Pooled prevalence and determinants of informed choice of contraceptive methods among reproductive age women in Sub-Saharan Africa: A multilevel analysis

  • Frontiers in Public Health, Volume 10, Year 2022

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Study Justification:
This study aimed to assess the pooled prevalence and determinants of informed choice of contraceptive methods among reproductive-aged women in sub-Saharan Africa. The justification for this study is that despite government commitments to minimize unintended pregnancy, abortion, and unmet need for contraceptives, there is a lack of research on this topic in sub-Saharan Africa.
Highlights:
– The pooled prevalence of informed choice of contraceptive methods among reproductive-age women in sub-Saharan Africa was found to be 49.47%.
– Women aged 25-34 and 35-49, those with higher levels of education, media exposure, and those utilizing specific contraceptive methods (IUD, injectable, and implants) were associated with increased odds of informed choice.
– Women accessing contraceptives from private clinics, pharmacies, and other sources, as well as those in East Africa, Central Africa, and South Africa, were associated with decreased odds of informed choice.
– The study highlights the low prevalence of informed choice of contraceptive methods in sub-Saharan Africa and the disparities among countries.
Recommendations:
– Enhancing maternal education and media exposure to increase awareness and knowledge about contraceptive methods.
– Providing greater concern for the source of contraceptive methods to ensure accurate information and counseling.
– Strengthening the economic status of the country to improve access to contraceptive methods.
Key Role Players:
– Government health departments and ministries responsible for reproductive health programs.
– Non-governmental organizations (NGOs) working in the field of reproductive health and family planning.
– Healthcare providers, including doctors, nurses, and midwives, who play a crucial role in counseling and providing contraceptive services.
– Community leaders and influencers who can help disseminate accurate information about contraceptive methods.
– Researchers and academics who can contribute to further studies and evidence-based interventions.
Cost Items for Planning Recommendations:
– Educational campaigns and materials to enhance maternal education and media exposure.
– Training programs for healthcare providers to improve their knowledge and skills in contraceptive counseling.
– Infrastructure development and resources for health facilities to ensure the availability and accessibility of contraceptive methods.
– Research funding for further studies and evaluations of interventions.
– Monitoring and evaluation systems to assess the impact of implemented interventions and make necessary adjustments.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a study using a large sample size and multilevel logistic regression analysis. The study provides adjusted odds ratios with 95% confidence intervals to determine significant determinants of informed choice of contraceptive methods. However, the abstract does not provide information on the specific methodology used for data cleaning, weighting, and analysis. Additionally, the abstract does not mention any limitations of the study or potential sources of bias. To improve the evidence, the abstract could include more details on the data cleaning, weighting, and analysis methods used. It would also be helpful to mention any limitations of the study and potential sources of bias that may affect the validity of the findings.

