Multilevel Mixed Effects Analysis of Individual and Community Factors Associated With Unmet Need for Contraception Among Married Women in Four East African Countries
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Research Square
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.
Description
Keywords
Unmet need, Community, Burundi, Rwanda, Uganda, East Africa, Multilevel, Tanzania
Citation
Kabagenyi, A., Wasswa, R., Henry, N., Paulino, A., Sseninde, J., & Rusatira, J. C. (2021). Multilevel Mixed Effects Analysis of Individual and Community Factors Associated With Unmet Need for Contraception Among Married Women in Four East African Countries. https://doi.org/10.21203/rs.3.rs-470884/v1