Knowledge and factors influencing long acting reversible contraceptive use among women of reproductive age in Nigeria

Prevalence and factors associated with the use of long-acting reversible and permanent contraceptive methods among women who desire no more children in Bangladesh

BACKGROUND

Long-acting reversible and permanent contraceptive methods (LARC/PM) with high efficacy and continuity of use are highly effective pregnancy prevention methods. However, most sexually active women do not use it and end up with unintended pregnancies and unsafe abortions in Bangladesh. This study aims to assess the prevalence of LARC/PM use and its determinants among sexually active women who desire no more children in Bangladesh.

METHODS

The study used Bangladesh Demographic and Health Survey (BDHS) 2017-18 data, which employed a two-stage cluster sampling design. This study extracted 6422 married women of reproductive age who desired no more children. Descriptive statistics were used to present the characteristics of the women. Chi-square and binary logistic regression were also used to identify the factors associated with LARC/PM use.

RESULTS

A total of 20.2% of women use LARC/PM who desire no more children. Women aged 25-34 (aOR = 1.52, 95% CI: 1.10-2.09) and 35 years and above (aOR = 1.99, 95% CI: 1.41-2.81), women from Rangpur (aOR = 2.27, 95% CI = 1.57-3.28), Rajshahi (aOR = 2.15, 95% CI = 1.49-3.11), Khulna (aOR = 2.17, 95% CI = 1.48-3.17), Sylhet (aOR = 1.66, 95% CI = 1.07-2.58) and Dhaka (aOR = 1.97, 95% CI = 1.37-2.83) divisions, who were non-Muslims (aOR = 1.72, 95% CI = 1.40-2.11), having a desired number of children (2+) (aOR = 1.27, 95% CI = 1.08-1.49), whose contraceptive decision solely made by husband (aOR = 3.61, 95% CI = 2.73-1.77) or jointly (aOR = 1.59, 95% CI = 1.32-1.92) were more likely to use LARC/PM. On the other hand, women with primary education (aOR = 0.78, 95% CI = 0.65-0.92), secondary education (aOR = 0.59, 95% CI = 0.47-0.72) and higher education (aOR = 0.64, 95% CI = 0.43-0.95) belonging to richest wealth index (aOR = 0.73, 95% CI = 0.55-0.97), having at least two living children (aOR = 0.62, 95% CI = 0.44-0.85), partner with secondary education (aOR = 0.79 95% CI = 0.65-0.97) and women who were visited by family planning (FP) visitors (aOR = 0.34, 95% CI = 0.29-0.40) were less likely to use LARC/PM.

CONCLUSION

The LARC/PM use rate among women in Bangladesh is low. It must be increased to meet the targets of the Sustainable Development Goals (SDGs). To increase LARC/PM use in Bangladesh, attention should be given to factors like women's age, education, partner's education, religion, wealth index, division, number of living children, and desired number of children.

Family planning uptake and its associated factors among women of reproductive age in Uganda: An insight from the Uganda Demographic and Health Survey 2016

Despite the government efforts to reduce the high fertility levels and increase the uptake of family planning services in Uganda, family planning use was still low at 30% in 2020 which was the lowest in the East African region. This study was undertaken to determine the prevalence and factors associated with the uptake of family planning methods among women of reproductive age in Uganda. This community-based cross-sectional study utilized secondary data from the Uganda Demographic and Health Survey (UDHS) of 2016. The survey data was downloaded from the Measure Demographic Health Survey website after data use permission was granted. Data was collected from a representative sample of women of the reproductive age group (15-49 years) from all 15 regions in Uganda. A total of 19,088 eligible women were interviewed but interviews were completed with 18,506 women. Data analysis was performed using SPSS statistical software version 32.0 where univariable, bivariable, and multivariable analyses were conducted. The prevalence of family planning use was found to be 29.3% and that of modern contraceptive use was found to be 26.6%. Multivariable analysis showed higher odds of current family planning use among older women (40-44 years) (aOR = 2.09, 95% CI: 1.40-3.12); women who had attained the secondary level of education (aOR = 1.91, 95% CI: 1.32-2.76); those living in households with the highest wealth index (aOR = 1.87, 95% CI: 1.29-2.72); and awareness of the availability of family planning methods (aOR = 1.41, 95% CI: 1.17-1.72). In conclusion, the study suggests improving women's education attainment, socio-economic position, and awareness may help increase use in the population.

