Factors influencing contraceptive use and non-use among women of advanced reproductive age in Nigeria

Journal of Health, Population and Nutrition, Volume 36, No. 1, Year 2017

Interpretation

Background: Factors influencing contraceptive use and non-use among women of advanced reproductive age have been insufficiently researched in Nigeria. This study examines factors influencing contraceptive use and non-use among women of advanced reproductive age in Nigeria. Methods: Secondary data were pooled and extracted from 2008 and 2013 Nigeria Demographic and Health Surveys (NDHS). The weighted sample size was 14,450 women of advanced reproductive age. The dependent variable was current contraceptive use. The explanatory variables were selected socio-demographic characteristics and three control variables. Analyses were performed using Stata version 12. Multinomial logistic regression was applied in four models. Results: Majority of the respondents are not using any method of contraceptive; the expected risk of using modern contraceptive relative to traditional method reduces by a factor of 0.676 for multiparous women (rrr = 0.676; CI: 0.464-0.985); the expected risk of using modern contraceptive relative to traditional method reduces by a factor of 0.611 for women who want more children (rrr = 0.611; CI: 0.493-0.757); the relative risk for using modern contraceptive relative to traditional method increases by a factor of 1.637 as maternal education reaches secondary education (rrr = 1.637; CI: 1.173-2.285); the relative risk for using modern contraceptive relative to traditional method increases by a factor of 1.726 for women in richest households (rrr = 1.726; CI: 1.038-2.871); and the expected risk of using modern contraceptive relative to traditional method increases by a factor of 1.250 for southern women (rrr = 1.250; CI: 1.200-1.818). Conclusions: Socio-demographic characteristics exert more influence on non-use than modern contraceptive use. The scope, content and coverage of existing BCC messages should be extended to cover the contraceptive needs and challenges of women of advanced reproductive age in the country. The geographic domain of the study is Nigeria, West Africa. The population of Nigeria is currently estimated at 181.8 million persons. Birth rate is high in the country with a total fertility rate of over five children per woman. Death rate is lower resulting in high natural increase. Infant and maternal mortality rates in Nigeria were among the highest in West Africa. Contraceptive prevalence rates either for all methods or for modern methods were less than 16% in the country [32]. However, population and health policies are being implemented to improve population health in the country. The key population policy is the 2004 National Policy on Population for Sustainable Development. The policy seeks to improve quality of life in the country through expansion of access to reproductive health services, improving safe motherhood programmes, increasing modern contraceptive prevalence by at least 2% yearly, promoting women empowerment and male involvement in reproductive health among other objectives and targets [33]. The policy also seeks to promote the detection, prevention and management of high-risk pregnancies and births. However, research has provided evidence that the policy has not been adequately implemented [34]. This has further aggravated the reproductive health of women in the country. Though, the policy has some specific programmes for some special population groups such as adolescents, refugees and internally displaced persons, the elderly and persons with disabilities, there are no specific programme for women of advanced reproductive age. Data analysed in the study were pooled and extracted from the 2008 and 2013 Nigeria Demographic and Health Survey (NDHS). The essence of the pooling was to improve the reliability and statistical power of the analyses. Samples covered in the surveys followed Demographic and Health Survey (DHS) international survey methodology of selecting samples through two-staged sampling process [35]. All survey staffs were well trained for the purpose of each round of the survey. Eligible men and women included in the surveys were men and women who were permanent residents or visitors in households that were randomly selected. Included visitors must have stayed in the household at least a night preceding the survey. Response rates in the surveys were of comparable international standard with 98% among women interviewed in the 2013 survey. Informed consent preceded all the interviews [18, 36]. The request to access and analyse the dataset was processed formally through online submission of abstract detailing the objective and methodology of the study to MEASURE DHS. Authorisation was granted without delay. Women in advanced reproductive age who were not sexually active and women who were less than 35 years were excluded from analysis. The weighted sample size analysed in the study was 14,450 women. The outcome variable was current contraceptive use which has three possible outcomes, namely non-use (1), using traditional method (2), and using modern method (3). The outcomes of interest were non-use and using modern method. All women who reported non-use of any method were