.05-1.41, RRR = 1.18; 1.04-1.33 and RRR = 1.38; 95% CI = 1.17-1.61, RRR = 1.27; 1.11-1.47)] respectively. Married women with higher education were more likely to decide by women-only category on contraceptive use (referance = husband/partner) (RRR = 1.26; 95% CI = 1.06-1.49). Women only decision-making to use contraceptives relative to the husband/partner only decreases by a factor of 0.86 (95% CI = 0.80-0.93) among rural than urban residences. Women only or joint decision making to use contraceptives was 1.25 and 1.35 times more likely relative to husband/partner decision making respectively among women who had work than that of had no work. The relative risk of women's decision to use family planning relative to husband increased among couples who had a marital duration of ≥ 10 years (RRR = 1.14; 95% CI = 1.06-1.22). But it has no significant effect on joint decision making. Respondents found in the richest wealth index category increase the relative risk of joint decision-making relative to husband/partner (RRR = 1.33; 95% CI = 1.20-1.47) compared to the poorest category.

CONCLUSIONS

Decision-making to use contraceptives among married women varies greatly by socio-demographic characteristics. The finding of this study showed that women's age, women educational status, residence, duration of the marriage, family economy, and country income were significantly associated with contraceptive decision-making. Therefore to promote ideal family planning decision making, there is a need to formulate policies and design programs that target women's socio-demographic characteristics and modern contraceptive interventions should be promoted by considering empowering women on decision making.

Spatial Distribution and Determinants of Nonautonomy on Decision Regarding Contraceptive Utilization among Married Reproductive-Age Women in Ethiopia: Spatial and Bayesian Multilevel Analysis

Background

Studies conducted to date in Ethiopia did not explore the spatial distribution, individual-level, and community-level factors affecting women's nonautonomy on decision to use contraceptives. Hence, this study aimed to assess the spatial distribution of women's nonautonomy on decision regarding contraceptive utilization and its determinants in Ethiopia.

Methods

Data were accessed from the Demographic Health Survey program official database website (https://dhsprogram.com). A weighted sample of 3,668 married reproductive-age women currently using contraceptives was included in this analysis. Bayesian multilevel logistic regression models were fitted to identify the determinants of women's nonautonomy on contraceptive utilization. Adjusted odds ratio with 95% credible interval was used to select variables that have a significant effect on nonautonomy on contraceptive utilization.

Results

A high proportion of women with nonautonomy on decision regarding contraceptive utilization was found in northern parts of Southern Nations, Nationalities, and People's Region, Southern parts of Oromia, and Benishangul-Gumuz regions of the country. Overall, 2876 (78.40% (95% CI: 77.0%, 79.7%)) women were nonautonomous on decision regarding contraceptive utilization. In the final model, age from 35–49 (AOR (95% CI) = 0.63 (0.54, 0.72)), living in the richer households (AOR (95% CI) = 0.12 (0.03, 0.26)), being married at 18 years or above (AOR (95% CI) = 0.33 (0.19, 0.57)), and residing in an rural areas (AOR (95% CI) = 1.34 (1.01, 1.71)) and metropolitan regions (AOR (95% CI) = 0.71(0.54, 0.91)) were associated with women's nonautonomy on decision regarding contraceptive utilization.

Conclusions

In Ethiopia, the spatial distribution of women's nonautonomy on decision about contraceptive utilization was nonrandom. More than three-fourths of married reproductive-age women in Ethiopia are nonautonomous on decision regarding contraceptive utilization. Region, residence, current age, age at marriage, and wealth index were statistically associated with women's nonautonomy on decision regarding contraceptive utilization.