Dataset Information

Wealth-related inequalities in demand for family planning satisfied among married and unmarried adolescent girls and young women in sub-Saharan Africa.

ABSTRACT:

Background

The use of modern contraception has increased in much of sub-Saharan Africa (SSA). However, the extent to which changes have occurred across the wealth spectrum among adolescents is not well known. We examine poor-rich gaps in demand for family planning satisfied by modern methods (DFPSm) among sexually active adolescent girls and young women (AGYW) using data from national household surveys.

Methods

We used recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys to describe levels of wealth-related inequalities in DFPSm among sexually active AGYW using an asset index as an indicator of wealth. Further, we used data from countries with more than one survey conducted from 2000 to assess DFPSm trends. We fitted linear models to estimate annual average rate of change (AARC) by country. We fitted random effects regression models to estimate regional AARC in DFPSm. All analysis were stratified by marital status.

Results

Overall, there was significant wealth-related disparities in DFPSm in West Africa only (17.8 percentage points (pp)) among married AGYW. The disparities were significant in 5 out of 10 countries in Eastern, 2 out of 6 in Central, and 7 out of 12 in West among married AGYW and in 2 out of 6 in Central and 2 out of 9 in West Africa among unmarried AGYW. Overall, DFPSm among married AGYW increased over time in both poorest (AARC = 1.6%, p < 0.001) and richest (AARC = 1.4%, p < 0.001) households and among unmarried AGYW from poorest households (AARC = 0.8%, p = 0.045). DPFSm increased over time among married and unmarried AGYW from poorest households in Eastern (AARC = 2.4%, p < 0.001) and Southern sub-regions (AARC = 2.1%, p = 0.030) respectively. Rwanda and Liberia had the largest increases in DPFSm among married AGYW from poorest (AARC = 5.2%, p < 0.001) and richest (AARC = 5.3%, p < 0.001) households respectively. There were decreasing DFPSm trends among both married (AARC = - 1.7%, p < 0.001) and unmarried (AARC = - 4.7%, p < 0.001) AGYW from poorest households in Mozambique.

Conclusion

Despite rapid improvements in DFPSm among married AGYW from the poorest households in many SSA countries there have been only modest reductions in wealth-related inequalities. Significant inequalities remain, especially among married AGYW. DFPSm stalled in most sub-regions among unmarried AGYW.

SUBMITTER: Mutua MK

PROVIDER: S-EPMC8210345 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background: Around 80% of the African population lives in urban areas, and a rapid urbanization is observed in almost all countries. Urban poverty has been linked to several sexual and reproductive health risks, including high levels of unintended pregnancies. We aim to investigate wealth inequalities in demand for family planning satisfied with modern methods (mDFPS) among women living in urban areas from African countries. Methods: We used data from 43 national health surveys carried out since 2010 to assess wealth inequalities in mDFPS. mDFPS and the share of modern contraceptive use were stratified by groups of household wealth. We also assessed the ecological relationship between the proportion of urban population living in informal settlements and both mDFPS and inequalities in coverage. Results: mDFPS among urban women ranged from 27% (95% CI: 23-31%) in Chad to 87% (95% CI: 84-89%) in Eswatini. We found significant inequalities in mDFPS with lower coverage among the poorest women in most countries. In North Africa, inequalities in mDFPS were identified only in Sudan, where coverage ranged between 7% (95% CI: 3-15%) among the poorest and 52% (95% CI: 49-56%) among the wealthiest. The largest gap in the Eastern and Southern African was found in Angola; 6% (95% CI: 3-11%) among the poorest and 46% (95% CI: 41-51%) among the wealthiest. In West and Central Africa, large gaps were found for almost all countries, especially in Central African Republic, where mDFPS was 11% (95% CI: 7-18%) among the poorest and 47% (95% CI: 41-53%) among the wealthiest. Inequalities by type of method were also observed for urban poor, with an overall pattern of lower use of long-acting and permanent methods. Our ecological analyses showed that the higher the proportion of the population living in informal settlements, the lower the mDFPS and the higher the inequalities. Conclusion: Our results rise the need for more focus on the urban-poorer women by public policies and programs. Future interventions developed by national governments and international organizations should consider the interconnection between urbanization, poverty, and reproductive health.