grouped as ‘non-use’ while women who reported using any modern method such as condom, implants, injectables, sterilisation and foaming tablets were grouped as ‘using modern method’. Women who reported use of traditional method such as abstinence, withdrawal and lactational amenorrhea were grouped as ‘using traditional method’. The explanatory variables were a set of socio-demographic characteristics. The demographic characteristics selected for analysis were age, parity, child mortality experience, age at first birth, fertility desire and ideal family size. The selected socio-economic characteristics were maternal education, household wealth, place of residence, employment status, media exposure and geographic region. Three variables, namely remarriage, paternal education and women’s autonomy were selected for statistical control. The selection of the variables was guided by literature [8, 9, 12, 37, 38]. Some of the variables were however re-classified. Parity was classified into three, namely low (two or fewer children ever born), multiparity (three to four children ever born) and grand multiparity (five or more children ever born). Ideal family size was categorised into two, namely small (four or less) and large (five or more). Exposure to mass media was derived from the frequencies of reading newspapers, listening to radio and watching television within a week. Women who reported no frequency of exposure were grouped as ‘none’, women who accessed at least one of the three outlets less than once a week were grouped as ‘low’ while women who accessed all media outlets more than once a week were grouped as ‘moderate’. Two control variables, namely women autonomy and partner education, were included based on their significance in earlier studies [8, 17, 39]. Women autonomy was derived from responses on women’s participation in three household decisions, namely decisions on own health, purchase of large household items and visit to friends and relatives. Women who either took the three decisions solely or takes at least one of the decisions jointly with male partner were grouped as having ‘autonomy’ while women whose male partner or someone else had final say on the decisions were grouped as having ‘no autonomy’. Remarriage was included as a control variable because in Nigeria, remarriage exerts pressure on women to have additional child as a way of consolidating the new union. All analyses in the study were performed using Stata version 12. Sample socio-demographic characteristics were described using frequency distribution and percentage. Simple cross tabulation was performed to obtain percentage of use and non-use of contraceptives among the respondents. The multinomial logistic regression was applied for two purposes. Firstly, unadjusted multinomial logistic regression coefficients were applied to examine the separate bivariate relationship between use and non-use of contraceptive and the explanatory variables. Secondly, the relative risk ratios (rrr) were applied to examine the multivariate influence of the selected socio-demographic variables on use and non-use of contraceptives. The dependent variable being current contraceptive use has three possible outcomes, namely non-use, using traditional method and using modern method. These outcomes are unordered, coded 1, 2 and 3 respectively, and recoded in y notation. The explanatory variables are recorded in X notation. Three coefficients corresponding to each of the possible outcome of the dependent variable, that is (β (1), β (2), β (3)), are to be estimated. The mathematical expression for estimating the coefficients are as follows: The expression will however be unidentified because it will result in the same probabilities for each of the three possible outcomes. To make the expression identifiable, outcome 2 (using traditional method) was selected as the base outcome. By this selection, change in outcome 1 (non-use) and outcome 3 (using modern method) will be measured relatively to outcome 2. The expression was thus modified as: [36]. The multinomial logistic regression model was fitted using the Stata mlogit command [40]. The logistic regressions were estimated using the relative risk ratio (rrr). The rrr measures the change in outcome 1 and outcome 3 in relation to the base outcome (2) and was derived from the relative probability of each outcome to the base outcome, that is: Pry=1Pry=2=eXβ1 and Pry=3Pry=2=eXβ3. The multinomial logistic regression was replicated in four models. Model 1 was based solely on the demographic variables, while model 2 was based solely on the socio-economic variables. In model 3, the demographic and socio-economic variables were combined. Model 4 was the full model which included all variables including the control variables. The goodness-of-fit of the model was determined by the likelihood ratio chi-square. The importance of this statistic was to show whether the model fits significantly than an empty model, which is a model not including any of the explanatory variables of the study. Statistical significance was set at 5% (p < 0.05). The variance inflation factor (VIF) was performed to detect multicollinearity between the explanatory variables. The mean VIF score of 3.12 confirms the non-existence of serious multicollinearity.