Spatial distribution and multilevel analysis of factors associated with long-acting reversible contraceptive use among sexually active women of reproductive age in Nigeria

BACKGROUND

Long-acting reversible contraceptives (LARCs), including hormonal implants and intrauterine devices, are highly effective pregnancy prevention methods. Aside its advantages over other hormonal methods, LARCs are cost-effective, easy to maintain, and have a low risk of non-compliance-related method failure. Besides, LARCs are also relatively safe for all sexually active women in the postpartum or post-abortion period. However, despite its effectiveness, most sexually active women use other short-term methods, such as condoms and contraceptive pills, which are associated with high discontinuation rates. Thus, this study examines the spatial distribution and multilevel factors associated with LARC use among sexually active reproductive-age women in Nigeria.

METHODS

This is a cross-sectional analysis of a population-based study from the 2018 Nigeria Demographic Health Survey (NDHS). The NDHS is a nationally representative survey that collects data on socio-demographic characteristics, sexual and reproductive health-related indicators such as contraceptive use and child & maternal health. A sample of 3,978 sexually active reproductive-age women (15-49 years) in Nigeria was used in the analysis. Frequency distribution and spatial analysis of LARC use were displayed with tables and maps, respectively, while multilevel analysis at a 95% confidence interval (CI) and a p-value of less than 0.05 was used to determine factors associated with LARC use among the sample.

RESULTS

The spatial distribution of LARC use among sexually active women of reproductive age in Nigeria ranges between 20 and 34.8%. Fifteen of the 36 states (excluding the Federal Capital Territory, FCT) recorded low utilization of LARCs. These states include Adamawa, Lagos, Ogun, Enugu, Anambra, Imo, Abia, Rivers, Kogi, Taraba, Yobe, Gombe, Jigawa, Borno, and Kebbi. Besides, the likelihood of LARC use was lower among participants with a prior history of pregnancy termination [aOR = 0.62; 95%(CI = 0.48-0.80)] compared to their counterparts without pregnancy termination history. Also, participants with no fertility intention had a higher likelihood of using LARCs [aOR = 1.65; 95%(CI = 1.30-2.08)] compared to those with fertility intention. At the community level, women with higher socioeconomic status were less likely to use LARCs [aOR = 0.66; 95%(CI = 0.45-0.97)] compared to women with lower socioeconomic status.

CONCLUSIONS

This study showed a relatively low utilisation of LARC among sexually active reproductive-age women in Nigeria. Notably, this low utilisation is also common in states that could be described as cosmopolitan, indicating a need for closer investigation to understand context-specific factors associated with LARC use. Population-specific family planning education and counselling for this population are important to address common misconceptions about LARCs in particular and modern contraceptive use in general.

Long-acting reversible contraceptives use among adolescent girls and young women in high fertility countries in sub-Saharan Africa

Background

Given the instrumental role long-acting reversible contraceptives (LARCs) play in reducing unintended pregnancies, there is a need to understand the factors that predict their use among adolescent girls and young women in high fertility countries. Our study examined the prevalence and predictors of LARCs use among adolescent girls and young women in high fertility countries in sub-Saharan Africa.

Materials and methods

We pooled data from the women’s files of the most recent Demographic and Health Surveys (DHS) from 2010 to 2020 of the top ten high fertility countries in sub-Saharan Africa, which are part of the DHS programme. The total sample was 5854 sexually active adolescent girls and young women aged 15–24 who were using modern contraceptives at the time of the survey. Descriptive and multilevel logistic regression models were used in the analyses. The results were presented using percentages and adjusted odds ratio (AOR) with their respective 95% confidence intervals (CIs).

Results

At the descriptive level, the overall prevalence of LARCs utilisation was 17.6% in the ten countries, with the lowest of 1.7% in Angola and the highest of 55.8% in Mali. Adolescent girls and young women who were married had a lower likelihood of LARCs utilisation than those who were never married [AOR = 0.63, 95% CI = 0.45, 0.88]. Adolescent girls and young women who wanted no more children had higher odds of LARCs use compared to those who wanted more children [AOR = 1.56, 95% CI = 1.09, 2.26]. Adolescent girls and young women with one to three births [AOR = 6.42, 95% CI = 4.27, 9.67], and those with four or more births [AOR = 7.02, 95% CI = 3.88, 12.67] were more likely to use LARCs compared to those who had no children. Countries in sub-Saharan Africa with lower probability of utilizing LARCs were Angola, Niger and Mozambique, whereas adolescent girls and young women in Mali had higher probability of utilizing LARCs.

