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Turi E, Mamo Ayana G, Temesgen S, Tafari Shama A, Merga BT, Tolossa T. Determinants of unmet need for contraceptive method among young married women in Ethiopia: Multilevel analysis of Ethiopia Demographic and Health Survey 2016. PLoS One 2024; 19:e0306068. [PMID: 39236003 PMCID: PMC11376545 DOI: 10.1371/journal.pone.0306068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 06/10/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND The notion of unmet need for family planning indicates the gap between women's contraceptive practice and their reproductive intention. Although universal access to sexual and reproductive health services including contraceptive methods is a bedrock for sustainable development goals, the unmet need for contraception is high among young women in low-income countries including Ethiopia. The unmet need for contraception is associated with unintended pregnancy which most of the time end in unsafe abortion. Hence, this study aimed to assess the determinants of unmet need for family planning among young married women in Ethiopia using nationally representative data. METHOD This study utilized secondary data collected in the 2016 Ethiopia Demographic and Health Survey (EDHS). A two-stage cluster sampling method was used. The analysis included a total of 2444 sexually active married young women (15-24 years). Multilevel logistic regression analysis was conducted to identify individual and community level factors associated with unmet need for contraceptives and the results were presented as adjusted odds ratio (AOR) at 95% confidence interval (CI), declaring statistical significance at a p-value <0.05 in all analyses. RESULTS In this study, the prevalence of unmet need for contraceptive method among married young women was 18.4% [95% CI: (16.9, 20.0)]. Female head of the household [AOR: 1.62, CI (1.25, 2.11)], primary level of education [AOR: 1.53, CI: (1.16, 2.03)], family size ≥5 [AOR: 1.53, 95%CI: (1.22, 1.93)], undecided to have child [AOR: 2.86, 95%CI: (1.58, 5.20)] and infecund [AOR: 1.54, 95%CI: (1.08, 2.20)] were factors positively associated with unmet need for family planning. Whereas the odds of unmet need for contraceptive method was lower among women-initiated sex between 15-17 years and >17 years [AOR:0.72, 95%CI (0.53, 0.98)] and [AOR: 0.58, 95%CI: (0.40, 0.85)] respectively and community with high proportion of poverty [AOR: 0.68, 95%CI: (0.46, 0.99)]. CONCLUSION The prevalence of unmet need for contraceptive methods among young married women was relatively high. Being female household head, age at first sexual intercourse, educational status of the woman, family size, desire for more children, and community poverty were significantly associated with unmet need for family planning. Hence, interventions targeting these special populations at the individual and community level would play a paramount role in meeting the unmet need for contraception among young married women in Ethiopia.
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Affiliation(s)
- Ebisa Turi
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Galana Mamo Ayana
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Sidise Temesgen
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Adisu Tafari Shama
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Bedasa Taye Merga
- Department of Public Health and Health Policy, School of Public Health, Haramaya University, Harar, Ethiopia
| | - Tadesse Tolossa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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K. C. SP, Adhikari B, Pandey AR, Pandey M, Kakchapati S, Giri S, Sharma S, Lamichhane B, Gautam G, Joshi D, Dulal BP, Regmi S, Baral SC. Unmet need for family planning and associated factors among currently married women in Nepal: A further analysis of Nepal Demographic and Health Survey-2022. PLoS One 2024; 19:e0303634. [PMID: 38820547 PMCID: PMC11142660 DOI: 10.1371/journal.pone.0303634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 04/30/2024] [Indexed: 06/02/2024] Open
Abstract
INTRODUCTION Family planning (FP) is crucial for improving maternal and newborn health outcomes, promoting gender equality, and reducing poverty. Unmet FP needs persist globally, especially in South Asia and Sub-Saharan Africa leading to unintended pregnancies, unsafe abortions, and maternal fatalities. This study aims to identify the determinants of unmet needs for FP from a nationally representative survey. METHODS We analyzed the data of 11,180 currently married women from nationally representative Nepal Health Demographic Survey 2022. We conducted weighted analysis in R statistical software to account complex survey design and non-response rate. We conducted univariate and multivariable binary and multinomial logistic regression to assess association of unmet need for FP with independent variables including place of residence, province, ecological belt, ethnicity, religion, current age, participant's and husband's education, occupation, wealth quintile, parity, desire for child, and media exposure. RESULTS The total unmet FP need was 20.8% (95%CI: 19.7, 21.9) accounting 13.4% (95%CI: 12.5, 14.4) for unmet need for limiting and 7.4% (95%CI: 6.8, 8.0) for unmet for spacing. Lower odds of total unmet need for FP were present in 20-34 years and 35-49 years compared to <20 years, women belonging to Madhesi ethnic group (AOR: 0.78; 95%CI: 0.64, 0.95) compared to Brahmin/Chhetri, women from richest (AOR: 0.69; 95%CI: 0.56, 0.84), richer (AOR: 0.82; 95%CI: 0.68, 0.97) and middle wealth quintile (AOR: 0.82; 95%CI:0.70, 0.98) groups compared poorest wealth quintile group and women belonging to rural area (AOR: 0.89; 95%CI: 0.80, 0.99) compared to urban area. Higher odds of unmet need for FP were present among women with basic (AOR: 1.34; 95%CI: 1.17, 1.54), and secondary level (AOR: 1.32; 95%CI: 1.12, 1.56) education compared to women without education, among women from Madhesh (AOR: 1.56; 95%CI: 1.22, 1.98), Gandaki (AOR: 2.11; 95%CI: 1.66, 2.68), Lumbini (AOR: 1.97; 95%CI: 1.61, 2.42) and Sudurpashchim province (AOR: 1.64; 95%CI: 1.27, 2.10) compared to Koshi province and among women whose husband education was basic level (AOR:1.37; 95%CI: 1.15, 1.63), or secondary level (AOR: 1.32; 95%CI: 1.09, 1.60) education. CONCLUSION Nepal faces relatively high unmet FP needs across various socio-demographic strata. Addressing these needs requires targeted interventions focusing on age, ethnicity, religion, education, and socio-economic factors to ensure universal access to FP services.