AI Digest

Study Justification:

This study aims to examine the factors influencing contraceptive use and non-use among women of advanced reproductive age in Nigeria. This research is important because there has been insufficient research on this topic in Nigeria. Understanding these factors can help inform policies and interventions to improve reproductive health outcomes for women in the country.

Highlights:

– Majority of the respondents in the study were not using any method of contraception.
– The risk of using modern contraceptive methods relative to traditional methods was lower for multiparous women and women who wanted more children.
– Maternal education and household wealth were associated with higher use of modern contraceptive methods.
– Women in southern Nigeria had a higher likelihood of using modern contraceptive methods compared to women in other regions.

Recommendations for Lay Reader:

– The study found that socio-demographic characteristics have a greater influence on non-use of contraception than on the use of modern methods.
– The findings suggest that existing behavior change communication (BCC) messages should be expanded to address the specific contraceptive needs and challenges of women of advanced reproductive age in Nigeria.

Recommendations for Policy Maker:

– Policies and interventions should focus on improving access to reproductive health services for women of advanced reproductive age in Nigeria.
– Efforts should be made to increase awareness and education about modern contraceptive methods, particularly among multiparous women and those who want more children.
– Programs should also aim to improve women’s empowerment and increase male involvement in reproductive health.

Key Role Players:

– Ministry of Health: Responsible for implementing and coordinating reproductive health programs and policies.
– Non-governmental organizations (NGOs): Involved in providing reproductive health services and education to women.
– Community health workers: Play a crucial role in delivering reproductive health information and services at the community level.
– Health facilities: Provide access to contraceptive methods and counseling services.

Cost Items for Planning Recommendations:

– Training and capacity building for healthcare providers and community health workers.
– Development and dissemination of educational materials and BCC messages.
– Provision of contraceptive methods and supplies.
– Monitoring and evaluation of program implementation.
– Research and data collection to monitor progress and inform future interventions.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on secondary data from the Nigeria Demographic and Health Surveys, which provides a large sample size. The study uses multinomial logistic regression to analyze the factors influencing contraceptive use and non-use among women of advanced reproductive age in Nigeria. The results show that socio-demographic characteristics have a greater influence on non-use than modern contraceptive use. The study suggests extending the scope, content, and coverage of existing behavior change communication (BCC) messages to address the contraceptive needs and challenges of women of advanced reproductive age. However, the abstract does not provide information on the representativeness of the sample or the generalizability of the findings. Additionally, the abstract does not mention any limitations of the study or potential biases in the data. To improve the evidence, future research could include a more detailed description of the sampling methodology, address potential biases in the data, and provide a discussion of the limitations of the study.