Conclusion

Our findings suggest that LARCs utilisation among adolescent girls and young women is low in high fertility countries in sub-Saharan Africa. To reduce the rates of unplanned pregnancies and induced abortions, it is imperative that adolescent girls and young women in sub-Saharan Africa are educated on the advantages of utilising LARCs. Additionally, governments, policymakers, and stakeholders in sub-Saharan Africa should raise awareness by executing health promotion measures to enhance the demand for LARCs among adolescent girls and young women. Achieving these would not only prevent unplanned pregnancies and induced abortions, but also help meet the United Nation’s health and well being for all as enshrined in Sustainable Development Goals 3 and 5.

Factors associated with use of long-acting reversible and permanent contraceptives among married women in rural Kenya: A community-based cross-sectional study in Kisii and Kilifi counties

Long-acting and permanent contraceptive methods (LAPM) are effective and economical methods for delaying or limiting pregnancies, however they are not widely used. The Kenya government is promoting the use of modern methods of family planning through various mechanisms. This study aimed to determine the prevalence and factors associated with the use of LAPM among married women of reproductive age in targeted rural sub-counties of Kilifi and Kisii counties, Kenya. Baseline and end line Data from a program implemented on improving Access to Quality Care and Extending and Strengthening Health Systems (AQCESS) in Kilifi and Kisii counties of Kenya were used. Multi-stage sampling was used to sample 1117 and 1873 women for the end line and baseline surveys, respectively. Descriptive analysis was used to explore the respondents' characteristics and use of LAPM on a self-weighted samples. Univariable and multivariable binary logistic regression models using svy command were used to assess factors associated with the use of LAPM. A total of 762 and 531 women for the baseline and end line survey, respectively were included in this study. The prevalence of use of LAPM for baseline and end line survey were 21.5% (95% CI: 18.7-24.6%) and 23.2% (95% CI: 19.6%-27.0%), p-value = 0.485. The use of LAPM in Kisii and Kilifi counties was higher than the national average in both surveys. The multivariable analysis for the end line survey showed having 3-5 number of children ever born (aOR = 2.04; 95% CI: 1.24-3.36) and future fertility preference to have another child (aOR = 0.50; 95% CI: 0.26-0.96) were significantly associated with odds of LAPM use. The baseline showed that having at least secondary education (aOR = 1.93; 95%CI: 1.04-3.60), joint decision making about woman's own health (aOR = 2.08; 95%CI: 1.36-3.17), and intention to have another child in future (aOR = 0.59; 95%CI: 0.40-0.89) were significantly associated with the use of LAPM. Future fertility preference to have another child was significantly associated with the use of LAPM in the two surveys. Continued health promotion and targeted media campaigns on the use of LAPM in rural areas with low socioeconomic status is needed in order to improve utilization of these methods. Programs involving men in decision making on partner's health including family planning in the rural areas should be encouraged.

Prevalence and predictors of long-acting reversible contraceptive use among sexually active women in 26 sub-Saharan African countries

Background

Long-acting reversible contraceptives (LARCs) are associated with high efficacy rates and continuity of use. Based on the foregoing, we sought to examine the prevalence and factors associated with LARC use among sexually active women in 26 countries in sub-Saharan Africa(SSA).

Methods

Secondary data from Demographic and Health Surveys conducted in 26 countries in SSA between January 2010 and December 2019 were pooled and analysed. A total of 56 067 sexually active women 15–49 y of age met the inclusion criteria. Bivariate and multivariate regression analyses were performed to examine the association between selected factors and the use of LARCs in SSA. Results were presented as crude odds ratios and adjusted odds ratios (aORs) with statistical precision at <0.05.

Results

The prevalence of LARC use was 21.73%, ranging from 1.94% in Namibia to 54.96% in Benin. Sexually active women with secondary or higher education (aOR 1.19 [95% confidence interval {CI} 1.08 to 1.32]), those cohabiting (aOR 1.25 [95% CI 1.06 to 1.47]) and those with four or more children (aOR 2.22 [95% CI 1.78 to 2.78]) were more likely to use LARCs compared with those without education, never married and with no biological child.

Conclusions

The use of LARCs in the 26 countries in SSA was relatively low. Hence, the identified contributory factors of LARC use should be tackled with appropriate interventions. These include continuous campaigns on the efficacy of LARCs in reducing unintended pregnancy, maternal mortality and morbidity.

Geographic variation and associated factors of long-acting contraceptive use among reproductive-age women in Ethiopia: a multi-level and spatial analysis of Ethiopian Demographic and Health Survey 2016 data

Background

High fertility rates and unintended pregnancies are public health concerns of lower and middle income countries such as Ethiopia. Long acting contraceptives (LACs) take the lion’s share in reducing unintended pregnancies and high fertility rates. Despite their numerous advantages, the utilization of LACs remains low in Ethiopia. This study is aimed to explore the geographic variation and associated factors of long acting contraceptive use among reproductive-age women in Ethiopia.