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Affiliation(s)
- Saugat Pratap K. C.
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Bikram Adhikari
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Achyut Raj Pandey
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Merina Pandey
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Sampurna Kakchapati
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Santosh Giri
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Shreeman Sharma
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Bipul Lamichhane
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Ghanshyam Gautam
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Deepak Joshi
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Bishnu Prasad Dulal
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Shophika Regmi
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Sushil Chandra Baral
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
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Osborne A, James PB, Bangura C, Kangbai JB. Exploring the drivers of unmet need for contraception among adolescents and young women in Sierra Leone. a cross-sectional study. Contracept Reprod Med 2024; 9:25. [PMID: 38755669 PMCID: PMC11100234 DOI: 10.1186/s40834-024-00286-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/10/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Sierra Leone grapples with a concerning reality: a high unmet need for contraception among adolescents and young women (AYW). This translates to a multitude of unintended pregnancies, jeopardising their health, education, and overall life trajectory. To effectively address this challenge, we aim to examine the factors associated with the unmet need for contraception among AYW in Sierra Leone. METHODS The study analysed the 2019 Sierra Leone Demographic and Health Survey data. A total of 1,796 married and cohabiting AYW aged 15 to 24 years, representing the nationally representative sample, comprised the study. A multivariable binary regression analysis was used to explore the drivers of unmet needs for contraception. The regression results were presented using an adjusted odds ratio (AOR) with 95% confidence intervals (CI). RESULTS The study found that 29% of Sierra Leonean AYW had an unmet need for contraception. AYW with three or more births(AOR = 6.80, 95% CI = 3.97, 11.65), two births (AOR = 4.11, 95% CI = 2.50, 6.76), one birth (AOR = 4.40, 95% CI = 2.81, 6.88), heard family planning on TV last few months (AOR = 1.94, 95% CI = 0.98, 3.83), and are cohabiting (AOR = 1.88, 95% CI = 1.29, 2.75) had higher odds of unmet need for contraception. AYW who read the newspaper or magazine at least once a week (AOR = 0.11, 95% CI = 0.01, 1.10) had lower odds of unmet need for contraception. CONCLUSIONS The study found a high unmet need among AYW in Sierra Leone, which indicates a significant gap between desired and actual contraceptive use, leading to unintended pregnancies and potentially adverse health and socio-economic consequences. Parity, media exposure and cohabitation were associated with a higher unmet need for contraception and newspaper/magazine readership was associated with a lower unmet need for contraception. The study highlights the need to increase access to affordable and diverse contraceptive options, especially in rural areas. Expand educational campaigns beyond TV to include print media and community-based interventions. Provide AYWs with knowledge and authority to make well-informed decisions around their sexual and reproductive well-being.
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Affiliation(s)
- Augustus Osborne
- Department of Biological Sciences, School of Basic Sciences, Njala University, PMB, Freetown, Sierra Leone
| | - Peter Bai James
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, Australia.
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Camilla Bangura
- Department of Biological Sciences, School of Basic Sciences, Njala University, PMB, Freetown, Sierra Leone
| | - Jia B Kangbai
- Department of Environmental Health, School of Community Health Sciences, Njala University, PMB, Freetown, Sierra Leone
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Kabagenyi A, Wasswa R, Kayemba V. Multilevel mixed effects analysis of individual and community factors associated with unmet need for contraception among married women in four East African countries. SSM Popul Health 2024; 25:101602. [PMID: 38375320 PMCID: PMC10875291 DOI: 10.1016/j.ssmph.2024.101602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 01/03/2024] [Accepted: 01/03/2024] [Indexed: 02/21/2024] Open
Abstract
Background Despite the use of contraceptives being an expression of a woman's reproductive control, the prevalence of unmet need remains high and a public concern among married women in East Africa. However, limited literature has explored the associated factors in the region. We live in age of leaving no one behind unfortunately many women still have unmet for family planning todate. This study therefore intends to examine the individual and community level factors associated with unmet need for contraception among married women in Burundi, Rwanda, Tanzania and Uganda. Methods The study utilizes data from the four recent demographic and health surveys for Burundi, Rwanda, Tanzania and Uganda. Analyses were conducted using multilevel mixed effects logistic regressions with random community and country level effects. Results are reported using predictive probabilities and margins. Results This study revealed that: 20%, 22%, 28% and 33% of the married women in Tanzania, Uganda, Rwanda and Burundi respectively had unmet need for contraception. Younger women, and those: without formal education, from the poorest households, had ever experienced child loss, whose husbands desire more children than them, and have no access to family planning messages faced a higher probability of unmet need for contraception. This was also true for women living in communities with low usage of modern contraception and those in communities where there is an increasing number of children per woman. Conclusions The findings reiterate the need for family planning efforts to focus on younger women. Additionally, improved education, economic empowerment, calls for spousal involvement in family planning matters, support for those with child loss, and comprehensive awareness initiatives remain vital to tackling unmet need for contraception.
