Determinants of unmet need for family planning in Gambia & Mozambique: implications for women's health

Eight out of every twenty-five married women have an unmet need for family planning in Meyu Muluke District, Eastern Ethiopia

Unmet family planning needs are a critical public health problem in developing countries, particularly in Sub-Saharan Africa. An estimated 225 million women in developing countries who want to postpone, space, or avoid becoming pregnant do not use effective contraception methods, resulting in over 75 million unintended pregnancies each year, accounting for 84% of unintended pregnancies in developing countries. Thus, this study aimed to assess the determinants of the unmet need for family planning in Meyu Muluke District, Eastern Ethiopia. A community-based cross-sectional study was conducted from February 1 to 28, 2018, among 436 randomly selected currently married women of the reproductive age group in Meyu Muluke district, Eastern Ethiopia. Data were entered using Epidata version 3.1 and analyzed using Statistical Package for the Social Sciences (SPSS) version 25. Multivariate logistic regression was used to identify factors associated with the outcome variable, and a 95% confidence interval was used to declare statistical significance at a p-value of < 0.05. Overall, the magnitude of unmet need for family planning among currently married women was 36.02% (95% confidence interval (CI) 32.5-39.2%). Ages 25 to 29 years old [adjusted odds ratio (AOR) = 1.95, 95% CI (1.09-7.35), no formal education [AOR = 1.91, 95% CI (1.11-4.57)], middle wealth quintiles [AOR = 1.50, 95% CI (1.54-12.26)], some living children [0-1 and 2-3] [AOR = 1.47, 95% CI (1.33-8.83 [AOR = 0.67, 95% CI (1.26-18.80)], respectively], intending to use family planning in the future [AOR = 6.55, 95% CI (5.49-18.59)], and less than ten minutes to get to the family planning source [AOR = 2.33, 95% CI (1.15-4.72-2.92)] statistically significant to the unmet need for family planning. The study's findings suggested that eight out of every twenty-five married women in Meyu Muluke District, Eastern Ethiopia, have unmet family planning needs. Age, education, children, intention, and time taken were significantly associated with the unmet need for family planning. Focusing on strategies that allow intervention in these factors is helpful to women because they, directly and indirectly, affect women's health and educational achievement.

Unmet need for family planning and associated factors among currently married women in Nepal: A further analysis of Nepal Demographic and Health Survey-2022

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.

Spatial distribution and determinants of unmet need for family planning among all reproductive‑age women in Uganda: a multi‑level logistic regression modeling approach and spatial analysis

INTRODUCTION

Unmet need for family planning is defined as the percentage of sexually active and fecund women who want to delay the next birth (birth spacing) or who want to stop childbirth (birth limiting) beyond two years but who are not using any modern or traditional method of contraception. Despite the provision of family planning services, the unmet need of family planning remains a challenge in low- and middle-income countries (LMICs). Thus, this study aimed to assess the spatial distribution and determinant factors of unmet need for family planning among all reproductive‑age women in Uganda.

METHODS

A secondary data analysis was done based on 2016 Ugandan Demographic and Health Surveys (UDHS). Total weighted samples of 18,506 women were included. Data processing and analysis were performed using SPSS Version 26, STATA 14.2, ArcGIS 10.8, and SaTScan 10.1.2 software. Spatial autocorrelation and hotspot analysis was made using Global Moran's index (Moran's I) and Gettis-OrdGi*statistics, respectively. Determinants of unmet needs for family planning were identified by multi-level logistic regression analysis. Variables with a p-value < 0.05 were declared statistically significant predictors.

RESULTS

The spatial distribution of unmet need for family planning among women of reproductive age in Uganda was found to be clustered (Global Moran's I = 0.27, Z-score of 12.71, and p-value < 0.0001). In the multivariable multilevel logistic regression analysis; women in West Nile (AOR = 1.86, 95% CI: 1.39, 2.47), aged 25-49 years old (AOR = .84; 95% CI .72, .99), highly educated (AOR = .69; 95% CI .54, .88), Muslim (AOR = 1.20, 95% CI: 1.03, 1.39), high wealth status (AOR = .73, 95% CI: .64, .82), and had five or more living child (AOR = 1.69, 95% CI: 1.51, 1.88) were significant predictors of unmet need for family planning. Significant hotspot areas were identified in West Nile, Acholi, Teso, and Busoga regions.