Background: Despite the commitments of the government to minimize unintended pregnancy, abortion, and unmet need for contraceptives, as per our search of the literature, there is no study on the pooled prevalence and determinants of informed choice of contraceptive methods in sub-Saharan Africa. Therefore, this study aimed to assess the pooled prevalence and determinants of informed choice of contraceptive methods among reproductive-aged women in sub-Saharan Africa. Methods: This study was based on the 32 Sub-Saharan African countries Demographic and Health Survey data. A total weighted sample of 65,487 women aged 15–49 was included in the study. The data were cleaned, weighted, and analyzed using STATA Version 14 software. Multilevel logistic regression modeling was used to identify determinants of an informed choice of contraceptive methods. Adjusted odds ratio (AOR) with 95% Confidence Interval (CI) and p-value < 0.05 were used to declare the significant determinants. Result: The pooled prevalence of informed choice of contraceptive methods among reproductive age (15–49) women in sub-Saharan Africa was 49.47% (95%CI: 44.33, 54.62%) with I2 =99.5%, and variations in range of 19.42 to 78.42%. Women aged 25–34 years old (AOR = 1.26 95%CI: 1.21, 1.32) and 35–49 years (AOR = 1.33 95%CI: 1.27, 1.40), attending primary education (AOR = 1.26, 95% CI: 1.20, 1.32), secondary education (AOR = 1.50, 95% CI: 1.43, 1.58) and higher education (AOR = 2.01, 95% CI: 1.84, 2.19), having media exposure (AOR = 1.12, 95%CI: 1.07, 1.16), utilizing IUD (AOR = 1.98, 95%CI: 1.79, 2.19), injectable (AOR = 1.29, 95%CI: 1.23, 1.36) and implants (AOR = 1.70, 95%CI: 1.61, 1.79), survey year 2016–2020 (AOR = 1.38, 95%CI: 1.31, 1.44), women from lower middle (AOR = 1.25, 95%CI: 1.19, 1.31) and upper middle income level countries (AOR = 1.37, 95%CI: 1.23, 1.53) were associated with increased odds of informed choice of contraceptive methods. While, women who accessed contraceptives from private clinics (AOR = 0.64, 95%CI: 0.61, 0.67), pharmacies (AOR = 0.37, 95%CI: 0.35, 0.40), and others (AOR = 0.47, 95%CI: 0.43, 0.52), women in East Africa (AOR = 0.70, 95% CI: 0.67, 0.73), Central Africa (AOR = 0.52, 95% CI: 0.47, 0.57), and South Africa (AOR = 0.36, 95% CI: 0.32, 0.40) were associated with decreased odds of informed choice of contraceptive methods. Conclusion: The pooled prevalence of informed choice of contraceptive methods in Sub-Saharan Africa is low with high disparities among the countries. Enhancing maternal education and media exposure, providing greater concern for the source of contraceptive methods, and strengthening the economic status of the country are recommended to enhance informed choice of contraceptive methods.