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Affiliation(s)
- Allen Kabagenyi
- Department of Population Studies, School of Statistics & Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda
| | - Ronald Wasswa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Complex, Kampala, Uganda
- Center of Excellence for Maternal and Newborn Health, Makerere University School of Public Health, New Mulago Complex, Makerere University, Kampala, Uganda
| | - Vincent Kayemba
- Department of Population Studies, School of Statistics & Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda
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Kebede SD, Mamo DN, Adem JB, Semagn BE, Walle AD. Machine learning modeling for identifying predictors of unmet need for family planning among married/in-union women in Ethiopia: Evidence from performance monitoring and accountability (PMA) survey 2019 dataset. PLOS DIGITAL HEALTH 2023; 2:e0000345. [PMID: 37847670 PMCID: PMC10581455 DOI: 10.1371/journal.pdig.0000345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/11/2023] [Indexed: 10/19/2023]
Abstract
Unmet need for contraceptives is a public health issue globally that affects maternal and child health. Reducing unmet need reduces the risk of abortion or childbearing by preventing unintended pregnancy. The unmet need for family planning is a frequently used indicator for monitoring family planning programs. This study aimed to identify predictors of unmet need for family planning using advanced machine learning modeling on recent PMA 2019 survey data. The study was conducted using secondary data from PMA Ethiopia 2019 cross-sectional household and female survey which was carried out from September 2019 to December 2019. Eight machine learning classifiers were employed on a total weighted sample of 5819 women and evaluated using performance metrics to predict and identify important predictors of unmet need of family planning with Python 3.10 version software. Data preparation techniques such as removing outliers, handling missing values, handling unbalanced categories, feature engineering, and data splitting were applied to smooth the data for further analysis. Finally, Shapley Additive exPlanations (SHAP) analysis was used to identify the top predictors of unmet need and explain the contribution of the predictors on the model's output. Random Forest was the best predictive model with a performance of 85% accuracy and 0.93 area under the curve on balanced training data through tenfold cross-validation. The SHAP analysis based on random forest model revealed that husband/partner disapproval to use family planning, number of household members, women education being primary, being from Amhara region, and previously delivered in health facility were the top important predictors of unmet need for family planning in Ethiopia. Findings from this study suggest various sociocultural and economic factors might be considered while implementing health policies intended to decrease unmet needs for family planning in Ethiopia. In particular, the husband's/partner's involvement in family planning sessions should be emphasized as it has a significant impact on women's demand for contraceptives.
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Affiliation(s)
- Shimels Derso Kebede
- Department of Health Informatics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Daniel Niguse Mamo
- Department of Health Informatics, College of Medicine and health sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Jibril Bashir Adem
- Department of Public Health, College of Medicine and Health Science, Arsi University, Asella, Ethiopia
| | - Birhan Ewunu Semagn
- Department of Public Health, School of Public Health, Asrat Woldeyes Health Science College, Debre Berhan University, Debre Berhan, Ethiopia
| | - Agmasie Damtew Walle
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, Mettu University, Mettu, Ethiopia
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Assefa AA, Selassie SG, Mesele A, Kebede HB, Fikrie A, Abera G. Unmet need for family planning and associated factors among currently married women in Hawella Tulla subcity, Hawassa, southern Ethiopia: community-based study. Contracept Reprod Med 2023; 8:14. [PMID: 36759856 PMCID: PMC9912635 DOI: 10.1186/s40834-022-00212-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 12/19/2022] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The unmet need for family planning remains a major public health concern in developing countries, especially in sub-Saharan Africa. Similarly, in Ethiopia, the unmet need for family planning is considerably high. However information regarding associated factors of unmet need of family planning is limited, the study area in particular. Thus, this study was aimed at assessing unmet family planning and associated factors among currently married women in Hawella Tulla Subcity. METHODS A community based cross-sectional study was employed on 436 currently married women. Both bivariable and multivariable logistic regression model were used and having P-value of < 0.05 was considered as independently associated factors. Strength of association of the variable was described using adjusted odd ratios with their 95% confidence interval. RESULT The overall unmet need for family planning among currently married women was found to be 18.1% (95% CI: 14.5%, 21.8%). Having age of below 18 years at first marriage AOR = 1.95 (95% CI: 1.14, 3.33), woman's not attained formal education AOR = 2.23 (95% CI: 1.02, 4.84), women whose partner had non-supportive for family planning use AOR = 2.32 (95% CI: 1.35, 3.99) and women without media access AOR = 2.13 (95% CI: 1.19, 3.81) were significantly associated with increasing unmet need for family planning. CONCLUSIONS Despite the presence of high family planning services coverage in the study area, the magnitude of unmet need for family planning is still reasonably high. Having age of below 18 years at first marriage, woman's not attained formal education, women whose partner had non-supportive for family planning use and inavailability of media access in the house were found to be associated with high unmet need for family planning. Therefore, efforts are needed to empower women through education, avoiding early marriage and encouraging couple-based family planning interventions. Increasing media access is also advisable intervention.
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Affiliation(s)
- Abiyu Ayalew Assefa
- Department of Public Health, Hawassa College of health science, P.O.Box 84, Hawassa, Ethiopia.
| | - Samson G. Selassie
- grid.192268.60000 0000 8953 2273Hawassa University Student Clinic, Hawassa, Ethiopia
| | - Abebayehu Mesele
- Departement of Public Health, Pharma College Hawassa Campus, PO.Box 67, Hawassa, Ethiopia
| | - Henok Bekele Kebede
- Departement of Public Health, Pharma College Hawassa Campus, PO.Box 67, Hawassa, Ethiopia
| | - Anteneh Fikrie
- Departement of Public Health, Pharma College Hawassa Campus, PO.Box 67, Hawassa, Ethiopia ,grid.472427.00000 0004 4901 9087School of Public Health, Institute of Health, Bule Hora University, PO. Box 144, Bule Hora, Ethiopia
| | - Geleta Abera
- Department of Public Health, Hawassa College of health science, P.O.Box 84, Hawassa, Ethiopia
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Budu E, Ahinkorah BO, Seidu AA, Armah-Ansah EK, Salihu T, Aboagye RG, Yaya S. Intention to use contraceptives among married and cohabiting women in sub-Saharan Africa: a multilevel analysis of cross-sectional data. BMJ Open 2022; 12:e060073. [PMID: 36424119 PMCID: PMC9693891 DOI: 10.1136/bmjopen-2021-060073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To examine the factors associated with intention to use contraceptives among married and cohabiting women in sub-Saharan Africa (SSA). DESIGN Data for the study were extracted from the most recent Demographic and Health Surveys of 29 countries in SSA conducted from 2010 to 2020. We included a total of 180 682 women who were married or cohabiting. Multilevel regression analysis was carried out and the results were presented as adjusted odds ratio (AOR), with 95% confidence interval (CI). SETTING 29 countries in SSA. PARTICIPANTS Women aged 15-49 years in sexual unions. OUTCOME MEASURE Intention to use contraceptives. RESULTS The pooled prevalence of intention to use contraceptives among married and cohabiting women in the 29 countries was 41.46%. The prevalence ranged from 18.28% in Comoros to 71.39% in Rwanda. Intention to use contraceptives was lower among women aged 45-49 (AOR=0.06, 95% CI= 0.05 to 0.07), those with no education (AOR=0.60, 95% CI= 0.58 to 0.61), and primary education (AOR=0.90, 95% CI 0.88 to 0.93), married women (AOR=0.81, 95% CI= 0.79 to 0.84), those of the poorest wealth quintile (AOR=0.78, 95% CI= 0.75 to 0.82), and women who were not exposed to mass media (AOR=0.87, 95% CI= 0.86 to 0.90). Women with four or more births (AOR=2.09, 95% CI= 1.99 to 2.19) had greater likelihood of contraceptive use intention compared to those with no birth. Women in rural settings were found to have greater likelihood of intention to use contraceptives compared to those in urban settings (AOR=1.10, 95% CI= 1.07 to 1.14). CONCLUSION There is a low prevalence of contraceptive use intention among married and cohabiting women in SSA with differences between countries. It is imperative for policymakers to consider these factors when developing and executing contraceptive programmes or policies to enhance contraceptive intents and use among married and cohabiting women. To resolve discrepancies and increase contraceptive intention among women, policymakers and other key stakeholders should expand public health education programmes.