CONCLUSION

A significant clustering of unmet need for family planning were found in Uganda. Moreover, age, educational status, religion, wealth status, number of alive children, and region were significant predictors of unmet need for family planning. Therefore, in order to minimize the burdens associated with unmet need, an interventions focusing on promotion of sexual and reproductive health service should be addressed to the identified hotspot areas.

Determinants of unmet need for family planning: Evidence from the 2018 Turkey Demographic and Health Survey

Unmet need for family planning is a valuable concept to indicate the discrepancy between women's fertility preferences and contraceptive use. Unmet need may lead to unintended pregnancies and unsafe abortions. These may result in health deterioration and reduced employment opportunities for women. The 2018 Turkey Demographic and Health Survey report indicated that the estimated unmet need for family planning doubled from 2013 to 2018, returning to the high levels of the late 1990s. Considering this unfavourable change, this study aims to investigate the determinants of unmet need for family planning among married women of reproductive age in Turkey by using the 2018 Turkey Demographic and Health Survey data. Logit model estimations revealed that women who were at older ages, more educated, wealthier, and had more than one child were less likely to have unmet need for family planning. Employment statuses of women and their spouses and place of residence were significantly associated with unmet need. Results emphasised that training and counselling to enhance the use of family planning methods should effectively target young, less educated, and poor women.

Unmet need for family planning and associated factors among currently married women in Hawella Tulla subcity, Hawassa, southern Ethiopia: community-based study

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.

Unmet need for family planning among married women in sub-Saharan Africa: a meta-analysis of DHS data (1995 - 2020)

BACKGROUND

Closing the gap of unmet needs for family planning (FP) in sub-Saharan Africa remains critical in improving maternal and child health outcomes. Determining the prevalence of unmet needs for family planning among married women in the reproductive age is vital for designing effective sexual reproductive health interventions and programmes. Here, we use nationally representative data drawn from sub-Saharan countries to estimate and examine heterogeneity of unmet needs for family planning among currently married women of reproductive age.

METHODS

This study used secondary data from Demographic and Health Surveys (DHS) conducted between January 1, 1995 to December 31, 2020 from 37 countries in sub-Saharan African. An Inverse Heterogeneity model (IVhet) in MetaXL application was used to estimate country and sub-regional level pooled estimates and confidence intervals of unmet needs for FP in SSA.

RESULTS

The overall prevalence of unmet need for family planning among married women of reproductive age in the sub-region for the period under study was 22.9% (95% CI: 20.9-25.0). The prevalence varied across countries from 10% (95% CI: 10-11%) in Zimbabwe to 38% (95% CI: 35-40) and 38 (95% CI: 37-39) (I2 = 99.8% and p-value < 0.0001) in Sao Tome and Principe and Angola, respectively. Unmet needs due to limiting ranged from 6%; (95% CI: 3-9) in Central Africa to 9%; (95% CI: 8-11) in East Africa. On the other hand, the prevalence of unmet needs due to spacing was highest in Central Africa (Prev: 18; 95% CI: 16-21) and lowest in Southern Africa (Prev: 12%; 95% CI: 8-16). Our study indicates that there was no publication bias because the Luis Furuya-Kanamori index (0.79) was within the symmetry range of -1 and + 1.

CONCLUSION

The prevalence of unmet need for FP remains high in sub-Saharan Africa suggesting the need for health policymakers to consider re-evaluating the current SRH policies and programmes with the view of redesigning the present successful strategies to address the problem.

Prevalence and determinants of unmet need for contraception among women in low and high-priority segments for family planning demand generation in Nigeria

BACKGROUND

Studies have identified various determinants of unmet need for contraception. These determinants cut across individual, household, community, and health facility levels. Despite this evidence, there remains a lack of information regarding differentials in the prevalence and determinants of unmet need for contraception among women in the low-priority segments (such as women of advanced reproductive age and women living with disabilities) and high-priority segments (such as adolescents, young adults, and unmarried women) for family planning demand generation, hence this study.