The data used in this study were the most recent Demographic and Health Surveys (DHS) data compiled in the 32 SSA countries (Angola, Burkina-Faso, Benin, Burundi, Democratic Republic of Congo, Congo, Ivory Coast, Cameroon, Ethiopia, Gabon, Ghana, Gambia, Guinea, Kenya, Comoros, Liberia, Lesotho, Mali, Malawi, Nigeria, Niger, Namibia, Rwanda, Sierra Leone, Senegal, Chad, Togo, Tanzania, Uganda, South Africa, Zambia, and Zimbabwe) from 2010 to 2019/2020. The data were derived from the measure DHS program. These datasets were merged together to determine the pooled prevalence and determinants of informed choice of contraceptive methods across the SSA countries. The DHS data is a nationwide representative survey and it has different datasets (men, women, birth, children, and household datasets). For this study, we used the individual data set (IR file). The DHS used two stages of stratified sampling technique to select the study participants. We pooled the DHS surveys conducted in the 32 SSA countries and a total weighted sample of 65,487 women aged 15–49 who are currently using selected modern contraceptive methods (pill, IUD, injectable, female sterilization, and implants) was included in the study. The outcome variable for this study was informed choice of contraceptive methods, which was a binary outcome variable coded as “0” if a woman did not receive informed choice of contraceptive methods, and “1” if she did receive informed choice of contraceptive methods. The variable was generated using the three questions. The three questions were: (1) “Were you told about possible side effects or problems you might have with the method?” (2) “Were you told what to do if you experience any side effects?” and (3) “Were you told about other methods of family planning?” Answers were coded as 1 = Yes and 0 = No, then categorized as a woman received informed choice of contraceptive methods if they answered all three questions, and otherwise they did not receive an informed choice of contraceptive methods (18, 25). The independent variables were classified as individual level variables such as age, marital status, and maternal educational status, husband educational status, maternal occupation, husband occupation, media exposure status, household wealth index, internet use, visiting health facilities in the last 12 months, source of contraceptive method, and type of contraceptive use. Whereas, community level variables, such as residence, region in SSA countries, DHS survey year, and country income level. Media exposure was calculated from three variables; listening to the radio, reading newspapers, and watching television. If a woman were exposed to at least one type of media, she was considered as exposed to media (26). The country income level was categorized as low income, lower middle income, and upper-middle-income country based on the World Bank List of Economies since 2019 (27). After we accessed the data from the DHS program, we cleaned the data, carried out cross-tabulation, and calculated descriptive and summary statistics using STATA version 14 software. Before inferential analysis, we applied weighting using sampling weight, primary sampling unit, and strata to restore the representativeness of the survey and to get reliable statistical estimates. The pooled prevalence of informed choice of contraceptive method across countries from 2010 to 2019/2020 was done using a metan STATA command and presented in a forest plot with 95% Confidence Interval (CI). Besides, further subgroup analyses were done to minimize the heterogeneity between studies using regions in SSA countries and the DHS survey year. The multilevel binary logistic regression analysis were used to determine the association between the likelihood of informed choice of contraceptive methods and explanatory variables at both individual and community levels. After bivariable analysis, variables with a p-value < 0.2 were included in the multivariable multilevel logistic regression model. Adjusted Odds Ratios (AOR) with a 95% CI and a p-value < 0.05 in the multivariable multilevel logistic model were used to declare significant determinants of informed choice of contraceptive methods. The DHS data has a hierarchical nature. Hence, women are nested within a cluster, and we anticipate that women within the same cluster may be more similar to each other than women in the rest of the country. This implies that advanced models need to take into account the between cluster variability. Therefore, we used the mixed-effect logistic regression analysis method. Moreover, model comparison and fitness were assessed based on the Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), Proportional Change in Variance (PCV), and deviance (-2LLR) values. The calculation for MOR and PCV is as follows; Generally, in this study, four models were fitted: the first model was a null model (model without the independent variables), which was used to check the variability of informed choice of contraceptive methods in the cluster. The second (model I) and third (model II) models, which contain individual-level variables and community-level variables, respectively. The final model (model III), which contains both individual and community-level variables simultaneously. We used deviance to select the best fit model for the data. The final model (model III) was selected because of its lowest deviance value (Table 3). Ethical approval and participant consent were not necessary for this study since it was a secondary data analysis based on the publically available DHS data. We requested to access the data from the measure DHS program and permission was obtained to download and use the data for this study. There are no personal identifier in the data files.

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The recommendations to improve access to maternal health based on the findings of the study “Pooled prevalence and determinants of informed choice of contraceptive methods among reproductive age women in Sub-Saharan Africa: A multilevel analysis” are as follows:

1. Enhance maternal education and media exposure: Prioritize education and media campaigns that provide accurate information about contraceptive options, their side effects, and how to address them. This can help women make informed decisions about their reproductive health.

2. Strengthen the economic status of the country: Implement policies that promote economic growth, poverty reduction, and social protection programs. This can contribute to better access to healthcare services, including maternal health services.

3. Provide greater concern for the source of contraceptive methods: Ensure that contraceptive methods are provided through reliable and trusted sources, such as public health facilities, where women can receive accurate information and counseling about their contraceptive options.

These recommendations aim to empower women with knowledge and resources to make informed decisions about their reproductive health, thereby improving access to maternal health services in Sub-Saharan Africa.
AI Innovations Description
The recommendation to improve access to maternal health based on the findings of the study “Pooled prevalence and determinants of informed choice of contraceptive methods among reproductive age women in Sub-Saharan Africa: A multilevel analysis” is as follows:

1. Enhance maternal education and media exposure: The study found that women with higher levels of education and media exposure were more likely to make informed choices about contraceptive methods. Therefore, it is recommended to prioritize education and media campaigns that provide accurate information about contraceptive options, their side effects, and how to address them. This can help women make informed decisions about their reproductive health.