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Affiliation(s)
- Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Bright Opoku Ahinkorah
- School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Abdul-Aziz Seidu
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Ebenezer Kwesi Armah-Ansah
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- Population Dynamics Sexual and Reproductive Health Unit, African Population and Health Research Center, Nairobi, Kenya
- Department of Population and Development, National Research University - Higher School of Economics, Moscow, Russia
| | - Tarif Salihu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Richard Gyan Aboagye
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Healtj, Imperial College London, London, UK
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Sidibé S, Grovogui FM, Kourouma K, Kolié D, Camara BS, Delamou A, Kouanda S. Unmet need for contraception and its associated factors among adolescent and young women in Guinea: A multilevel analysis of the 2018 Demographic and Health Surveys. Front Glob Womens Health 2022; 3:932997. [DOI: 10.3389/fgwh.2022.932997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 10/10/2022] [Indexed: 11/18/2022] Open
Abstract
Despite the recent repositioning efforts to increase the use of modern contraceptives, the prevalence of unmet need for contraception remains high among adolescent and young women in Guinea. This study analyzed the individual and contextual factors associated with the unmet need for contraception among adolescent and young women in 2018 in Guinea. We conducted a secondary analysis of the 2018 Demographic and Health Survey data. Multilevel mixed-effects logistic regression models were used to assess the association between individual and contextual characteristics and unmet need for contraception among adolescents and young women. Adjusted odds ratios (AORs) with their 95% confidence intervals (CIs) were calculated, with statistical significance set at p < 0.05. The prevalence of total unmet need for contraception was 22.6% (95% CI, 18.1–27.8). Being an adolescent aged 15–19 years (AOR = 1.44; 95% CI, 1.01–2.05), unmarried (AOR = 5.19; 95% CI, 3.51–7.67), having one or two children (AOR = 3.04; 95% CI, 2.18–4.25), or more than two children (AOR = 4.79; 95% CI, 3.00–7.62) were individual factors associated with the unmet need for contraception. As for community factors, only living in Labé (AOR = 2.54; 95% CI, 1.24–5.18) or Mamou (AOR = 1.73; 95% CI, 1.21–2.48) was significantly associated with the unmet need for contraception. In conclusion, both individual and community characteristics were significantly associated with the unmet need for contraception. This highlights the need to focus and strengthen communication and counseling strategies targeting adolescents and young women and aiming to increase the uptake of family planning in Guinea.
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Hailu S, Assefa N, Dingeta T, Abdurahman C, Adem M. Unmet need for contraception among married adolescent girls and young women in Haramaya Health and demographic surveillance system, Eastern Ethiopia. Front Glob Womens Health 2022; 3:999860. [PMID: 36420450 PMCID: PMC9678183 DOI: 10.3389/fgwh.2022.999860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/05/2022] [Indexed: 11/02/2023] Open
Abstract
Background The prevalence of unmet need for contraception is the highest in low- and middle-income countries (LMIC). Contraceptive use among young married or unmarried women is lower than that among older women in developing countries. Previous studies generalized the findings to all women of reproductive age and have not investigated psychosocial factors that influence contraceptive use. This study aimed to identify factors associated with unmet need for contraception among young married women in the Haramaya Health and Demographic Surveillance System (HDSS), eastern Ethiopia. Methodology A cross-sectional, community-based study of young married women aged 15-24 years was conducted. A simple random sampling method was used to select 550 young married women. Data were collected using a pretested structured questionnaire. Using adjusted odds ratio (AOR) with a 95% confidence interval (CI), factors associated with unmet need for contraception were identified using multivariable logistic regression analysis. Results The overall prevalence of unmet need for contraception was 154 (30.3%). Adolescents (15-19) (AOR = 2.05, 95% CI: 1.16-3.62), husbands' negative attitude toward contraception (AOR = 2.1, 95% CI: 1.05-4.46), and no previous use of contraception (AOR = 3.9, 95% CI: 2.29-6.71) were significantly and positively associated with unmet need for contraception. On the contrary, young women with secondary education or higher (AOR = 0.55, 95% CI: 0.28-1.084) were negatively and significantly associated with unmet need for contraception. Conclusion The prevalence of unmet need for contraception among young women in Haramaya was high. Unmet need was affected by age, husbands' attitude toward contraceptives, the educational status of women, and previous use of contraception. This study underscored the need to improve girls' educational status to empower them in making contraceptive use decisions with their partners. Programs should also engage male partners who are perceived as key decision-makers when it comes to contraceptive use.
