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Socio-demographic and economic inequalities in modern contraception in 11 low- and middle-income countries: an analysis of the PMA2020 surveys.

ABSTRACT: BACKGROUND:Contraception is a key component of sustainable development, empowering women, reducing the risk of maternal and child mortality and promoting economic growth. It is part of the Sustainable Development Goals agenda, where the aim is to achieve universal access to sexual and reproductive health. Our objective was to evaluate trends and inequalities in modern contraceptive prevalence, and according to the type of modern contraceptive, in 11 low- and middle-income countries that are partners of the Family Planning 2020 initiative. METHODS:Analyses were performed using 62 Performance Monitoring and Accountability 2020 (PMA2020) surveys from 11 countries. Forty surveys were nationally representative, while 22 had regional coverage. Regional surveys were analyzed separately, totalizing 15 geographies from 11 countries. We described trends on modern contraceptive prevalence, and its subtypes (short- and long-acting reversible contraceptives, and permanent methods), by calculating absolute average annual changes. Absolute inequalities on the prevalence of modern contraceptives were assessed for the most recent survey of each geography using the slope index of inequality, and according to wealth, education and age. RESULTS:The overall prevalence of modern contraception increased in most geographies analyzed, reaching a 7.2 percentage points increase per year in Lagos, Nigeria. This increase was mostly influenced by the long-acting reversible contraceptives, which increased in 73% of the geographies. Although the largest share of modern contraception is represented by short-acting reversible contraceptives, these are reducing and giving space for the long-acting methods. The exception was Rajasthan, India, where the permanent methods accounted for 70% of the modern contraception share, and their prevalence was almost 40%. Inequalities were identified in favor of richer, older and better educated women. CONCLUSIONS:Out of the 15 geographies analyzed, 11 demonstrated an increase in overall modern contraceptive use - mainly driven by the uptake of long-acting reversible contraception. However, even in the groups with the highest prevalence, modern contraceptive use was at most 60% in most geographies. So, we are far from reaching the desired universal coverage proposed by the Sustainable Development Goals.

SUBMITTER: Blumenberg C

PROVIDER: S-EPMC7268403 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Socio-demographic and economic inequalities in modern contraception in 11 low- and middle-income countries: an analysis of the PMA2020 surveys.

Blumenberg Cauane C Hellwig Franciele F Ewerling Fernanda F Barros Aluísio J D AJD

Reproductive health 20200601 1

<h4>Background</h4>Contraception is a key component of sustainable development, empowering women, reducing the risk of maternal and child mortality and promoting economic growth. It is part of the Sustainable Development Goals agenda, where the aim is to achieve universal access to sexual and reproductive health. Our objective was to evaluate trends and inequalities in modern contraceptive prevalence, and according to the type of modern contraceptive, in 11 low- and middle-income countries that ...[more]

PMID: 32487182

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Project description: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.

Project description:Although many countries are making progress towards achieving the global sustainable development goals, sub-Saharan Africa (SSA) lags behind. SSA bears a relatively higher burden of maternal morbidity and mortality than other regions despite existing cost-effective interventions. This paper assesses antenatal care (ANC) service utilisation among women in the Southern African Development Community (SADC) countries, one of the four SSA regions. Specifically, it assesses socioeconomic inequality in the number of ANC visits, use of no ANC service, between one and three ANC visits and at least four ANC visits, previously recommended by the World Health Organization (WHO). Data come from the most recent Demographic and Health Surveys in twelve SADC countries. Wagstaff's normalised concentration index (CI) was used to assess socioeconomic inequalities. Factors explaining these inequalities were assessed using a standard method and similar variables contained in the DHS data. A positive CI means that the variable of interest is concentrated among wealthier women, while a negative CI signified the opposite. The paper found that wealthier women in the SADC countries are generally more likely to have more ANC visits than their poorer counterparts. Apart from Zambia, the CIs were positive for inequalities in at least 4 ANC visits and negative for between 1 and 3 ANC visits. Women from poorer backgrounds significantly report no ANC visits than wealthier women. Apart from the portion that was not explainable due to limitations in the variables included in the model, critical social determinants of health, including wealth, education and the number of children, explain socioeconomic inequalities in ANC coverage in SADC. A vital policy consideration is not to leave any woman behind. Therefore, addressing access barriers and critical social determinants of ANC inequalities, such as women's education and economic well-being, can potentially redress inequalities in ANC coverage in the SADC region.