Methods

This is a secondary data analysis of 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total of weighted sample sizes of 10,439 reproductive-age women were included in the final analysis. To clean and analyze the none-spatial data Stata 14 was used while ArcGIS 10.6 and SaTScanTM version 9.6 software were used for spatial analysis. Multilevel Mixed-effect Logistic regression model was used to identify associated factors of LACs utilization. An Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was reported to identify significant variables.

Results

Long acting contraceptive utilization was non-random (Moran’s I: 0.30, p-value < 0.01). Statistically, clusters with significant low utilization of LACs were found in Somali, Afar, Gambela, northern Amhara, eastern Oromia and western part of Southern Nations Nationalities and Peoples (SNNP) regions. Adjusting for other factors such as being married (AOR = 2.51, 95% CI: 1.29–4.87), having one to two (AOR = 2.14, 95% CI: 1.43–3.22), and three to four children (AOR = 1.68, 95% CI: 1.02–2.76), urban (AOR = 1.59, 95% CI: 1.16–2.19), want no more children (AOR = 1.40, 95% CI: 1.08–1.83), working status of women (AOR = 1.33, 95% CI: 1.07–1.65) increased the odds of LACs utilization. While previous history of abortion (AOR = 0.56, 95% CI: 0.39–0.80), and living in the pastoralist community (AOR = 0.22, 95% CI: 0.14–0.35) reduced the odds of LACs utilization in Ethiopia

Conclusions

Significant geographic variation of LACs utilization was observed in Ethiopia. Spots with Low LACs utilization were found in the eastern, north eastern and western part of the country. Socio-demographic and pregnancy related factors were significant determinants of LACs utilization. Designing intervention programs targeting the identified hot spot clusters, and variables that can hinder the utilization of LACs is very important to increase the utilization.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-021-01171-2.

Lower and middle-income countries such as Ethiopia face a challenge of an ever increasing population with high maternal mortality. In Ethiopia, the population is estimated to be more than 110 million. High fertility rates, unintended pregnancy, maternal and child mortalities are the main concerns of the country. Accordingly, it is required of the country to make a robust intervention to limit these public concerns. In relation to this, LACs utilization happens to be one of the solutions to solving the concerns. Despite their efficacy, availability, and acceptability the utilization of LACs remains low and varies among different geographic areas. However, the reason is still undefined and geographic variation was not assessed before.

In our study, we analyze the Ethiopian demographic and health survey 2016 data to assess the presence of significant geographic variation and associated factors of long-acting contraceptive utilization. Hence, a spatial and multilevel analysis were employed to assess the geographic variation and associated factors of LACs utilization in Ethiopia.

A statistically significant geographic variation was observed among different clusters. Clusters with significantly low utilization of LACs were found in the pastoralist (Afar, Gambela, and Somalia) regions of the country. Thus, more organized efforts need to be made to increase the utilization of LACs. Controlling for others: Marital statuses, occupation, future pregnancy interest, urban residence, previous history of abortion, living in the pastoralist community were statistically significant determinant factors of LACs utilization.

In conclusion, significant geographic variation of LACs utilization was observed among different clusters. Besides, different socio-demographic, pregnancy, and child health-related variables were significant determinants of LACs utilization.

The association between recent sexual activity and the use of modern contraceptive methods among married/cohabiting women in Indonesia

Background: Modern contraceptive methods are considered more reliable for preventing and spacing pregnancy than traditional methods in sexual activity. The study aimed to analyze the association between recent sexual activity and the use of modern contraceptive methods among married/cohabiting women in Indonesia.

Design: The samples used were married/cohabiting women aged 15-49 years old. The sample size was 34,467 women. The variables analyzed included modern contraceptive use, recent sexual activity, age groups, marital status, education level, and wealth status. Analysis using multinomial logistic regression.

Results: It was found that women who were sexually not active last 4 weeks had the likely to use modern contraceptive non-LARC (long-acting reversible contraceptives) 0.416 times compared to women who were sexually active last 4 weeks. Women who were sexually active last 4 weeks were more likely to use modern contraceptive LARC 0.535 times than women who were sexually active last 4 weeks. The results of this analysis inform that women who are sexually active last 4 weeks have a higher possibility to use modern contraceptives, both non-LARC and LARC types.

Conclusions: Based on the results of the research analysis it could be concluded that recent sexual activity was associated with modern contraceptive use among married/cohabiting women in Indonesia.

