Influencing factors of unmet needs for child spacing among selected countries experiencing high maternal-mortality in sub-Saharan Africa
Keywords:Family planning, Maternal mortality, Unmet need for child spacing
Background: Maternal complication and death have implicated unintended pregnancy. The indicator for measuring the risk of unintended pregnancy is unmet need for family planning (FP). It is necessary to explore the current situation of unmet need for child spacing (UNCS) as well as its influencing factors among countries that are experiencing high maternal mortality ratio. We aimed to unveil the prevalence of UNCS and its associated factors in Nigeria, Liberia and Sierra Leone.
Methods: We analysed the data from DHS phase VII survey, a cross- sectional study conducted from year 2017 to 2018 across several countries. Total records of 25,539, 5,553, and 10,050 were extracted for Nigeria, Liberia and Sierra Leone respectively. Explored variables were UNCS, demographic characteristics and husband’s partners profile. Data was analysed using SPSS version 25. Descriptive statistics, test of association (chi-square) and binary logistic regression were used during the data analysis (α0.05).
Results: UNCS was high in Nigeria (15.9%), Liberia (22.5%) and Sierra Leone (21.9%). In Nigeria, Liberia and Sierra Leone, 40%, 37% and 49.1% were uneducated respectively. The proportion of married women were 89% in Nigeria, 32% in Liberia and 70.2% in Sierra Leone. Also, female headship of household (OR: 1.29, 95%CI: 1.09-1.54) was associated with UNCS relative to male headship of household.
Conclusions: UNCS was high in the three countries. Factors like educational status of women, age, as well as women as head of the households should be given much attention in the efforts to reduce UNCS as identified in this study.
Ahmed S, Li Q, Liu L, Tsui AO. Maternal deaths averted by contraceptive use: an analysis of 172 countries. Lancet. 2012;380(9837):111-25.
Almalik MM. Understanding maternal postpartum needs: a descriptive survey of current maternal health services. J Clin Nurs. 2017;26(23-24):4654-63.
Bahk J, Yun SC, Kim YM, Khang YH. Impact of unintended pregnancy on maternal mental health: a causal analysis using follow up data of the Panel Study on Korean Children (PSKC). BMC Pregnancy Childbirth. 2015;15(1):85.
Deater-Deckard K. Parenting stress. Yale University Press; 2014:220.
Dehingia N, Dixit A, Atmavilas Y, Chandurkar D, Singh K, Silverman J, Raj A. Unintended pregnancy and maternal health complications: cross-sectional analysis of data from rural Uttar Pradesh, India. BMC Pregnancy Childbirth. 2020;20:1-11.
Demographic and Health Survey. Version 20. Report on contraceptive, published by Nigeria Bureau of Statistics, Nigeria. 2017. Available from: https://dhsprogram.com. Accessed on 10 May 2021.
Essi MJ, Yakum MN, Mbu ER, Bhusal CK. Factors affecting unmet need of family planning among married Tharu women of Dang District, Nepal. BMC Womens Health. 2018;9312687.
Fagbamigbe AF, Afolabi RF, Idemudia ES. (2018). Demand and unmet needs of contraception among sexually active in-union women in Nigeria: distribution, associated characteristics, barriers, and program implications. SAGE Open. 2018;8(1).
Fure E. Are children poor men’s riches? Scand Econom History Rev. 1983;31(3):161-77.
Getaneh T, Negesse A, Dessie G, Desta M, Moltot T. Predictors of unmet need for family planning in Ethiopia 2019: a systematic review and meta-analysis. Arch Public Health. 2020;78;102.
Guure C, Maya ET, Dery S, da-Costa VB, Alotaibi RM, Rezk HR, et al. (2019). Factors influencing unmet need for family planning among Ghanaian married/union women: a multinomial mixed effects logistic regression modelling approach. Arch Public Health. 2019;77:11.
National Institute of Statistics and Economic Analysis, and ICF. (2019). Republic of Benin Fifth Demographic and Health Survey in Benin (EDSB-V) 2017-2018. Cotonou, Benin: INSAE/Benin and ICF.
Juarez F, Gayet C, Mejia-Pailles G. Factors associated with unmet need for contraception in Mexico: evidence from the National Survey of Demographic Dynamics 2014. BMC Public Health. 2018;18(1):1-8.
Klaus K. (2021). Crna Gora-Country Profile: Montenegro. Nations online.org, Stle-(12 October 1992). Available from: https://www.nationsonline. org/oneworld/montenegro.htm. Accessed on 13 May 2021.