2. Strengthen the economic status of the country: The study found that women from lower middle and upper middle-income countries had increased odds of making informed choices about contraceptive methods. Improving the economic status of countries in Sub-Saharan Africa can contribute to better access to healthcare services, including maternal health services. This can be achieved through policies that promote economic growth, poverty reduction, and social protection programs.

3. Provide greater concern for the source of contraceptive methods: The study found that women who accessed contraceptives from private clinics, pharmacies, and other sources had decreased odds of making informed choices. It is recommended to ensure that contraceptive methods are provided through reliable and trusted sources, such as public health facilities, where women can receive accurate information and counseling about their contraceptive options.

Overall, these recommendations aim to empower women with knowledge and resources to make informed decisions about their reproductive health, thereby improving access to maternal health services in Sub-Saharan Africa.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health based on the findings of the study, the following methodology can be used:

1. Enhance maternal education and media exposure:
– Develop and implement educational programs targeting women of reproductive age in Sub-Saharan Africa, focusing on contraceptive methods, their side effects, and how to address them.
– Collaborate with local media outlets to disseminate accurate information about contraceptive options through radio, television, and newspapers.
– Monitor the reach and effectiveness of these educational and media campaigns through surveys and data collection.

2. Strengthen the economic status of the country:
– Advocate for policies that promote economic growth, poverty reduction, and social protection programs in Sub-Saharan African countries.
– Collaborate with international organizations and governments to allocate resources towards improving access to healthcare services, including maternal health services.
– Monitor the progress of economic development and its impact on access to maternal health services through indicators such as GDP per capita and poverty rates.

3. Provide greater concern for the source of contraceptive methods:
– Strengthen the capacity of public health facilities to provide contraceptive methods and accurate information to women.
– Develop guidelines and standards for private clinics and pharmacies to ensure they adhere to best practices in contraceptive counseling and provision.
– Conduct regular assessments and inspections of private clinics and pharmacies to ensure compliance with guidelines.

To simulate the impact of these recommendations, the following steps can be taken:

1. Baseline data collection:
– Collect baseline data on the prevalence of informed choice of contraceptive methods and access to maternal health services in Sub-Saharan Africa.
– Use surveys, interviews, and existing data sources to gather information on the current state of maternal education, media exposure, economic status, and sources of contraceptive methods.

2. Implementation of recommendations:
– Implement the recommendations outlined above, including educational programs, media campaigns, economic development initiatives, and improvements in the provision of contraceptive methods.
– Monitor the implementation process, including the reach and effectiveness of educational programs, media campaigns, and policy changes.

3. Data collection after implementation:
– Collect post-implementation data on the prevalence of informed choice of contraceptive methods and access to maternal health services.
– Compare the post-implementation data with the baseline data to assess the impact of the recommendations on improving access to maternal health.

4. Analysis and evaluation:
– Analyze the data collected before and after the implementation of the recommendations.
– Use statistical methods to assess the significance of any changes observed in the prevalence of informed choice of contraceptive methods and access to maternal health services.
– Evaluate the effectiveness of each recommendation individually and in combination.

By following this methodology, it will be possible to simulate the impact of the main recommendations on improving access to maternal health in Sub-Saharan Africa based on the findings of the study. This will provide valuable insights for policymakers and stakeholders in designing and implementing interventions to enhance maternal health services in the region.


Identifiers:
DOI: 10.3389/fpubh.2022.962675
Research Areas:
Community Interventions, Disparities, Genetics and Genomics, Health System and Policy, Maternal Access, Maternal and Child Health, Sexual and Reproductive Health, Social Determinants
Study Countries:
Angola, Benin, Burundi, Cameroon, Chad, Comoros, Congo, Ethiopia, Gabon, Gambia, Ghana, Guinea, Ivory Coast, Kenya, Lesotho, Liberia, Malawi, Mali, Multi-Countries, Namibia, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, South Africa, Tanzania, Togo, Uganda, Zambia, Zimbabwe
Study Design:
Case-Control Study, Cross Sectional Study
Study Approach:
Quantitative
Participants Gender:
Male & Female
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