Abstract

The geographic domain of the study is Nigeria, West Africa. The population of Nigeria is currently estimated at 181.8 million persons. Birth rate is high in the country with a total fertility rate of over five children per woman. Death rate is lower resulting in high natural increase. Infant and maternal mortality rates in Nigeria were among the highest in West Africa. Contraceptive prevalence rates either for all methods or for modern methods were less than 16% in the country [32]. However, population and health policies are being implemented to improve population health in the country. The key population policy is the 2004 National Policy on Population for Sustainable Development. The policy seeks to improve quality of life in the country through expansion of access to reproductive health services, improving safe motherhood programmes, increasing modern contraceptive prevalence by at least 2% yearly, promoting women empowerment and male involvement in reproductive health among other objectives and targets [33]. The policy also seeks to promote the detection, prevention and management of high-risk pregnancies and births. However, research has provided evidence that the policy has not been adequately implemented [34]. This has further aggravated the reproductive health of women in the country. Though, the policy has some specific programmes for some special population groups such as adolescents, refugees and internally displaced persons, the elderly and persons with disabilities, there are no specific programme for women of advanced reproductive age. Data analysed in the study were pooled and extracted from the 2008 and 2013 Nigeria Demographic and Health Survey (NDHS). The essence of the pooling was to improve the reliability and statistical power of the analyses. Samples covered in the surveys followed Demographic and Health Survey (DHS) international survey methodology of selecting samples through two-staged sampling process [35]. All survey staffs were well trained for the purpose of each round of the survey. Eligible men and women included in the surveys were men and women who were permanent residents or visitors in households that were randomly selected. Included visitors must have stayed in the household at least a night preceding the survey. Response rates in the surveys were of comparable international standard with 98% among women interviewed in the 2013 survey. Informed consent preceded all the interviews [18, 36]. The request to access and analyse the dataset was processed formally through online submission of abstract detailing the objective and methodology of the study to MEASURE DHS. Authorisation was granted without delay. Women in advanced reproductive age who were not sexually active and women who were less than 35 years were excluded from analysis. The weighted sample size analysed in the study was 14,450 women. The outcome variable was current contraceptive use which has three possible outcomes, namely non-use (1), using traditional method (2), and using modern method (3). The outcomes of interest were non-use and using modern method. All women who reported non-use of any method were grouped as ‘non-use’ while women who reported using any modern method such as condom, implants, injectables, sterilisation and foaming tablets were grouped as ‘using modern method’. Women who reported use of traditional method such as abstinence, withdrawal and lactational amenorrhea were grouped as ‘using traditional method’. The explanatory variables were a set of socio-demographic characteristics. The demographic characteristics selected for analysis were age, parity, child mortality experience, age at first birth, fertility desire and ideal family size. The selected socio-economic characteristics were maternal education, household wealth, place of residence, employment status, media exposure and geographic region. Three variables, namely remarriage, paternal education and women’s autonomy were selected for statistical control. The selection of the variables was guided by literature [8, 9, 12, 37, 38]. Some of the variables were however re-classified. Parity was classified into three, namely low (two or fewer children ever born), multiparity (three to four children ever born) and grand multiparity (five or more children ever born). Ideal family size was categorised into two, namely small (four or less) and large (five or more). Exposure to mass media was derived from the frequencies of reading newspapers, listening to radio and watching television within a week. Women who reported no frequency of exposure were grouped as ‘none’, women who accessed at least one of the three outlets less than once a week were grouped as ‘low’ while women who accessed all media outlets more than once a week were grouped as ‘moderate’. Two control variables, namely women autonomy and partner education, were included based on their significance in earlier studies [8, 17, 39]. Women autonomy was derived from responses on women’s participation in three household decisions, namely decisions on own health, purchase of large household items and visit to friends and relatives. Women who either took the three decisions solely or takes at least one of the decisions jointly with male partner were grouped as having ‘autonomy’ while women whose male partner or someone else had final say on the decisions were grouped as having ‘no autonomy’. Remarriage was included as a control variable because in Nigeria, remarriage exerts pressure on women to have additional child as a way of consolidating the new union. All analyses in the study were performed using Stata version 12. Sample socio-demographic characteristics were described using frequency distribution and percentage. Simple cross tabulation was performed to obtain percentage of use and non-use of contraceptives among the respondents. The multinomial logistic regression was applied for two purposes. Firstly, unadjusted multinomial logistic regression coefficients were applied to examine the separate bivariate relationship between use and non-use of contraceptive and the explanatory variables. Secondly, the relative risk ratios (rrr) were applied to examine the multivariate influence of the selected socio-demographic variables on use and non-use of contraceptives. The dependent variable being current contraceptive use has three possible outcomes, namely non-use, using traditional method and using modern method. These outcomes are unordered, coded 1, 2 and 3 respectively, and recoded in y notation. The explanatory variables are recorded in X notation. Three coefficients corresponding to each of the possible outcome of the dependent variable, that is (β (1), β (2), β (3)), are to be estimated. The mathematical expression for estimating the coefficients are as follows: The expression will however be unidentified because it will result in the same probabilities for each of the three possible outcomes. To make the expression identifiable, outcome 2 (using traditional method) was selected as the base outcome. By this selection, change in outcome 1 (non-use) and outcome 3 (using modern method) will be measured relatively to outcome 2. The expression was thus modified as: [36]. The multinomial logistic regression model was fitted using the Stata mlogit command [40]. The logistic regressions were estimated using the relative risk ratio (rrr). The rrr measures the change in outcome 1 and outcome 3 in relation to the base outcome (2) and was derived from the relative probability of each outcome to the base outcome, that is: Pry=1Pry=2=eXβ1 and Pry=3Pry=2=eXβ3. The multinomial logistic regression was replicated in four models. Model 1 was based solely on the demographic variables, while model 2 was based solely on the socio-economic variables. In model 3, the demographic and socio-economic variables were combined. Model 4 was the full model which included all variables including the control variables. The goodness-of-fit of the model was determined by the likelihood ratio chi-square. The importance of this statistic was to show whether the model fits significantly than an empty model, which is a model not including any of the explanatory variables of the study. Statistical significance was set at 5% (p < 0.05). The variance inflation factor (VIF) was performed to detect multicollinearity between the explanatory variables. The mean VIF score of 3.12 confirms the non-existence of serious multicollinearity.