Project description:BackgroundDemand for family planning met/satisfied with modern contraceptive methods (mDFPS) has been proposed to track progress in Family Planning (FP) programs for Sustainable Development Goals. This study measured mDFPS among married women of reproductive age (MWRA) in Kenya to identify which groups were not being reached by FP programs.Materials and methodsPerformance, Monitoring and Accountability 2020 (PMA2020) survey data from 2014-2018 was used. PMA2020 surveys are cross-sectional including women 15-49 years. PMA2020 used a 2-stage cluster design with urban/rural regions as strata with random selection of households. Univariate and multivariate analysis was done using stata V15.ResultsOf the 34,832 respondents interviewed from 2014 to 2018, 60.2% were MWRA. There was a significant decrease in demand for FP from 2014 to 2018, p = 0.012. Lowest demand was among 15-19 and 45-49 years old women. Overall, modern contraceptive prevalence rate increased significantly from 54.6% to 60.8%, p = 0.004, being higher for women from urban areas, home visits by health care worker (HCW), educated, wealthy, visited health facilities and exposed to mass media. Unmet need for FP decreased from 23.0-13.8% over the 5-years, p<0.001. Married adolescent 15-19 had the highest unmet need and those from rural areas, poor, uneducated and not exposed to mass media. mDFPS increased significantly from 69.7-79.4% over the 5-years, p<0.001, with increase in long acting reversible contraception/permanent methods from 19.9-37.2% and decrease in short acting methods from 49.9-42.2%. Significant determinants of mDFPS were age, rural/urban residence, education, wealth, health facility visitation, exposure to FP messages via mass media in the last 12 months, year of study and county of residence.ConclusionsResults show a good progress in key FP indicators. However, not all MWRA are being reached and should be reached if Kenya is to achieve the desired universal health coverage as well as Sustainable Development Goals. Targeted home visits by HCW as well increase in mass media coverage could be viable interventions.

Project description:BACKGROUND:A novel indicator, 'percentage of women of reproductive age who are sexually active and who have their demands for FP satisfied with modern contraceptive methods (mDFPS)', was developed in 2012 to accelerate the reduction of unmet needs of family planning (FP). In Jordan, unmet needs for modern contraception remain high. To address this situation, this study measured the mDFPS and identified its associated factors in rural Jordan. METHODS:This cross-sectional study included married women of reproductive age (15-49 years) from ten villages in Irbid Governorate, Jordan, where advanced health facilities are difficult to reach. A two-stage stratified sampling with random sampling at the household stage was used for this field survey which was conducted between September and October 2016. Univariate analysis was used to assess the differences between mDFPS and unmet mDFPS groups. Logistic regression analysis was performed to identify the correlates of mDFPS. RESULTS:Of 1019 participants, 762 were identified as needing modern contraception. mDFPS coverage accounted for 54.7%. The most significant factors associated with mDFPS were the husband's agreement on FP (adjusted odds ratio [AOR]: 15.43, 95% confidence interval [CI]: 5.26-45.25), knowledge of modern contraceptives (AOR: 8.76, 95% CI: 5.72-13.40), and lack of awareness of the high risk of conception in the postpartum period (AOR: 2.21, 95% CI: 1.41-3.47). Duration of current residence, receipt of FP counselling at health centres and number of living children were also correlated. In addition, 95.3% of local women were aware of the presence of health centres that were mostly located in a 10-minute walking distance. CONCLUSION:To increase mDFPS, this study suggested that accelerating male involvement in FP decision-making is necessary through community-based health education. Furthermore, expanding FP services in village health centres and improving the quality of FP counselling in public health facilities are required to correct misconceptions about modern methods among rural women.