METHODS

The study design is cross-sectional. The study analyzed merged data from the individual, and persons recode of the 2018 Nigeria Demographic and Health Survey (NDHS). The samples analyzed are 5,147 women in the high-priority segment and 7,536 women in the low-priority segment. The outcome variable in the study was unmet need for contraception. The explanatory variables were selected at the individual, household, community, and facility levels. Statistical analyzes were performed using Stata 14. Three multilevel mixed-effects regression models were fitted. Model 1 was the empty model, while Model 2 included the sets of individual, household, and community variables. Model 3 controlled for the facility-level variables.

RESULTS

Findings show a higher prevalence of unmet need for contraception among women in the family planning low-priority segment compared to women in the family planning high-priority segment. Religion and desired family size were the two individual characteristics that significantly predicted the unmet need for contraception among women in the two segments. Sexual autonomy was the only household characteristic that predicted unmet need for contraception in both segments. There were differences in the community characteristics that predicted unmet need for contraception among women in the two segments.

CONCLUSION

The prevalence of unmet need for contraception is not the same among women in low and high family planning priority segments. The determinants also differ among women in the two segments. Though, women in different family planning segments have the same contraceptive needs of avoiding pregnancy when not needed, however, getting the needs satisfied requires that existing programs be further examined to develop initiatives that will resonate with each segment of reproductive-age women.

Prevalence and factors associated with unmet need for family planning among women of reproductive age (15-49) in the Democratic Republic of Congo: A multilevel mixed-effects analysis

The Democratic Republic of Congo (DRC) has experienced high levels of unmet need for family planning (UNFP) for many years, alongside high fertility, maternal and infant mortality rates. Previous research addressed the UNFP in DRC, but analyses were limited to the individual-level and to specific regions. This study aims to determine the individual- and community-level factors associated with UNFP among married women of reproductive age in DRC. Using data from the 2014 DRC Demographic and Health Survey, a two-level mixed-effect logistic model examined i) the associations between UNFP and individual- and community level factors, and ii) the extent to which individual variability in UNFP is due to the variability observed at the community-level, given the individual characteristics. A total of 10,415 women in 539 clusters were included. Prevalence of unmet need for limiting was 8.13%, and 23.81% for spacing. Compared to adolescents (15-24), young (25-34) (aOR = 0.75, CI: 0.63-0.90) and middle-aged (35-49) (aOR = 0.65, CI: 0.51-0.82) women were less likely to have unmet need for family planning. The odds of having unmet need increased significantly with number of living children [1-2 children (aOR = 2.46, CI: 1.81-3.35), 7+ children (aOR = 6.46, CI: 4.28-9.73)] and among women in a female-headed household (aOR = 1.22, CI: 1.04-1.42). Women from provinces Equateur (aOR = 1.82, CI: 1.24-2.68), Nord-Kivu (aOR = 1.66, CI: 1.10-2.55) and Orientale (aOR = 1.60, CI: 1.10-2.32) were more likely to have unmet need, compared to women from Kinshasa. Women from communities with medium (aOR = 1.32, CI: 1.01-1.72) and high (aOR = 1.46, CI: 0.98-2.18) proportion of women in wealthy households, and medium (aOR = 1.32, CI: 1.01-1.72) and high (aOR = 1.46, CI: 0.98-2.18) proportion of women with low ideal family size (≤6) were more likely to have unmet need, compared to those from communities with low proportion of wealthy households and high ideal family size, respectively. Policies should consider strengthening family planning programs in provinces Equateur, Orientale, and Nord-Kivu, and in wealthier communities and communities with a higher ideal family size. Family planning programs should target adolescents and young women.

rspatialdata: a collection of data sources and tutorials on downloading and visualising spatial data using R

Spatial and spatio-temporal data are used in a wide range of fields including environmental, health and social disciplines. Several packages in the statistical software R have been recently developed as clients for various databases to meet the growing demands for easily accessible and reliable spatial data. While documentation on how to use many of these packages exist, there is an increasing need for a one stop repository for tutorials on this information. In this paper, we present rspatialdata a website that provides a collection of data sources and tutorials on downloading and visualising spatial data using R. The website includes a wide range of datasets including administrative boundaries of countries, Open Street Map data, population, temperature, vegetation, air pollution, and malaria data. The goal of the website is to equip researchers and communities with the tools to engage in spatial data analysis and visualisation so that they can address important local issues, such as estimating air pollution, quantifying disease burdens, and evaluating and monitoring the United Nation’s sustainable development goals.