Wealth-related inequalities in demand for family planning satisfied among married and unmarried adolescent girls and young women in sub-Saharan Africa

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Abstract

Background

The use of modern contraception has increased in much of sub-Saharan Africa (SSA). However, the extent to which changes have occurred across the wealth spectrum among adolescents is not well known. We examine poor-rich gaps in demand for family planning satisfied by modern methods (DFPSm) among sexually active adolescent girls and young women (AGYW) using data from national household surveys.

Methods

We used recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys to describe levels of wealth-related inequalities in DFPSm among sexually active AGYW using an asset index as an indicator of wealth. Further, we used data from countries with more than one survey conducted from 2000 to assess DFPSm trends. We fitted linear models to estimate annual average rate of change (AARC) by country. We fitted random effects regression models to estimate regional AARC in DFPSm. All analysis were stratified by marital status.

Results

Overall, there was significant wealth-related disparities in DFPSm in West Africa only (17.8 percentage points (pp)) among married AGYW. The disparities were significant in 5 out of 10 countries in Eastern, 2 out of 6 in Central, and 7 out of 12 in West among married AGYW and in 2 out of 6 in Central and 2 out of 9 in West Africa among unmarried AGYW. Overall, DFPSm among married AGYW increased over time in both poorest (AARC = 1.6%, p < 0.001) and richest (AARC = 1.4%, p < 0.001) households and among unmarried AGYW from poorest households (AARC = 0.8%, p = 0.045). DPFSm increased over time among married and unmarried AGYW from poorest households in Eastern (AARC = 2.4%, p < 0.001) and Southern sub-regions (AARC = 2.1%, p = 0.030) respectively. Rwanda and Liberia had the largest increases in DPFSm among married AGYW from poorest (AARC = 5.2%, p < 0.001) and richest (AARC = 5.3%, p < 0.001) households respectively. There were decreasing DFPSm trends among both married (AARC = − 1.7%, p < 0.001) and unmarried (AARC = − 4.7%, p < 0.001) AGYW from poorest households in Mozambique.

Conclusion

Despite rapid improvements in DFPSm among married AGYW from the poorest households in many SSA countries there have been only modest reductions in wealth-related inequalities. Significant inequalities remain, especially among married AGYW. DFPSm stalled in most sub-regions among unmarried AGYW.

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Most cited references 42

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Constructing socio-economic status indices: how to use principal components analysis.

S Vyas, L Kumaranayake (2006)

Theoretically, measures of household wealth can be reflected by income, consumption or expenditure information. However, the collection of accurate income and consumption data requires extensive resources for household surveys. Given the increasingly routine application of principal components analysis (PCA) using asset data in creating socio-economic status (SES) indices, we review how PCA-based indices are constructed, how they can be used, and their validity and limitations. Specifically, issues related to choice of variables, data preparation and problems such as data clustering are addressed. Interpretation of results and methods of classifying households into SES groups are also discussed. PCA has been validated as a method to describe SES differentiation within a population. Issues related to the underlying data will affect PCA and this should be considered when generating and interpreting results.

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Demographic and health surveys: a profile.

Daniel J. Corsi, Melissa Neuman, Jocelyn E Finlay … (2012)

Demographic and Health Surveys (DHS) are comparable nationally representative household surveys that have been conducted in more than 85 countries worldwide since 1984. The DHS were initially designed to expand on demographic, fertility and family planning data collected in the World Fertility Surveys and Contraceptive Prevalence Surveys, and continue to provide an important resource for the monitoring of vital statistics and population health indicators in low- and middle-income countries. The DHS collect a wide range of objective and self-reported data with a strong focus on indicators of fertility, reproductive health, maternal and child health, mortality, nutrition and self-reported health behaviours among adults. Key advantages of the DHS include high response rates, national coverage, high quality interviewer training, standardized data collection procedures across countries and consistent content over time, allowing comparability across populations cross-sectionally and over time. Data from DHS facilitate epidemiological research focused on monitoring of prevalence, trends and inequalities. A variety of robust observational data analysis methods have been used, including cross-sectional designs, repeated cross-sectional designs, spatial and multilevel analyses, intra-household designs and cross-comparative analyses. In this profile, we present an overview of the DHS along with an introduction to the potential scope for these data in contributing to the field of micro- and macro-epidemiology. DHS datasets are available for researchers through MEASURE DHS at www.measuredhs.com.

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Contraception for adolescents in low and middle income countries: needs, barriers, and access

Venkatraman Chandra-Mouli, Donna McCarraher, Sharon J Phillips … (2014)

Substantial numbers of adolescents experience the negative health consequences of early, unprotected sexual activity - unintended pregnancy, unsafe abortions, pregnancy-related mortality and morbidity and Sexually Transmitted Infections including Human Immunodeficiency Virus; as well as its social and economic costs. Improving access to and use of contraceptives – including condoms - needs to be a key component of an overall strategy to preventing these problems. This paper contains a review of research evidence and programmatic experiences on needs, barriers, and approaches to access and use of contraception by adolescents in low and middle income countries (LMIC). Although the sexual activity of adolescents (ages 10–19) varies markedly for boys versus girls and by region, a significant number of adolescents are sexually active; and this increases steadily from mid-to-late adolescence. Sexually active adolescents – both married and unmarried - need contraception. All adolescents in LMIC - especially unmarried ones - face a number of barriers in obtaining contraception and in using them correctly and consistently. Effective interventions to improve access and use of contraception include enacting and implementing laws and policies requiring the provision of sexuality education and contraceptive services for adolescents; building community support for the provision of contraception to adolescents, providing sexuality education within and outside school settings, and increasing the access to and use of contraception by making health services adolescent-friendly, integrating contraceptive services with other health services, and providing contraception through a variety of outlets. Emerging data suggest mobile phones and social media are promising means of increasing contraceptive use among adolescents.