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Affiliation(s)
- Saba Hailu
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Nega Assefa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tariku Dingeta
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Chaltu Abdurahman
- Department of Public Health, College of Health and Medical Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Mewardi Adem
- Department of Public Health, College of Health and Medical Sciences, Dire Dawa University, Dire Dawa, Ethiopia
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Agyekum AK, Adde KS, Aboagye RG, Salihu T, Seidu AA, Ahinkorah BO. Unmet need for contraception and its associated factors among women in Papua New Guinea: analysis from the demographic and health survey. Reprod Health 2022; 19:113. [PMID: 35527266 PMCID: PMC9080214 DOI: 10.1186/s12978-022-01417-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unmet need for contraception is highest in low-and middle-income countries. In Papua New Guinea, about 26% of married women and 65% of unmarried sexually active women have an unmet need for contraception. This study investigated the prevalence and correlates of unmet need for contraception among women in Papua New Guinea. METHODS Data for the study were extracted from the most recent 2016-18 Papua New Guinea Demographic and Health Survey. We included 7950 women with complete data on all variables of interest. Multilevel logistic regression analysis was conducted to examine the factors associated with unmet needs for contraception using four models. Adjusted odds ratios (AOR) and 95% confidence intervals (CIs) were used to present the results of the regression analysis. RESULTS We found that the overall unmet need for contraception was 32.2%. The odds of unmet needs for contraception was higher among cohabiting women [AOR = 1.25, 95% CI = 1.01, 1.56], women with 1-3 births [AOR = 1.57, 95% CI = 1.18, 2.08], and women with 4 or more births [AOR = 1.06, 95% CI = 1.13, 2.27]. Likewise, a higher probability of unmet need was found among women whose partners decided on their healthcare as compared to those who decided on their own healthcare [AOR = 1.35, 95% CI = 1.066, 1.71]. With regards to wealth, the likelihood of unmet contraceptive need decreased with an increase in wealth status. With region, it was found that women in the Mamose region had greater likelihood of unmet contraceptive need compared to those in Southern region [AOR = 1.33, 95% CI = 1.09, 1.63]. CONCLUSION Our study contributes to the discussion on unmet need for contraception in the context of Papua New Guinea. We found the overall prevalence of unmet need for contraception to be relatively high among women in Papua New Guinea. Public health interventions aimed at addressing women's contraception needs should be encouraged so that women can make informed decisions about contraceptive use. These interventions should be implemented taking into consideration significant socio-demographic characteristics of women as identified in this study.
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Affiliation(s)
- Amma Kyewaa Agyekum
- Department of Construction Technology and Management, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kenneth Setorwu Adde
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Richard Gyan Aboagye
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Tarif Salihu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
- Department of Real Estate Management, Takoradi Technical University, P.O.Box 256, Takoradi, Ghana
- Centre for Gender and Advocacy, Takoradi Technical University, P.O. Box 256, Takoradi, Ghana
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Harzif AK, Maidarti M, Handayaning FN, Andyra AF. Factors affecting knowledge regarding unmet need on fertile aged women in Indonesia: evaluation of 2012 and 2017 IDHS. Reprod Health 2022; 19:26. [PMID: 35093108 PMCID: PMC8800337 DOI: 10.1186/s12978-022-01338-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022] Open
Abstract
Background The Family Planning (FP) Program is a national method of controlling population growth rates while improving maternal and child health. Indonesia, as one of the largest countries, has abysmally low contraceptive coverage. One of its main issues is unmet contraceptive needs. This study aims to determine the factors that influence women's unmet need of childbearing age (WCA) in Indonesia. Methods We performed an unpaired comparative analytic study with a cross-sectional method was conducted on secondary data obtained from 2012 to 2017 Indonesia Demographic and Health Survey (IDHS). The subjects in this study were all women of childbearing age (15–49 years). Subjects with incomplete data were excluded from the study. Unmet need was defined as WCA who did not use contraception but decline to have more children or wanted to delay their pregnancies. Chi-square analysis was performed on categorical data and Mann–Whitney U analysis on numerical data. Result A total of 45,607 WCA in the 2012 IDHS data and 29,627 WCA in the 2017 IDHS data were included in the study. In the 2012 IDHS data, factors influencing unmet needs were age (p = 0.023) and parity (p < 0.0001). In the 2017 IDHS data, factors influencing unmet needs were the residential area (p = 0.003), level of education (p = 0.008), level of spouse’s education (p < 0.0001), employment status (p = 0.03), possession of electricity (p = 0.001), and possession of television (p = 0.01). Conclusion Factors affecting unmet needs are age, parity, residential area, level of education, level of spouse’s education, employment status, possession of television, and possession of electricity. There were no recurring factors on 2012 and 2017 IDHS data. The Family Planning (FP) Program is a national method of controlling population growth rates while improving maternal and child health. Indonesia, as one of the largest countries, has abysmally low contraceptive coverage. One of its main issues is unmet contraceptive needs. This study aims to determine the factors that influence women's unmet need of childbearing age (WCA) in Indonesia. An unpaired comparative analytic study with a cross-sectional method was conducted on secondary data obtained from 2012 and 2017 Indonesia Demographic and Health Survey (IDHS). The subjects in this study were all women of childbearing age (15–49 years). Subjects with incomplete data were excluded from the study. Unmet need was defined as WCA who did not use contraception but decline to have more children or wanted to delay their pregnancies. Chi-square analysis was performed on categorical data and Mann–Whitney U analysis on numerical data. A total of 45,607 WCA in the 2012 IDHS data and 29,627 WCA in the 2017 IDHS data were included in the study. In the 2012 IDHS data, factors influencing unmet needs were age and parity. In the 2017 IDHS data, factors influencing unmet needs were the residential area, level of education, level of spouse’s education, employment status, possession of electricity, and possession of television. In conclusion, factors affecting unmet needs are age, parity, residential area, level of education, level of spouse's education, employment status, possession of television, and possession of electricity. There were no recurring factors on 2012 and 2017 IDHS data.