Project description:BACKGROUND:Nonuse of contraceptive methods by women in need of contraception may impact their sexual and reproductive health. The aim of this study was to describe the reasons for nonuse of contraception among women with demand for contraception not satisfied in low and middle-income countries (considering both overall countries and various subgroups of women). METHODS:We used the latest Demographic and Health Survey data from 47 countries. A descriptive analysis of the reasons for nonuse of contraceptive methods was performed among sexually active women with demand for contraception not satisfied. The prevalence of each reported reason was also evaluated according to marital status, woman's age and schooling, area of residence, wealth index, and parity. Wealth-related absolute inequality for each reason was also evaluated using the Slope Index of Inequality. A pro-rich inequality pattern means that the reason is more prevalent among the richest women while a pro-poor means the reason is more common among the poorest ones. RESULTS:On average, 40.9% of women in need of contraception were not using any contraceptive methods to avoid pregnancy. Overall, the most prevalent reasons for nonuse of contraceptives were "health concerns" and "infrequent sex," but the prevalence of each reason varied substantially across countries. Nonuse due to "opposition from others" was higher among married than unmarried women; in turn, the prevalence of nonuse due to "lack of access" or "lack of knowledge" was about two times higher in rural areas than in urban areas. Women with less schooling more often reported nonuse due to "lack of access." Pro-rich inequality was detected for reasons "health concerns," "infrequent sex," and "method-related", while the reasons "other opposed," "fatalistic," "lack of access," and "lack of knowledge" were linked to patterns of pro-poor inequality. CONCLUSIONS:Family planning promotion policies must take into account the different reasons for the nonuse of contraceptive methods identified in each country as well as the contextual differences regarding women of reproductive age (such as social norms and barriers that prevent women from accessing and using contraceptives).

Project description:BackgroundLow-income and middle-income countries (LMICs) face a double burden of malnutrition (DBM), whereby overnutrition and undernutrition coexist within the same individual, household, or population. This analysis investigates global inequalities in household-level DBM, expressed as a stunted child with an overweight mother, and its association with economic, social, and political globalisation across country income and household wealth.MethodsWe pooled anthropometric and demographic data for 1 132 069 children (aged <5 years) and their mothers (aged 15-49 years) from 189 Demographic and Health Surveys in 55 LMICs between 1992 and 2018. These data were combined with country-level data on economic, social, and political globalisation from the Konjunkturforschungsstelle Globalisation Index and gross national income (GNI) from the World Bank. Multivariate associations between DBM and household wealth, GNI, and globalisation and their interactions were tested using multilevel logistic regression models with country and year fixed-effects and robust standard errors clustered by country.FindingsThe probability of DBM was higher among richer households in poorer LMICs and poorer households in richer LMICs. Economic globalisation was associated with higher odds of DBM among the poorest households (odds ratio 1·49, 95% CI 1·20-1·86) compared with the richest households. These associations attenuated as GNI increased. Social globalisation was associated with higher odds of DBM (1·39, 95% CI 1·16-1·65), independently of household wealth or country income. No associations were identified between political globalisation and DBM.InterpretationIncreases in economic and social globalisation were associated with higher DBM, although the impacts of economic globalisation were mostly realised by the world's poorest. The economic patterning of DBM observed in this study calls for subpopulation-specific double-duty actions, which should further aim to mitigate the potential negative and unequal impacts of globalisation.FundingUK Biotechnology and Biological Sciences Research Council.TranslationsFor the Spanish and Portuguese translations of the abstract see Supplementary Materials section.

Project description:IntroductionExtant studies universally document a positive gradient between socioeconomic status (SES) and health. A notable exception is the apparent concentration of HIV/AIDS among wealthier individuals. This paper uses data from the Demographic Health Surveys and AIDS Indicator Surveys to examine socioeconomic inequalities in HIV/AIDS prevalence in 24 sub-Saharan African (SSA) countries, the region that accounts for two-thirds of the global HIV/AIDS burden.MethodsThe relative and generalized concentration indices (RC and GC) were used to quantify wealth-based socioeconomic inequalities in HIV/AIDS prevalence for the total adult population (aged 15-49), for men and women, and in urban and rural areas in each country. Further, we decomposed the RC and GC indices to identify the determinants of socioeconomic inequalities in HIV/AIDS prevalence in each country.ResultsOur findings demonstrated that HIV/AIDS was concentrated among higher SES individuals in the majority of SSA countries. Swaziland and Senegal were the only countries in the region where HIV/AIDS was concentrated among individuals living in poorer households. Stratified analyses by gender showed HIV/AIDS was generally concentrated among wealthier men and women. In some countries, including Kenya, Lesotho Uganda, and Zambia, HIV/AIDS was concentrated among the poor in urban areas but among wealthier adults in rural areas. Decomposition analyses indicated that, besides wealth itself (median = 49%, interquartile range [IQR] = 90%), urban residence (median = 54%, IQR = 81%) was the most important factor contributing to the concentration of HIV/AIDS among wealthier participants in SSA countries.ConclusionsFurther work is needed to understand the mechanisms explaining the concentration of HIV/AIDS among wealthier individuals and urban residents in SSA. Higher prevalence of HIV/AIDS could be indicative of better care and survival among wealthier individuals and urban adults, or reflect greater risk behaviour and incidence. Moreover, differential findings across countries suggest that effective intervention efforts for reducing the burden of HIV/AIDS in the SSA should be country specific.

Dataset Information

Socio-demographic and economic inequalities in modern contraception in 11 low- and middle-income countries: an analysis of the PMA2020 surveys.

Publications

Socio-demographic and economic inequalities in modern contraception in 11 low- and middle-income countries: an analysis of the PMA2020 surveys.

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