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Author and article information

Contributors

Martin K. Mutua:

ORCID: http://orcid.org/0000-0003-1643-9934

mkavao@aphrc.org , martin.mutuah@gmail.com

Yohannes D. Wado:

ORCID: http://orcid.org/0000-0002-7200-6116

ywado@aphrc.org

Monica Malata: mpmalata@medcol.mw

Caroline W. Kabiru:

ORCID: http://orcid.org/0000-0002-0735-9839

carolinekabiru@gmail.com

Elsie Akwara:

ORCID: http://orcid.org/0000-0002-7751-9930

akwarae@gmail.com

Dessalegn Y. Melesse:

ORCID: http://orcid.org/0000-0003-3917-5329

Dessalegn.Melesse@umanitoba.ca

Ndèye Awa Fall: nfall@aphrc.org

Carolina V. N. Coll:

ORCID: http://orcid.org/0000-0003-0808-8230

ccoll@equidade.org

Cheikh Faye:

ORCID: http://orcid.org/0000-0002-4028-0575

cfaye@aphrc.org

Aluisio J. D. Barros:

ORCID: http://orcid.org/0000-0002-2022-8729

abarros@equidade.org

Journal

Journal ID (nlm-ta): Reprod Health

Journal ID (iso-abbrev): Reprod Health

Title: Reproductive Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1742-4755

Publication date (Electronic): 17 June 2021

Publication date PMC-release: 17 June 2021

Publication date Collection: 2021

Volume: 18

Issue : Suppl 1 Issue sponsor : The Supplement benefitted from two author workshops which were supported by a grant from the Canadian Partnership for Women and Children’s Health (CanWaCH). The Supplement was produced as part of the work of the Countdown to 2030 for Women's, Children's and Adolescents' Health which is funded by the Bill and Melinda Gates Foundation. Information about the source of funding for publication charges can be found in the individual articles. The articles have undergone the journal's standard peer review process for supplements. Supplement Editors were not involved in the peer review for any article that they co-authored. The Supplement Editors declare that they have no other competing interests.

Electronic Location Identifier: 116

Affiliations

[1 ]GRID grid.413355.5, ISNI 0000 0001 2221 4219, African Population and Health Research Center, ; Nairobi, Kenya

[2 ]GRID grid.10595.38, ISNI 0000 0001 2113 2211, Centre for Reproductive Health, , University of Malawi, ; Blantyre, Malawi

[3 ]GRID grid.21613.37, ISNI 0000 0004 1936 9609, Institute for Global Public Health, , University of Manitoba, ; Winnipeg, Canada

[4 ]GRID grid.411221.5, ISNI 0000 0001 2134 6519, International Center for Equity in Health, , Federal University of Pelotas, ; Pelotas, RS Brazil

[5 ]GRID grid.3575.4, ISNI 0000000121633745, World Health Organization, ; Geneva, Switzerland

Author information

Martin K. Mutua http://orcid.org/0000-0003-1643-9934

Yohannes D. Wado http://orcid.org/0000-0002-7200-6116

Caroline W. Kabiru http://orcid.org/0000-0002-0735-9839

Elsie Akwara http://orcid.org/0000-0002-7751-9930

Dessalegn Y. Melesse http://orcid.org/0000-0003-3917-5329

Carolina V. N. Coll http://orcid.org/0000-0003-0808-8230

Cheikh Faye http://orcid.org/0000-0002-4028-0575

Aluisio J. D. Barros http://orcid.org/0000-0002-2022-8729

Article

Publisher ID: 1076

DOI: 10.1186/s12978-021-01076-0

PMC ID: 8210345

PubMed ID: 34134700

SO-VID: 4f6f802c-8f27-4722-b8db-12e4da57d2f2

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 8 January 2021

Date accepted : 11 January 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000865, Bill and Melinda Gates Foundation;

Award ID: OPP1148933

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: demand for family planning satisfied by modern methods,adolescent girls and young women,wealth inequality,sub-saharan africa

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: demand for family planning satisfied by modern methods, adolescent girls and young women, wealth inequality, sub-saharan africa

Wealth-related inequalities in demand for family planning satisfied among married and unmarried adolescent girls and young women in sub-Saharan Africa

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Abstract

Background

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Conclusion

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Bacterial vaginosis and biofilm

Most cited references 42

Constructing socio-economic status indices: how to use principal components analysis.

Demographic and health surveys: a profile.

Contraception for adolescents in low and middle income countries: needs, barriers, and access

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