Materials

N/A

Innovations

Based on the information provided, here are some potential innovations that could be recommended to improve access to maternal health in Nigeria:

1. Increase access to modern contraceptive methods: Since the study found that the majority of women of advanced reproductive age in Nigeria are not using any method of contraception, it is important to improve access to modern contraceptive methods such as condoms, implants, injectables, sterilization, and foaming tablets. This could be done by expanding the availability of these methods in healthcare facilities and ensuring that they are affordable and easily accessible to women across the country.

2. Improve reproductive health education and awareness: The study found that maternal education is a significant factor influencing contraceptive use. Therefore, it is crucial to provide comprehensive reproductive health education to women, especially those in rural areas who may have limited access to information. This could be done through community health programs, school-based education, and the use of mass media to disseminate information about contraceptive methods, family planning, and safe motherhood practices.

3. Strengthen healthcare infrastructure and services: To improve access to maternal health, it is important to strengthen healthcare infrastructure and services in Nigeria. This includes increasing the number of healthcare facilities that provide maternal health services, ensuring that these facilities are well-equipped and staffed with trained healthcare professionals, and improving the quality of care provided. Additionally, efforts should be made to address the geographic disparities in access to healthcare by ensuring that healthcare services are available in rural and remote areas.

4. Promote women empowerment and gender equality: The study found that women in richest households and those with higher levels of education were more likely to use modern contraceptive methods. Therefore, promoting women empowerment and gender equality is crucial to improving access to maternal health. This could be done through initiatives that promote women’s education, economic empowerment, and decision-making power in reproductive health matters.

5. Strengthen implementation of population and health policies: The study highlighted that the implementation of population and health policies in Nigeria has been inadequate. Therefore, it is important to strengthen the implementation of existing policies, such as the National Policy on Population for Sustainable Development, which aims to improve access to reproductive health services and increase contraceptive prevalence. This could be done through increased funding, capacity building for healthcare providers, and monitoring and evaluation of policy implementation.

These recommendations are based on the findings of the study and aim to address the factors influencing contraceptive use and non-use among women of advanced reproductive age in Nigeria. By implementing these innovations, it is hoped that access to maternal health will be improved, leading to a reduction in maternal and infant mortality rates in the country.

AI Innovations Description

Based on the description provided, the recommendation to improve access to maternal health in Nigeria is to expand the scope, content, and coverage of existing behavior change communication (BCC) messages to address the contraceptive needs and challenges of women of advanced reproductive age in the country.

The study found that socio-demographic characteristics have a greater influence on non-use of contraceptives than on modern contraceptive use. Factors such as multiparity, desire for more children, lower maternal education, lower household wealth, and residing in certain geographic regions were associated with lower use of modern contraceptives.

