Prevalence and determinants of intention to use modern contraceptives among grand-multiparous women in sub-Saharan Africa.

Sub-Saharan Africa, characterised by high fertility and low contraceptive use prevalence, remains one of the settings with the poorest maternal and child health indices globally. Studies have established that grand-multiparous women are at increased risk of these adverse maternal health outcomes, and contraceptive use is important to averting these adverse outcomes. Thus, this study examines the prevalence and determinants of intention to use modern contraceptives among grand-multiparous women in 10 sub-Saharan African countries with high fertility rates. The study utilized data from the last installments of the Demographic and Health Survey from the 10 leading countries with the highest total fertility rates in sub-Saharan Africa. These countries include: Angola, Benin, Burundi, Chad, Cote d'Ivoire, the Republic of the Congo, Democratic Republic of Congo, Mali, Niger, and Nigeria. Data analysis of 23,500 grand-multiparous women was done at three univariate levels involving a frequency table and bar chart. We employed bivariate logit and multivariate logit regression at the bivariate and multivariate levels to achieve the study objectives. A significant level was determined at p < 0.05. Our study found that less than 40% of grand-multiparous women in these high fertility countries in sub-Saharan Africa, have the intention to use modern contraceptives (39%), but country variations exist with as low as 32.8% in Angola to as high as 71.2% in the Republic of the Congo. The study found that modern contraceptives use intention among grand-multiparous women in these high fertility countries was predicted by a history of contraceptive use and pregnancy termination, exposure to family planning messages on social media, and knowledge of family planning methods. Others were women's fertility planning status, ideal family size, number of marriages (remarriage), couple's fertility desire, current age, and level of education. In the high fertility context of sub-Saharan Africa, characterized by low contraceptive use, improving contraceptive use intention among grand-multiparous women is vital for preventing adverse maternal and child health outcomes, including mortality, resulting from a high-risk pregnancy. Hence, interventions should be more innovative in targeting this group of women to increase the contraceptive prevalence rate in line with Family Planning 2030 goals, and ultimately reduce high fertility rates in the region. [Abstract copyright: © 2022. The Author(s).

Prevalence and factors associated with the use of long-acting reversible and permanent contraceptive methods among women who desire no more children in high fertility countries in sub-saharan Africa.

The proportion of women with family planning needs increased from 74 to 76% between 2000 and 2019, and this improvement has not transcended to a fertility rate stall or decrease in sub-Saharan Africa (SSA). In the face of a continuous increase in the fertility rate in SSA, population experts agreed that the efficient use of reliable family planning methods such as long-acting reversible and permanent contraceptive methods (LARC/PMs) could help reduce the high fertility rate and associated adverse reproductive health outcomes in the region. However, despite the effectiveness of LARC/PMs, its use remains elusive in SSA. Thus, this study examines the prevalence and factors associated with the use of LARC/PMs among women who desire no more children in high-fertility countries in SSA. Secondary datasets from the demographic health surveys conducted in 20 countries in SSA between 2010 and 2019 were included in the study. A total sample size of 46,290 sexually active women of reproductive age who desire no more children and who met the study inclusion criteria was pooled and analysed. Prevalence of LARC/PMs use was displayed using a graph whilst binary logistic regression was used to determine the associated factors, and results were presented as unadjusted odds ratio and adjusted odds ratio with a statistical significance of p < 0.05. The prevalence of LARC/PMs use among women who desire no more children was 7.5%. Ranging from 20.9% in Senegal and as low as 0.4% in Congo. Women within the richest wealth index [aOR = 1.18, 95% CI = 1.03-1.36] and those exposed to mass media [aOR = 1.54, 95% CI = 1.41-1.68] had higher odds of LARC/PMs use among sexually active women of reproductive age who desire no more children compared to those within poorest wealth index and women with no mass media exposure. The study concluded that LARC/PMs use among sexually active women who desire no more children was very low, and women within the richest wealth index and those with mass media exposure were likely to use LARC/PMs. Interventions that will encourage using LARC/PMs should be prioritised to reduce fertility rates in SSA. [Abstract copyright: © 2022. The Author(s).

