Multilevel Mixed Effects Analysis of Individual and Community Factors Associated With Unmet Need for Contraception Among Married Women in Four East African Countries

Abstract

Although use of contraceptives is an expression of a woman’s reproductive control, unmet need for contraception remains high and a public concern among married women in East Africa. Limited literature has explored the associated factors in the region. This study examined the individual and community level factors associated with unmet need for contraception among married women in Burundi, Rwanda, Tanzania and Uganda. Methods: The study utilized data from the four most recent demographic and health surveys on the following selected samples of women in Burundi (8767), Rwanda (6472), Tanzania (7417) and Uganda (10288). Analyses were conducted using multilevel mixed effect logistic regressions with random community and country level effects. Results: Findings showed that: 20%, 22%, 28% and 33% of the married women in Rwanda Tanzania, Uganda and Burundi respectively had unmet need for contraception. Young married women, low education level, low wealth quintile, higher number of living children, couples that are not staying together, husband’s desire for more children, history of child death, women who are not working, no access to family planning messages, long distances to health facilities, and husbands as decision-makers on women’s health care were associated with high level of unmet need for contraception. Also, low community wealth, low community use of modern contraceptives, higher community age at marriage, higher community mean number of living children and lower community age at sexual debut were found to be significantly associated with high risk of unmet need for contraception in at least one of the countries. Conclusions: The findings suggest the need to design programs and policies that ensure awareness and access to modern contraceptive services among all disadvantaged communities and unique groups like couples who are not staying together through increased outreaches and increased mass media campaigns. In addition, concerted efforts aimed at raising the educational levels of people to bring about change in social and cultural norms that influence the husbands desire for higher number of children are much needed. Deliberate efforts of empowering women through education, job creation, and reproductive health decisions will significantly reduce the levels of unmet need for contraception in East Africa.