Mulenga JN, Bwalya BB, Mulenga MC, Mumba K. Determinants of unmet need for family planning among married women in Zambia. J Public Health Afr. 2020;11(1):1084.
National Population Commission- NPC, and ICF. (2019). Nigeria Demographic and Health Survey 2018- Final Report. Abuja, Nigeria: NPC and ICF. Available from: https://dhsprogram.com/ pubs/pdf/FR359/FR359.pdf. Accessed on 13 May 2021.
United Nation. 2011 report: World contraceptive use. United Nation. Available at: https://www.un.org/en/development/desa/population/publications/family/contraceptive-wallchart-2011.asp. Accessed on 20 July 2021.
Nzokirishaka A, Itua I. Determinants of unmet need for family planning among married women of reproductive age in Burundi: a cross-sectional study. Contracept Reprod Med. 2018;3(1):1-13.
Okigbo CC, McCarraher DR, Chen M, Gwarzo U, Vance G, Chabikuli O. Unmet need for contraception among clients of FP/HIV integrated services in Nigeria: the role of partner opposition. Afr J Reprod Health. 2014;18(2):134-43.
Pack AP, McCarraher DR, Chen M, Okigbo CC, Albert LM, Wambugu S. Factors associated with unmet need for modern contraception in post-conflict Liberia. Afr J Reprod Health. 2014;18(2):58-67.
Regan L. Addressing unmet needs in global women’s health. British Medical Association. 2018. Available from: https://www.bma.org.uk/media/2117/bma-womens-global-health-report-aug-2018.pdf. Accessed on 20 July 2021.
Sedgh G, Ashford LS, Hussain R. Unmet need for contraception in developing countries: examining women’s reasons for not using a method. New York: Guttmacher Institute; 2016.
Stigum H, Htay TT, Liabsuetrakul T, Moe Myint AN, Sundby J, Solomon T, et al. Unmet need for family planning and associated factors among currently married reproductive age women in Tiro Afeta District, South West Ethiopia, 2017: cross-sectional study. Int J Environ Res Public Health. 2019;19(1):170.
Surkan PJ, Strobino DM, Mehra S, Shamim AA, Rashid M, Wu LSF, et al. Unintended pregnancy is a risk factor for depressive symptoms among socio-economically disadvantaged women in rural Bangladesh. BMC Pregnancy Childbirth. 2018;18(1):1-13.
Tsegaye D, Shuremu M, Bidira K. Practice of child spacing and its associated factors among women of child bearing age (15 to 49 years) in Illubabor zone, South West Ethiopia. Int J Nurs Midwife. 2017;9(7):102-8.
UNICEF. (2017). Maternal mortality declined by 38 per cent between 2000 and 2017. Available from: https://data.unicef.org/topic/maternal-health/maternal-mortality/. Accessed on 10 May 2021.
United Nations. (2017a). Goal 11: Make Cities Inclusive, Safe, Resilient and Sustainable, Sustainable Development Goals. United Nation. Available at https://sdgs.un.org/goals/goal11. Accessed on 13 May 2021.
Utomo B, Sucahya PK, Romadlona NA, Robertson AS, Aryanty RI, Magnani RJ. The impact of family planning on maternal mortality in Indonesia: what future contribution can be expected? Popul Health Metrics. 2021;19(1):1-13.
World Health Organization. Report of a WHO technical consultation on birth spacing: Geneva, Switzerland 13-15 June 2005: World Health Organization. 2007. Available from: https://apps.who.int/iris/handle/10665/69855. Accessed on 13 May 2021.
World Health Organization. Contraception within the context of adolescents’ sexual and reproductive lives: country factsheet: Afghanistan: World Health Organization. 2021. Available from: https://apps.who.int/iris/handle/10665/339250. Accessed on 13 May 2021.
Worldometers, i. (2018). Nigeria Population (2018). Available at: https://www.worldometers.info/world-population/nigeria-population/. Accessed on June 6 2021.
Wulifan JK, Mazalale J, Kambala C, Angko W, Asante J, Kpinpuo S, et al. Prevalence and determinants of unmet need for family planning among married women in Ghana-a multinomial logistic regression analysis of the GDHS, 2014. Contracept Reprod Med. 2019;4(1):1-14.
Wulifan JK, Mazalale J, Kambala C, Angko W, Asante J, Kpinpuo S, et al. Prevalence and determinants of unmet need for family planning among married women in Ghana-a multinomial logistic regression analysis of the GDHS. Contracept Reprod Med. 2019;4(1):1-4.
Yaya S, Ghose B. Prevalence of unmet need for contraception and its association with unwanted pregnancy among married women in Angola. PloS One. 2019;13(12).