Intention to use contraceptives and its correlates among reproductive age women in selected high fertility sub-saharan Africa countries: a multilevel mixed effects analysis

Abstract

Background: Intention to use contraceptive methods has an overriding importance to better visualize the women's future needs and more likely to translate it to actual behavior. It is therefore important to identify the motivating correlates such as education, women empowerment, as well as deterring factors like fear of side effects, infertility after contraceptive use, lack of knowledge regarding family planning methods among married women in countries with high fertility rates in sub-Saharan Africa. This helps to control family size, unintended pregnancies, and poor health outcomes for infants and mothers.

Methods: A secondary data analysis was performed using the recent Demographic and Health Surveys. A total weighted sample of 178,875 reproductive age women was included in this study. A multilevel mixed-effect binary logistic regression model was fitted. The odds ratios along with the 95% confidence interval were generated to identify the correlates of the intention to use contraceptives. A p-value less than 0.05 was declared as statistical significance.

Results: Overall, the intention to use contraception was 37.66% (95% CI, 37.44, 37.88). Whereas, the proportion of women who intend to use contraception was 59.20%, 53.30%, 42.32%, 37.88%, 37.63%, 35.25%, 31.32%, 20.64%, 20.30% in Burkina Faso, Burundi, Niger, Mali, DR. Congo, Nigeria, Angola, Gambia, and Chad respectively. Age; 15-24 (AOR = 3.72, 95% CI, 3.58, 3.86) and 25 - 24 years (AOR = 2.81, 95% CI, 2.74, 2.89), education of women; primary (AOR = 1.16, 95% CI, 1.13, 1.20), and secondary (AOR = 1.32, 95% CI, 1.27, 1.37), wealth index; middle (AOR = 1.15, 95% CI, 1.12, 1.18), rich (AOR = 1.28, 95% CI, 1.24, 1.32), number of living children 1-2 (AOR = 1.42, 95% CI, 1.37, 1.48), 3 or more (AOR = 1.77, 95% CI, 1.69, 1.85), age at cohabitation ≥ 18years (AOR = 1.37, 95% CI, 1.33, 1.40), heard family planning messages in the media (AOR = 1.47, 95% CI, 1.43, 1.50), history of ever terminated pregnancy (AOR = 1.13, 95% CI, 1.09, 1.17) and perceived distance to the health facility as not big problem (AOR = 1.16, 95% CI, 1.13, 1.19) were the correlates of intention to use contraceptives.

Conclusion: The finding of the current study demonstrates that the intention of contraceptive use among reproductive age women in high fertility countries in SSA was relatively low as compared to previous studies. Thus, each national authority, especially in Chad and Gambia would be keen to know the level of contraceptive use intentions for their respective region, the drivers of contraceptive use intention and to map priorities for behavioral change. Any intervention strategy that promotes intention of contraceptive use should consider these factors for better success. Future researchers interested in the area should also address qualitative variables like socio-cultural factors, which might have an effect on intention of contraceptive use.

Keywords: Contraceptive; High fertility countries; Intention; Reproductive age women.

Fig. 1

Intention to use contraception in high fertility sub-Saharan Africa countries: based on 2010–2018 DHS