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Girma Garo M, Garoma Abe S, Dugasa Girsha W, Daka DW. Unmet need for family planning and associated factors among currently married women of reproductive age in Bishoftu town, Eastern Ethiopia. PLoS One 2021; 16:e0260972. [PMID: 34871318 PMCID: PMC8648111 DOI: 10.1371/journal.pone.0260972] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background Unmet family planning is one of the common causes for low contraceptive prevalence rates in developing countries, including Ethiopia. Rapid urbanization had profound effect on population health, however, little is known about the unmet need of family planning in settings where there was increased industrializations and internal migrations in Ethiopia. This study aims to determine the unmet need for family planning services among currently married women and identify factors associated with it in Bishoftu town, Eastern Ethiopia. Methods Community-based cross-sectional study was conducted from 1st January to 28th February, 2021 among 847 randomly sampled currently married women of the reproductive age group. Data were collected using semi structured interviewer administered questionnaire. Multivariate logistic regression was used to identify factors associated with the outcome variable and a 95% confidence interval was used to declare the presence of statistical significance associations. Results Eight hundred twenty-eight women were participated in the study. The prevalence of unmet need for family planning among currently married women was 26% [95% CI: 23,29]. Maternal age [AOR, 3.00, 95% CI:1.51–5.95], educational status [AOR, 2.49, 95% CI:1.22–5.07], occupational status of self-employee [AOR, 1.98, 95% CI:1.15–3.39] and housewife [AOR, 1.78, 95% CI:1.02–3.12], being visited by health care provider in the last 12 months [AOR, 1.81, 95% CI: 1.26–2.60] and desired number of children less than two [AOR, 1.53, 95% CI:1.01–2.30] were significantly associated with unmet need for family planning. Conclusions Unmet need for family planning was higher in the study area compared with the United Nations sphere standard of unmet need for family planning and the national average, and slightly lower than the regional average. Socio-demographic, economic, and health institution factors were determinants of the unmet need for family planning in the study area. Therefore, health education and behaviour change communication related to family planning services should be strengthened and access to family planning services should be improved.
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Tomar S, Johns N, Challa S, Brooks MI, Aliou S, Abdoul-Moumouni N, Raj A, Silverman J. Associations of Age at Marriage With Marital Decision-Making Agency Among Adolescent Wives in Rural Niger. J Adolesc Health 2021; 69:S74-S80. [PMID: 34809904 DOI: 10.1016/j.jadohealth.2021.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Child marriage is associated with multiple adverse health and social outcomes. Although evidence suggests that child marriage is associated with reduced participation in personal and household decisions for women, less is known about the association between age at marriage and decision-making among married adolescent girls. This study assesses associations between adolescents' age at marriage and two dimensions of decision-making (participation and satisfaction) in the high early marriage prevalence settings of Niger. METHODS Cross-sectional data from a cluster-randomized control trial of a community-level program to increase the use of modern contraceptives among married adolescents in the Dosso region of Niger were analyzed. Multiple logistic regression models were used to determine the association of age at marriage with married girls' participation in and satisfaction with decision-making processes. RESULTS More than half of married adolescents (N = 796) were married before reaching the age of 15 years. Older age at marriage was associated with adolescents' increased participation in decisions related to economics (adjusted odds ratio: 1.23; 95% confidence interval: 1.05-1.43) and health-care access (adjusted odds ratio: 1.18; 95% confidence interval: 1.01-1.40), but not with greater reported satisfaction with their control over these decisions. CONCLUSIONS The study suggests that marrying as a very young adolescent places girls in even more disadvantaged positions regarding decision-making. These findings indicate the need to design programs targeted at addressing inequitable gender norms to reduce early child marriage and increase participation in decision-making. Further study of satisfaction with participation in decision-making is recommended, including consideration of whether it is related to gender norms for participation in decisions rather than actual participation.
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Affiliation(s)
- Shweta Tomar
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, La Jolla California; Joint Doctoral Program, San Diego State University/University of California San Diego, San Diego, California.
| | - Nicole Johns
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, La Jolla California
| | - Sneha Challa
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, La Jolla California
| | | | | | | | - Anita Raj
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, La Jolla California
| | - Jay Silverman
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, La Jolla California
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Belay HG, Arage G, Degu A, Getnet B, Necho W, Dagnew E, Melkie A, Seid T, Bezie M, Nibret G, Worke MD. Youth-friendly sexual and reproductive health services utilization and its determinants in Ethiopia: A systematic review and meta-analysis. Heliyon 2021; 7:e08526. [PMID: 34934842 PMCID: PMC8661021 DOI: 10.1016/j.heliyon.2021.e08526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/04/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In most developing countries, meeting young people's sexual and reproductive health (SRH) needs remains a problem. Despite policy initiatives and strategic measures aimed at increasing youth utilization of sexual and reproductive health services in Ethiopia, its utilization remains very low. Therefore, this study aimed to assess Ethiopia's youth-friendly sexual and reproductive health services' utilisation and determinants. METHODS Scopus, Medline, Google Scholar, and CINAHL databases were searched for articles published until March 2021. The pooled prevalence and effect size of youth-friendly sexual and reproductive health service use and associated factors were estimated using a weighted DerSimonian-laird random effect model. The I2 statistics were used to determine the degree of heterogeneity. The funnel plot and Egger's regression test were used to examine publication bias. Subgroup analyses were performed to reduce underlying heterogeneity. RESULTS One thousand one hundred and ninety-one articles were generated from various databases, and a final 26 articles were included in the review, including 16246 participants. Ethiopia's pooled prevalence of youth-friendly sexual and reproductive health service utilization was 42.73 % (95% CI: 35.38-50.09). The findings of this study showed that grade level 11-12, grade level 9-10, close to home sexual and reproductive health services, male sex, and discussion of sexual and reproductive health service with family, friends, and groups, ever experience sexual activity were associated with utilization of youth-friendly sexual and reproductive health services. Maternal educational status secondary school and above, age 15-19 years, age 20-24 years, having ever experienced reproductive problems, living with a partner, living alone, knowing about sexual and reproductive health, having a convenient working hour for youth-friendly service, and participation in a school clubs were also associated with the utilization of youth-friendly sexual and reproductive health services. CONCLUSION We found several determinant factors for adolescent and youth utilization of sexual and reproductive health services. The review highlights the importance of improving service usage through youth education and promotion and the scaling up and institutionalizing of youth-friendly services through extensive capacity building.