Prevalence and factors associated with the use of long-acting reversible and permanent contraceptive methods among women who desire no more children in high fertility countries in sub-saharan Africa

BACKGROUND: The proportion of women with family planning needs increased from 74 to 76% between 2000 and 2019, and this improvement has not transcended to a fertility rate stall or decrease in sub-Saharan Africa (SSA). In the face of a continuous increase in the fertility rate in SSA, population experts agreed that the efficient use of reliable family planning methods such as long-acting reversible and permanent contraceptive methods (LARC/PMs) could help reduce the high fertility rate and associated adverse reproductive health outcomes in the region. However, despite the effectiveness of LARC/PMs, its use remains elusive in SSA. Thus, this study examines the prevalence and factors associated with the use of LARC/PMs among women who desire no more children in high-fertility countries in SSA. METHODS: Secondary datasets from the demographic health surveys conducted in 20 countries in SSA between 2010 and 2019 were included in the study. A total sample size of 46,290 sexually active women of reproductive age who desire no more children and who met the study inclusion criteria was pooled and analysed. Prevalence of LARC/PMs use was displayed using a graph whilst binary logistic regression was used to determine the associated factors, and results were presented as unadjusted odds ratio and adjusted odds ratio with a statistical significance of p < 0.05. RESULTS: The prevalence of LARC/PMs use among women who desire no more children was 7.5%. Ranging from 20.9% in Senegal and as low as 0.4% in Congo. Women within the richest wealth index [aOR = 1.18, 95% CI = 1.03–1.36] and those exposed to mass media [aOR = 1.54, 95% CI = 1.41–1.68] had higher odds of LARC/PMs use among sexually active women of reproductive age who desire no more children compared to those within poorest wealth index and women with no mass media exposure. CONCLUSION: The study concluded that LARC/PMs use among sexually active women who desire no more children was very low, and women within the richest wealth index and those with mass media exposure were likely to use LARC/PMs. Interventions that will encourage using LARC/PMs should be prioritised to reduce fertility rates in SSA

Multiple high-risk fertility behaviours and children under five mortality survivors among ever-married women of reproductive age in Nigeria

Background Multiple high-risk fertility behaviours (MHRFBs), including maternal age  34 years old, a birth order 4+, and birth spacing < 24 months, can directly or indirectly affect survival outcomes among under-five children. There is a dearth of available information and data about these two phenomena in Nigeria. Thus, this study evaluates the prevalence of MHRFBs and examines the association between MHRFBs and under-five mortality survival (U5M) outcomes among ever-married women of reproductive age in Nigeria. Methods This study used the recent secondary datasets from the Nigerian Demographic Health Surveys conducted in 2018, with a total sample size of 10,304 women of reproductive age. The outcome variable was MHRFBs. Multivariable logistic regression analysis was employed to examine the association between U5M and MHRFBs. Odds ratios with a p-value of less than 0.05 were considered significant. Results It was found that among women who had MHRFBs, U5M was prevalent, particularly in young maternal age (< 18 years) and within short birth intervals (< 24 months). The adjusted odds ratio of the association between MHRFBs and U5M shows the experience of MHRFBs, in addition to other factors such as household wealth index, type of marriage, and sex of child, to be significant predictors for U5M. The odds were higher for U5M to occur among women who had experienced MHRFBs compared to those who have not had an experience of MHRFBs [aOR = 1.48; 95%CI: 1.02–2.17 ]. Similarly, the odds of U5M occurrence among women in polygamous marriages are higher compared to those in monogamous unions [aOR = 1.35; 95% CI: 1.10–1.65]. While under-five children born in the richest households (wealth quintiles) are less likely to die compared to those born in the poorest households [aOR = 0.64; 95% CI: 0.41–1.01]. Conclusion This study concludes that women in Nigeria who engaged in MHRFBs, particularly maternal ages < 18 years and short birth intervals (< 24 months), were more likely to experience U5M. Furthermore, children born to women who received post-natal care after delivery were more likely to survive U5M, as were children born to women with educated partners. We recommend strengthening educational opportunities and creating adaptive reproductive health education programs for ever-married women of reproductive age in Nigeria

How does the rise in contraceptive usage predict pregnancy termination among young women in Kenya? an in-depth multilevel analysis

Background: Young women were less likely to practise consistent contraceptive use and are also known to exhibit risky sexual behaviours, which could lead to unintended pregnancy. Studies have also shown that about half of the Kenyan population is young, an age bracket that predominantly experiences unwanted pregnancy. However, adequate attention has not been given to the relationship between pregnancy termination and contraceptive use among this teeming population in Kenya. Thus, this study examined the association between pregnancy termination history and contraceptive use among women aged 15–24 years old in Kenya. Methods: A total of 12,166 women aged 15–24 years old from Kenya were drawn using a secondary dataset from the most recent Kenya Demographic Health Surveys conducted in the year 2022. Frequency distribution and multilevel logistic regression analyses were employed to determine the association between contraceptive use and pregnancy termination history among young women aged 15–24 years old with covariates at p < 0.05. Results: The results showed that the higher percentage of contraceptive users among young women are those aged 15–19 years (50.1%); consequently, a higher percentage of pregnancy termination was also found among women who reported the use of contraceptive methods (6.2%) compared to 2.9% among non-users. The main findings of the study showed that young women who reported using contraceptives were more likely to have a history of pregnancy termination [aOR = 1.03; 95% CI: 0.80–1.26] compared to those who were non-users. Also, age, marital status, and parity are significantly associated with the history of pregnancy termination. Conclusion: Our analyses established an association between history of contraceptive use and termination of pregnancy among young women between 20 and 24 years in Kenya. Place of residence, age, wealth index, level of education, and met needs of children have been identified as risk factors. Intervention to reduce pregnancy termination in Kenya should focus on women aged 20–24 years, those with no formal education, urban residence, and women with met need for children