Knowledge and factors influencing long-acting reversible contraceptives use among women of reproductive age in Nigeria

Background: Approximately 48% of unintended pregnancies occur as a result of contraceptives failure around the world, which is mostly due to incorrect use, poor adherence, and/or technology failure. Long-acting reversible contraceptive (LARC) methods have been developed to close this gap. The main aim of this study is to identify factors associated with the use of LARCs among women of reproductive age and to examine the relationship between knowledge of LARCs and the current use of LARCs in Nigeria. Methods: This study assessed the PMA2020 methodology and secondary dataset using female datasets from PMA 2016 (Round 3) exercise. The survey was conducted out in seven states of Nigeria. The target population for this study was women of reproductive age (15-49 years) currently using contraception prior to the survey. The sample size of women that met the inclusion criteria was 1927. The data were analyzed using frequency distribution, chi-square, and logistic regression at a 5% level of significance. Results: The results showed that 21.0% of women were using traditional methods. 14.8% of the sampled women were using LARCs methods. Findings further showed that at both levels of analyses, there is a significant relationship (P<0.05 and P=0.00 for binary and logistic regression, respectively) between knowledge of LARCs and the use of LARCs. This means that knowledge of LARCs and socio-demographic variables among women of reproductive age in Nigeria can influence the use of LARCs. Conclusions: We concluded in this study that 14.8% of women using contraception were using LARCs. Additionally, the level of education, age of women, household wealth, and the number of living children were significantly associated with using LARCs in Nigeria. Also, when discussing contraception with women, health care practitioners should discuss the risks and benefits of LARCs with women of reproductive age and recommend them as a first-line method.

Knowledge and factors influencing long acting reversible contraceptive use among women of reproductive age in Nigeria

Background: Approximately 48% of unintended pregnancies occur as a result of contraceptive failure around the world, which is largely due to incorrect use, poor adherence and/or technology failure. Long-acting reversible contraceptive (LARC) methods have been developed to close this gap because it's not dependent on compliance with a pill-taking regimen; remembering to change patch or ring; or fixing an appointment with physicians. The main aim of this study is to identify the factors influencing the women associated with use of LARC and to examine the relationship between knowledge of LARC and its current use. Methods: This study assessed the PMA2020 methodology and secondary dataset using female datasets from PMA 2016 (Round 3) exercise. PMA 2016 was a survey carried out in seven states of Nigeria. The target population for this study was women of reproductive age (15-49 years) currently using contraception prior to the survey. The sample size of women meeting inclusion criteria in this study was 1927. The data were analyzed using frequency distribution, chi-square and logistic regression at 5% level of significant. Results: The results showed that 21.0% of women were using traditional methods. Concerning LARC methods, the table showed that 14.8% of the sampled women were using LARC methods. Findings further showed that at both levels of analyses there is a significant relationship (P<0.05 and P=0.00 for binary and multivariable logistic regression, respectively) between knowledge of LARCs and uses in this study. This means that knowledge of LARC & other socio-demographic variables among women of reproductive age in Nigeria can influence the use of it. Conclusions: From the result of the study we concluded that 14.8% of women using contraception were using LARC. Additionally, level of education, age of women, household wealth and number of living children were significantly associated with using LARC.

Knowledge and factors influencing long acting reversible contraceptive use among women of reproductive age in Nigeria

Background: Over a month when contraception is used, approximately 48% of unintended pregnancies occur as a result of human error, which is largely due to incorrect use, poor adherence and/or technology failure. Long-acting reversible contraceptive (LARC) methods have been developed to bridge this gap because it's not dependent on compliance with a pill-taking regimen; remembering to change patch or ring; or fixing an appointment with physicians. The main aim of this study is to examine the characteristics of women associated with use of LARC and also to examine the relationship between knowledge of LARC and its current use. Methods: This study assessed the PMA2020 secondary dataset using female datasets from PMA 2016 (Round 3) exercise. PMA 2016 was a survey carried out in seven states of Nigeria. The target population for this study was women of reproductive age (15-49 years) currently using any method of contraception prior to the survey. The weighted sample size of women meeting inclusion criteria in this study is 1927. The data were analyzed using frequency distribution, chi-square and logistic regression. Results: The results showed that 21.0% of women were using traditional methods. Concerning LARC methods, the table showed that 14.8% of the sampled women were using LARC methods. Findings further revealed that at both levels of analysis there is a significant relationship (P<0.05 and P=0.00 for binary and multivariable logistic regression, respectively) between knowledge of LARCs and uses in this study. This means that the use of LARC is being influenced by its knowledge among women of reproductive age in Nigeria. Conclusions: This study concludes that 14.8% of women using any methods of contraceptive were using LARC. Additionally, after controlling for other confounding factors, level of education, age of women, household wealth and number of living children were significantly associated with using LARC.