To address these barriers, it is recommended to enhance the existing BCC messages to specifically target women of advanced reproductive age. The messages should provide information and education on the benefits of contraceptive use, dispel myths and misconceptions, and address concerns related to contraceptive methods. Additionally, the messages should emphasize the importance of family planning in improving maternal health outcomes and empowering women to make informed decisions about their reproductive health.

Furthermore, the recommendation includes expanding access to reproductive health services, improving safe motherhood programs, and increasing the prevalence of modern contraceptive use by at least 2% annually, as outlined in the 2004 National Policy on Population for Sustainable Development. This policy aims to improve the quality of life in Nigeria by promoting women’s empowerment, male involvement in reproductive health, and the detection, prevention, and management of high-risk pregnancies and births.

It is important to note that the implementation of these recommendations should involve collaboration between government agencies, healthcare providers, community leaders, and other stakeholders. Additionally, monitoring and evaluation mechanisms should be put in place to assess the effectiveness of the interventions and make necessary adjustments to ensure continuous improvement in access to maternal health services.

AI Innovations Methodology

Based on the provided description, here are some potential recommendations to improve access to maternal health in Nigeria:

1. Increase awareness and education: Implement comprehensive and targeted education campaigns to raise awareness about the importance of maternal health and the available contraceptive methods. This can be done through various channels such as mass media, community outreach programs, and school-based education.

2. Improve access to contraceptives: Strengthen the supply chain and distribution systems to ensure a consistent availability of contraceptives in both urban and rural areas. This can involve establishing more family planning clinics, training healthcare providers, and utilizing mobile health technologies to reach remote areas.

3. Address socio-cultural barriers: Develop culturally sensitive strategies to address the socio-cultural factors that influence contraceptive use among women of advanced reproductive age. This can involve engaging community leaders, religious institutions, and traditional birth attendants to promote positive attitudes towards family planning and maternal health.

4. Enhance healthcare infrastructure: Invest in improving healthcare facilities, particularly in rural areas, to provide comprehensive maternal health services. This can include upgrading existing facilities, providing necessary equipment and supplies, and ensuring the availability of skilled healthcare providers.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could involve the following steps:

1. Define indicators: Identify key indicators to measure the impact of the recommendations, such as contraceptive prevalence rate, maternal mortality rate, and access to antenatal care.

2. Collect baseline data: Gather data on the current status of maternal health indicators in Nigeria, including contraceptive use, maternal mortality, and access to healthcare services. This can be done through surveys, health facility records, and existing data sources.

3. Develop a simulation model: Create a mathematical or statistical model that incorporates the identified recommendations and their potential impact on the selected indicators. This model should consider factors such as population size, geographic distribution, and socio-economic characteristics.

4. Input data and run simulations: Input the baseline data into the simulation model and run multiple simulations to estimate the potential impact of the recommendations on the selected indicators. This can involve adjusting variables related to contraceptive use, healthcare infrastructure, and socio-cultural factors.

5. Analyze results: Analyze the simulation results to determine the projected changes in the selected indicators. This can involve comparing the baseline data with the simulated data to assess the potential improvements in access to maternal health.

6. Validate and refine the model: Validate the simulation model by comparing the simulated results with real-world data and expert opinions. Refine the model based on feedback and make adjustments as necessary.

7. Communicate findings: Present the findings of the simulation study to relevant stakeholders, policymakers, and healthcare providers. Use the results to advocate for the implementation of the recommended interventions and to guide decision-making in improving access to maternal health.

It is important to note that the methodology for simulating the impact of recommendations may vary depending on the specific context and available data.

Author

Dima Health

Statistics:

Citations: 33

Identifiers:

DOI: 10.1186/s41043-016-0077-6

ISSN: 16060997

Research Areas:

Community Interventions, Disability, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants

Study Countries:

Multi-Countries, Nigeria

Study Design:

Cross Sectional Study, Phenomenological Study

Study Approach:

Quantitative

Participants Gender:

Male & Female