Analysis of Non-Marital Fertility in Nigeria and Implications for Intervention and Future Research

Fertility and marriage are inextricably linked in sub-Saharan Africa, but recent changes, such as the rise in non-marital fertility, signals a weakening link, and the second demographic transition offers some explanations. Non-marital fertility comes with disadvantages, but it has not been adequately studied in Nigeria. Hence, this study examined the levels, patterns, and correlates of non-marital fertility, and offers implications for interventions and future research. Using data from the Nigeria Demographic and Survey 2008–2018, with a pooled weighted sample size of 11,925 unmarried women, percentage distribution was employed and a two-part model for count data was fitted, with the result showing that the level of non-marital fertility is 29%, and it is common among younger, rural dwelling, and uneducated unmarried women. The correlates of non-marital fertility include age, region of residence, level of education, religion, household wealth index, relationship status, ethnicity, work status, and age at sexual debut. Interventions to arrest rise of non-martial fertility due to its obvious disadvantages, should strengthen sexual and reproductive health programs for unmarried rural-dwelling young women, and revitalize welfare efforts for children born outside wedlock, for poor women, while future research should explore an in-depth understanding of non-marital births.</jats:p

Analysis of Non-Marital Fertility in Nigeria and Implications for Intervention and Future Research

Fertility and marriage are inextricably linked in sub-Saharan Africa, but recent changes, such as the rise in non-marital fertility, signals a weakening link, and the second demographic transition offers some explanations. Non-marital fertility comes with disadvantages, but it has not been adequately studied in Nigeria. Hence, this study examined the levels, patterns, and correlates of non-marital fertility, and offers implications for interventions and future research. Using data from the Nigeria Demographic and Survey 2008–2018, with a pooled weighted sample size of 11,925 unmarried women, percentage distribution was employed and a two-part model for count data was fitted, with the result showing that the level of non-marital fertility is 29%, and it is common among younger, rural dwelling, and uneducated unmarried women. The correlates of non-marital fertility include age, region of residence, level of education, religion, household wealth index, relationship status, ethnicity, work status, and age at sexual debut. Interventions to arrest rise of non-martial fertility due to its obvious disadvantages, should strengthen sexual and reproductive health programs for unmarried rural-dwelling young women, and revitalize welfare efforts for children born outside wedlock, for poor women, while future research should explore an in-depth understanding of non-marital births

Modern contraceptive use among female adolescents in rural Nigeria: Does exposure to family planning messages matter? A cross-sectional study

Background: The world currently has the highest number of adolescents in all of history. Africa is home to quite a number of them, with most of these adolescents in Africa live in rural areas where they are more disadvantaged and their reproductive decisions could have telling impacts on their lives, family planning (contraception) has been identified as important to avoid such impacts. Factors associated with the use of modern contraceptives among female adolescents have been extensively researched but the importance of mass media family planning messages on modern contraceptives use among female adolescents in rural Nigeria is under-researched, hence this study. Method: This paper uses the 2013 Nigeria Demographic and Health Survey (NDHS) data with a weighted sample size (n=4473) to examine the association between exposure to family planning messages and use of modern contraceptives among female adolescents in rural Nigeria. Results: Findings indicated that exposure to family planning messages on radio and television were significantly associated with modern contraceptive use, however, educational attainment and region of residence were other factors that influenced modern contraceptive use.. Conclusion: The study concludes that family planning messages through mass media especially radio and television are associated with modern contraceptives use among rural adolescents. The continued use of mass media would enhance opportunities to achieve more results, however, other interventions addressing education with objectives of closing the rural-urban socio-economic gap should be encouraged also, as these factors play critical roles in improving uptake of family planning among rural adolescents.  Further, messages on modern contraceptive use should be sensitive to regional divides in terms of content and delivery.</ns4:p