Modern Contraceptive Use among Women in Sub-Saharan Africa: Individual, Interpersonal, and Healthcare System Indicators

Abstract

Background: Contraceptives promote maternal and child health by reducing the prevalence of: unintended pregnancies, unsafe abortions, maternal deaths, low birth weight infants, preterm birth, and infant mortality. Despite its benefits, the uptake of contraceptives among women of childbearing age remains low in sub-Saharan Africa. In sub-Saharan Africa, the prevalence of contraceptive use among women in a union is 28%. To advance maternal and child health in this region, it is imperative to identify various individual, interpersonal, cultural, and healthcare system factors that affect the adoption of modern contraceptives. Objective: This project assesses individual, interpersonal, and healthcare systems indicators of modern contraceptive use among women in sub-Saharan Africa. Methods: Quantitative insight into the determinants of modern contraceptive use was obtained through analyses of multiple Demographic and Health Surveys (DHS) and Performance Monitoring and Accountability (PMA) 2020 data. The quantitative research studies were limited to women with a need for contraception, i.e. respondents who want to limit or space childbirth. Multivariable logistic regression models assessed the relationship between modern contraceptive use and: a) individual; b) interpersonal; and c) healthcare system factors. To further explore the barriers and facilitators of modern contraceptive use, this project employed focus group discussions and semi-structured interviews of healthcare providers in Calabar, Nigeria. Data from focus group discussions and interviews were analyzed using the thematic analysis approach. Results: The prevalence of modern contraceptives ranged from 7.8% in Gambia to 68.9% in Kenya among women. Several factors were positively associated with modern contraceptives use. Evidence from the DHS revealed that two domains of women’s empowerment—labor force participation and education—were most consistently associated with increased rates of modern contraceptive use. Results from analysis of the PMA2020 data identified four healthcare factors associated with women’s use of modern contraceptives. Health worker home-visits, adolescent reproductive health services, and polyclinic/hospitals were associated with modern contraceptive use in Ghana, Kenya, and Nigeria. Evidence from focus group discussions showed that women mostly used condoms, emergency contraceptives pills, fertility awareness (rhythm), and folkloric methods of contraception. In addition, myths about contraceptives prevented participants from using certain forms of modern contraception. For instance, participants cited that pills, injectables, and implants caused infertility and diseases among women who use these methods. Conclusion: Modern contraceptive use among sub-Saharan African women can be increased by promoting the health-worker visits, empowering women through education and labor force participation, and correcting myths about the side effects of modern contraceptives. By addressing individual, interpersonal, and healthcare correlates of contraceptive use, findings from this research can inform the design of comprehensive and more effective contraceptive interventions. Therefore, findings from this research can inform the design and implementation of interventions that acknowledge multiple correlates of contraceptive use.