Project description:BackgroundGiven the health and economic benefits of family planning (FP), Nigeria's very low demand for FP satisfied by modern methods (mDFPS) of less than 50% is therefore a major public health concern, especially considering the global target aimed at achieving an mDFPS of at least 75% by year 2030 for all countries. In view of this, together with recognising the possible contextual nature of health outcomes, this study aimed to empirically analyse the mDFPS among married or in-union women of reproductive age (WRA) in Nigeria.Materials and methodsA multilevel binomial logistic model with two levels of analysis was used: individual and community levels. Secondary cross-sectional data were obtained from the 2018 Nigeria Demographic and Health Survey, and analyses were performed using Stata 15.0. The analytical sample size was 9,122 WRA nested in a total of 1,072 communities.ResultsThe mDFPS was approximately 31.0%. The median odds ratio (MOR) estimated from the final multilevel model was 2.245, which was greater than the adjusted odds ratio (aOR) for most of the individual-level variables, suggesting that the unexplained/residual between-community variation in terms of the odds of women having their mDFPS was more relevant than the regression effect of most of the individual-level variables. This was with the exception of the regression effects of the following individual-level variables: women's husbands that had higher education level in comparison to their counterparts who had husbands with no formal education (aOR = 2.539; 95% CI = 1.896 to 3.399; p<0.001); and women from the Yoruba ethnic group in comparison to their counterparts from the Hausa/Fulani/Kanuri ethnic group (aOR = 2.484; 95% CI = 1.654 to 3.731; p value<0.001). However, other individual-level variables with positive statistically significant regression effects on mDFPS were: women who mentioned that money for accessing health care was not a problem; women's empowerment in relation to the visitation of family and relatives; and women being exposed to FP messages through various media sources, all in comparison to their respective counterparts. On the other hand, at the community level, women in communities where a high percentage of them had at least a secondary education had statistically significant greater odds of having mDFPS than women in communities with lower education levels (aOR = 1.584; 95% CI = 1.259 to 1.991; p<0.001). We found similar findings regarding women residing in communities with exposure to FP messages through various media sources. However, using the 80% interval ORs (80% IORs) as a supplemental statistical measure for further understanding the regression effects of community-level variables showed that all of the 80% IORs had a value of '1', signifying considerable uncertainty in the regression effects of all community-level variables due to the substantial residual variation existing between communities.ConclusionsOur study showed that to achieve the dire increase in mDFPS in Nigeria, policy interventions aimed at improving the education level of both females and males, especially beyond the secondary school level, should be implemented. Additionally, all of the various media sources should be extensively utilised, both at the individual and the community level, by the Nigerian government to spread information on the importance of women having their mDFPS.

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Project description:ObjectiveTo estimate educational and wealth inequalities in demand satisfied with modern methods of family planning (mDFPS).DesignA secondary data analyses of Demographic and Health Surveys.SettingSix South Asian countries, Afghanistan (2015), Bangladesh (2014), India (2015-2016), Maldives (2016-2017), Nepal (2016) and Pakistan (2017-2018).ParticipantsWomen aged 15-49 years. Primary and secondary outcome measures mDFPS was defined as married women aged 15-49 years or their partners, who desired no child, no additional children or to postpone the next pregnancy and who are currently using any modern contraceptive method. We estimated weighted and age-standardised estimates of mDFPS. We calculated the slope index of inequality (SII) and relative index of inequality (RII) as the measures of socioeconomic inequalities.ResultsA total of 782 639 women were surveyed. The response rate was 84.0% and above. The prevalence of mDFPS was below 50% in Maldives (22.8%, 95% CI 20.7 to 25.0), Pakistan (42.0%, 95% CI 39.9 to 44.0) and Afghanistan (39.1%, 95% CI 36.9 to 41.3), whereas Bangladesh had achieved 76% (75.8%, 95% CI 74.2 to 77.3). Both wealth and educational inequalities varied in magnitude and direction between the countries. Except in Nepal and Bangladesh, mDFPS wealth inequalities showed a trend of increasing mDFPS as we moved towards richer, and richest wealth quintiles that is, pro-poor (RII (0.5 to 0.9); SII (-4.9 to -23.0)). In India and Nepal, higher versus no education was in favour of no education (higher mDFPS among not educated women) (RII 1.1 and 1.4; SII 4.1 and 15.3, respectively) and reverse in other countries ((RII (0.4 to 0.8); SII (-10.5 to -30.3)). Afghanistan, Maldives and Pakistan fared badly in both educational and wealth inequalities among the countries.ConclusionsSouth Asia region still has a long way ahead towards achieving universal access to mDFPS. Diverse patterns of socioeconomic inequalities between the countries call for national governments and international development agencies to target the population subgroups for improving the mDFPS coverage.