Article

Contextual Influences on Modern Contraceptive Use in Sub-Saharan Africa

Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Ga 30322, USA.
American Journal of Public Health (Impact Factor: 4.55). 08/2007; 97(7):1233-40. DOI: 10.2105/AJPH.2005.071522
Source: PubMed

ABSTRACT

We examined the role of community-level factors in explaining geographic variations in modern contraceptive use in 6 African countries.
We analyzed Demographic and Health Survey and contextual data sources with multilevel modeling techniques to identify factors contributing to geographic variations in women's use of modern contraceptives.
We found significant associations between several community-level factors and reported use of modern contraceptive methods. We also identified several pathways of influence between the community and the individual.
Aspects of a community's sociocultural and economic environment appear to influence a woman's use of modern contraceptive methods.

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    • "Low or poor educationalof women and their knowledge of danger signs, knowledge of where to access services and the risk associated with service were also key determinants influencing service utilization in some settings. Conspicuously missing in almost all reviewed publications was the role health provider's play in influencing the services use through their educational sessions for women at the clinic or community setting as outlined in other studies[25]. Overall, single determinants alone were never observed in publications. "
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    ABSTRACT: Identifying relevant measures of women’s reproductive health needs is critical to improve women’s chances of service utilization. The study aims to systematically review and analyze the adequacy of outcome measures and determinants applied in previous studies for assessing women reproductive health needs across West Africa. Evidence on outcomes and determinants of unmet reproductive health needs among women of childbearing age in diverse multicultural, religious, and ethnic settings in West African countries was systematically reviewed. The review included recent English language publications (from January 2009 - March 2014). Clinical studies particularly on obstetric care services and reproductive services in relation to HIV/AIDS were excluded. We acknowledge the possibility to have excluded non-English publications and yet-to-be-published articles related to the study aim and objectives. Outcomes and determinants were assessed and defined at three main levels; contraceptive use, obstetric care, and antenatal care utilization. Results show increasing unmet need for women’s reproductive health needs. Socio-cultural norms and practices resulting in discontinuation of service use, economic constraints, travel distance to access services and low education levels of women were found to be key predictors of service utilization for contraception, antenatal and obstetric care services. Outcome measures were mainly assessed based on service utilization, satisfaction, cost, and quality of services available as core measures across the three levels assessed in this review. Evidence from this review indicates that currently applied measures of women’s reproductive health needs might be inadequate in attaining best maternal outcomes since they appear rather broad. More support and research for developing and advancing context-related measures may help to improve women’s maternal health.
    Full-text · Article · Dec 2015 · Reproductive Health
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    • "Lutz and Kc (2011) noted that this pattern is typically more pronounced in countries that have high fertility levels and that are in the early stages of demographic transition. In particular, some scholars suggest that more educated women have greater autonomy in reproductive decisionmaking and engage in more intensive parenting to ensure a better quality of life for their children (e.g., Martin, 1995; Kravdal, 2000; Basu, 2002; Manda and Meyer, 2005; Stephenson et al., 2007; Lutz and Kc, 2011). "
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    ABSTRACT: Many studies have suggested that there is an inverse relationship between education and number of children among women from sub-Saharan Africa countries, including Malawi. However, a crucial limitation of these analyses is that they do not control for the potential endogeneity of education. The aim of our study is to estimate the role of women’s education on their number of children in Malawi, accounting for the possible presence of endogeneity and for non-linear effects of continuous observed confounders. Our analysis is based on micro data from the 2010 Malawi Demographic Health Survey, by using a flexible instrumental variable regression approach. The results suggest that the relationship of interest is affected by endogeneity and exhibits an inverted-U shape among women living in rural areas of Malawi, whereas it exhibits an inverse (non-linear) relationship for women living in urban areas.
    Full-text · Article · Jan 2015 · Journal of Population Economics
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    • "A fundamental factor in the study of contraceptive decision-making is the space/environment in which people operate [11]. It is now an increasingly recognized problem that to achieve the MDG goals in developing countries, one must integrate the spatial dimension [10, 12–15]. This proposed study involving spatial analysis sheds light for policymakers on repositioning family planning methods, specifically an understanding of birth intervals. "
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    ABSTRACT: Background The length of time between two successive live births (birth interval), is associated with child survival in the developing world. Short birth intervals (<24 months) contribute to infant and child mortality risks. Contraceptive use contributes to a reduction in short birth intervals, but evidence is lacking in the DRC. We aimed to investigate the proportion of short birth intervals at the provincial level among young women in the DRC. Methods Data from the Demographic and Health Survey undertaken in the DRC in 2007 were analyzed. Logistic regression and Bayesian geo-additive models were used to explain provincial inequalities in short birth intervals among women of reproductive age and young women. Posterior odds ratio (OR) and 95% credible region (CR) were estimated via Markov chain Monte Carlo (MCMC) techniques. Posterior spatial effects and the associated posterior probability maps were produced at the provincial-level to highlight provinces with a significant higher risk of short birth interval. Results The overall proportion of short birth intervals among all women of reproductive age (15–49 years) and young women (15–24 years) were 30.2% and 38.7% respectively. In multivariate Bayesian geo-additive regression analyses, among the whole sample of women, living in rural areas [OR = 1.07, 95% CR: (0.97, 1.17)], exclusive breastfeeding [1.08 (1.00, 1.17)] and women with primary education [1.06 (1.00, 1.16)], were consistently associated with a higher risk of short birth intervals. For the young women, none of the factors considered were associated with the risk of short birth interval except a marginal effect from the lack of education. There was a spatial variation in the proportion of women reporting short birth intervals and among all women of reproductive age across provinces, with Nord-Kivu [1.12 (1.02, 1.24)], Sud Kivu [1.17 (1.05, 1.29)] and Kasai Occidental [1.18 (1.06, 1.32)] reporting a higher risk of short birth intervals. For young women, the higher risk provinces were Nord-Kivu [1.22 (1.00, 1.54)] and Sud Kivu [1.34 (1.14, 1.63)]. Conclusions This study suggests distinct geographic patterns in the proportion of short birth intervals among Congolese women, as well as the potential role of demographic and geographic location factors driving the ongoing higher youth fertility, higher childhood and maternal mortality in the DRC.
    Full-text · Article · Aug 2014 · BMC Pregnancy and Childbirth
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