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Affiliation(s)
- Habtamu Gebrehana Belay
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getachew Arage
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Alemu Degu
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Bekalu Getnet
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Worku Necho
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Enyew Dagnew
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abenezer Melkie
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tigist Seid
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Minale Bezie
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gedefaye Nibret
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mulugeta Dile Worke
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Alem AZ, Agegnehu CD. Magnitude and associated factors of unmet need for family planning among rural women in Ethiopia: a multilevel cross-sectional analysis. BMJ Open 2021; 11:e044060. [PMID: 33837100 PMCID: PMC8043003 DOI: 10.1136/bmjopen-2020-044060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study was aimed to assess the magnitude and associated factors of unmet need for family planning among rural women in Ethiopia. DESIGN Cross-sectional study. SETTING Ethiopia. PARTICIPANTS Reproductive age group women. PRIMARY OUTCOME Unmet need for family planning. METHODS This study drew data from Ethiopian Demographic and Health Survey, which was conducted from 18 January to 27 June 2016. A total of 8327 rural reproductive-aged (15-49 years) women were included. A two-level multivariable logistic regression model was carried out to identify individual and community-level factors associated with unmet need for family planning. Adjusted OR (AOR) with a 95% CI was used to assess the strength of association between independent and dependent variables. RESULTS The overall unmet need for family planning among rural women was 24.08% (95% CI 23.17 to 25.01), of which 14.79% was for spacing and 9.29% for limiting. Number of children (AOR=1.15; 95% CI 1.07 to 1.24) and working status of women (AOR=1.18; 95% CI 1.02 to 1.37) were significantly associated with a higher odds of unmet need for family planning. However, women with primary education (AOR=0.87; 95% CI 0.74 to 0.94), women married at age 18 or later (AOR=0.82; 95% CI 0.70 to 0.96), women from households with high wealth index (AOR=0.77; 95% CI 0.64 to 0.94), women who deem distance to a health facility as not a big problem (AOR=0.85; 95% CI 0.73 to 0.99), women from communities with a high percentage of educated women (AOR=0.73; 95% CI 0.59 to 0.89) and women who live in communities with high media exposure (AOR=0.81, 95% CI 0.68 to 0.98) were significantly associated with a lower odds of unmet needs for family planning. CONCLUSION Unmet need for family planning among reproductive-aged women in rural Ethiopia was high. Number of children, working status of women, women's education, age at first marriage, household wealth, distance to a health facility, community women's education and community media exposure were significantly associated with unmet needs for family planning. Therefore, to reduce unmet need for family planning, public health policymakers should consider both individual and community-level factors when designing FP programmes and emphasis should be given to high-risk populations.
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Affiliation(s)
- Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chilot Desta Agegnehu
- School of Nursing, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
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Ahinkorah BO, Ameyaw EK, Seidu AA, Agbaglo E, Budu E, Mensah F, Adu C, Yaya S. Sexual violence and unmet need for contraception among married and cohabiting women in sub-Saharan Africa: Evidence from demographic and health surveys. PLoS One 2020; 15:e0240556. [PMID: 33141830 PMCID: PMC7608905 DOI: 10.1371/journal.pone.0240556] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 09/28/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Contraception plays a significant role in fertility regulation and determines the reproductive health rights of women. Studies in other parts of the world have found that sexual violence has negative effects on unmet need for contraception. There has not been any study on the association between these two phenomena in sub-Saharan Africa using current nationally-representative survey data. We investigated the association between sexual violence and unmet need for contraception among married and cohabiting women in sub-Saharan Africa. MATERIALS AND METHODS This study was based on secondary datasets from 26 sub-Saharan African countries' Demographic and Health Surveys conducted between 2010 and 2018. A sample of 101,968 women in sexual unions (married and cohabiting) with complete information on sexual violence and all the variables of interest were included in the analyses. Both bivariate and multilevel logistic regression analyses were carried out to examine the association between sexual violence and unmet need for contraception. Other individual and contextual level socio-economic and demographic variables were considered as covariates. Crude odds ratios [cOR] and adjusted odds ratios [aOR] with their corresponding 95% confidence intervals [CI], signifying precision, were presented. Level of statistical significance was declared at p<0.05. RESULTS The overall prevalence of sexual violence and unmet need for contraception in the 26 sub-Saharan African countries were 8.7% and 28.7% respectively. Experience of sexual violence within the last 12 months resulted in 10% increase in unmet need for contraception [OR = 1.10, CI = 1.03-1.14] and 5% increase in unmet need for contraception after controlling for individual and contextual level factors [aOR = 1.05, CI = 1.01-1.11]. With the individual level factors, women with 4 or more births [aOR = 4.85, CI = 4.41-5.33], those cohabiting [aOR = 1.43, CI = 1.37-1.47], those in female headed households [aOR = 1.22, CI = 1.18-1.27] and those who watched television at least once a week [aOR = 1.12, CI = 1.07-1.16] had higher odds of unmet need for family planning. However, those aged 30-34 [aOR = 0.56, CI = 0.52-0.61], those with secondary/higher level of education [AOR = 0.80, CI = 0.77-0.84], those who read newspaper less than once a week [aOR = 0.75, CI = 0.71-0.79] and those who listened to radio at least once a week [aOR = 0.94, CI = 0.90-0.97] had lower odds of unmet need for contraception. In terms of the contextual factors, women in rural areas [aOR = 0.87, CI = 0.84-0.91] and those in the richest wealth quintile households [aOR = 0.80, CI = 0.75-0.85] had lower odds of unmet need for contraception. CONCLUSION Our study has shown an association between sexual violence and unmet need for contraception in sub-Saharan Africa. Experiencing sexual violence increases the likelihood of unmet need for contraception in sub-Saharan Africa. It is also worthy to note that having four or more children, cohabiting with a male partner, and living in female-headed households are some of the key variables associated with unmet need for contraception in sub-Saharan Africa. Our study recommends that, successful contraceptive initiatives should focus on reducing sexual violence, while taking into consideration other significant factors that increase unmet need for contraception. Meanwhile, in doing this, contextual factors ought to be prioritised.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- * E-mail:
| | - Felix Mensah
- Fr. Thomas Alan Rooney Memorial Hospital, Asankrangwa, Western Region, Ghana
| | - Collins Adu
- Department of Health Promotion, and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sanni Yaya
- The George Institute for Global Health, The University of Oxford, Oxford, United Kingdom
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
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Ahinkorah BO, Ameyaw EK, Seidu AA. Socio-economic and demographic predictors of unmet need for contraception among young women in sub-Saharan Africa: evidence from cross-sectional surveys. Reprod Health 2020; 17:163. [PMID: 33097088 PMCID: PMC7585192 DOI: 10.1186/s12978-020-01018-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/15/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction Globally, sub-Saharan Africa (SSA) bears the highest proportion of women with unmet need for contraception as nearly 25% of women of reproductive age in the sub-region have unmet need for contraception. Unmet need for contraception is predominant among young women. We examined the association between socio-economic and demographic factors and unmet need for contraception among young women in SSA. Methods Data for this study obtained from current Demographic and Health Surveys (DHS) conducted between January 1, 2010 and December 31, 2018 in 30 sub-Saharan African countries. The sample size consisted of young women (aged 15–24), who were either married or cohabiting and had complete cases on all the variables of interest (N = 59,864). Both bivariate and multivariable binary logistic regression analyses were performed using STATA version 14.0. Results The overall prevalence of unmet need for contraception among young women was 26.90% [95% CI: 23.82–29.921], ranging from 11.30% [95% CI: 5.1–17.49] in Zimbabwe to 46.7% [95% CI: 36.92–56.48] in Comoros. Results on socio-economic status and unmet need for contraception showed that young women who had primary [aOR = 1.18; CI = 1.12–1.25, p < 0.001] and secondary/higher levels of formal education [aOR = 1.27; CI = 1.20–1.35, p < 0.001] had higher odds of unmet need for contraception compared to those with no formal education. With wealth status, young women in the richest wealth quintile had lower odds of unmet need for contraception compared with those in the poorest wealth quintile [aOR = 0.89; CI = 0.81–0.97, p < 0.01]. With the demographic factors, the odds of unmet need for contraception was lower among young women aged 20–24 [aOR = 0.74; CI = 0.70–0.77, p < 0.001], compared with 15–19 aged young women. Also, young women who were cohabiting had higher odds of unmet need for contraception compared to those who were married [aOR = 1.35; CI = 1.28–1.43, p < 0.001]. Conclusion Our study has demonstrated that unmet need for contraception is relatively high among young women in SSA and this is associated with socio-economic status. Age, marital status, parity, occupation, sex of household head, and access to mass media (newspaper) are also associated with unmet need for contraception. It is therefore, prudent that organisations such as UNICEF and UNFPA and the Bill & Melinda Gates Foundation who have implemented policies and programmes on contraception meant towards reducing unmet need for contraception among women take these factors into consideration when designing interventions in sub-Saharan African countries to address the problem of high unmet need for contraception among young women.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana. .,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.
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Ahinkorah BO. Predictors of unmet need for contraception among adolescent girls and young women in selected high fertility countries in sub-Saharan Africa: A multilevel mixed effects analysis. PLoS One 2020; 15:e0236352. [PMID: 32760153 PMCID: PMC7410238 DOI: 10.1371/journal.pone.0236352] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/03/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Despite the desire of adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) to use contraceptives, the majority of them have challenges with access to contraceptive services. This is more evident in high fertility countries in SSA. The purpose of this study was to examine the predictors of unmet need for contraception among AGYW in selected high fertility countries in SSA. MATERIALS AND METHODS Data from current Demographic and Health Surveys (DHS) carried out between 2010 and 2018 in 10 countries in SSA were analysed. A sample size of 24,898 AGYW who were either married or cohabiting was used. Unmet need for contraception was the outcome variable in this study. The explanatory variables were age, marital status, occupation, educational level, frequency of reading newspaper/magazine, frequency of listening to radio, frequency of watching television and parity (individual level variables) and wealth quintile, sex of household head, place of residence and decision-maker in healthcare (household/community level variables). Descriptive and multilevel logistic regression analyses were carried out. The results of the multilevel logistic regression analyses were reported using adjusted odds ratios at 95% confidence interval. RESULTS The prevalence of unmet need for contraception in all the countries considered in this study was 24.9%, with Angola, recording the highest prevalence of 42.6% while Niger had the lowest prevalence of 17.8%. In terms of the individual level predictors, the likelihood of unmet need for contraception was low among AGYW aged 20-24 [aOR = 0.82; 95% CI = 0.76-0.88], those with primary [aOR = 1.22; 95% CI = 1.13-1.31] and secondary/higher levels of formal education [aOR = 1.18; 95% CI = 1.08-1.28, p < 0.001], cohabiting AGYW [aOR = 1.52; 95% CI = 1.42-1.63] and AGYW with three or more births [aOR = 3.41; 95% CI = 3.02-3.85]. At the household/community level, the odds of unmet need for contraception was highest among poorer AGYW [aOR = 1.36; 95% CI = 1.21-1.53], AGYW in female-headed households [aOR = 1.22; 95% CI = 1.13-1.33], urban AGYW [aOR = 1.21; 95% CI = 1.11-1.32] and AGYW who took healthcare decisions alone [aOR = 1.10; 95% CI = 1.01-1.21]. CONCLUSION This study has identified disparities in unmet need for contraception among AGYW in high fertility countries in SSA, with AGYW in Angola having the highest prevalence. Both individual and household/community level factors predicted unmet need for contraception among AGYW in this study. However, based on the ICC values, household/community level factors prevailed the individual level factors. Enhancing access to contraception among poorer AGYW, those in female-headed households, those in urban areas and those who take healthcare decisions alone by both governmental and non-governmental organisations in high fertility countries is recommended.
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Affiliation(s)
- Bright Opoku Ahinkorah
- The Australian Centre for Population and Public Health Research [ACPPHR], Faculty of Health, University of Technology Sydney, Liverpool, Australia
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