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Women empowerment domains and unmet need for contraception among married and cohabiting fecund women in Sub-Saharan Africa: A multilevel analysis based on gender role framework

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  • Aklilu Habte
  • Aiggan Tamene
  • Biruk Bogale

Abstract

Background: Low women empowerment, is a known contributing factor to unmet needs for contraception by limiting access to health services through negative cultural beliefs and practices. However, little is known about the association between unmet needs and domains of women empowerment in Sub-Saharan African (SSA) countries. Hence, this study aimed at assessing the influence of women empowerment domains on the unmet need for contraception in the region using the most recent Demographic and Health Survey (DHS) data (2016–2021). Methods: The data for the study was derived from the appended women’s (IR) file of eighteen SSA countries. A weighted sample of 128,939 married women was analyzed by STATA version 16. The Harvard Institute’s Gender Roles Framework, which comprised of influencer, resource, and decision-making domains was employed to identify and categorize the covariates across three levels. The effects of each predictor on the unmet need for spacing and limiting were examined using a multivariable multilevel mixed-effect multinomial logistic regression analysis. Adjusted relative risk ratio (aRRR) with its corresponding 95% confidence interval was used to declare the statistical significance of the independent variables. Results: The pooled prevalence of unmet needs for contraception was 26.36% (95% CI: 24.83–30.40) in the region, with unmet needs for spacing and limiting being 16.74% (95% CI: 16.55, 17.02) and 9.62% (95% CI: 9.45, 12.78), respectively. Among variables in the influencer domain, educational level, family size of more than five, parity, number of children, attitude towards wife beating, and media exposure were substantially linked with an unmet need for spacing and limiting. Being in the poorest wealth quintile and enrollment in health insurance schemes, on the other hand, were the two variables in the resource domain that had a significant influence on unmet needs. The overall decision-making capacity of women was found to be the sole significant predictor of unmet needs among the covariates in the decision-making domain. Conclusion: Unmet needs for contraception in SSA countries were found to be high. Reproductive health program planners and contraceptive service providers should place due emphasis on women who lack formal education, are from low-income families, and have large family sizes. Governments should collaborate with insurance providers to increase health insurance coverage alongside incorporating family planning within the service package to minimize out-of-pocket costs. NGOs, government bodies, and program planners should collaborate across sectors to pool resources, advocate for policies, share best practices, and coordinate initiatives to maximize the capacity of women’s decision-making autonomy.

Suggested Citation

  • Aklilu Habte & Aiggan Tamene & Biruk Bogale, 2023. "Women empowerment domains and unmet need for contraception among married and cohabiting fecund women in Sub-Saharan Africa: A multilevel analysis based on gender role framework," PLOS ONE, Public Library of Science, vol. 18(9), pages 1-26, September.
    • Handle: RePEc:plo:pone00:0291110
    DOI: 10.1371/journal.pone.0291110
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    References listed on IDEAS

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    1. Achamyeleh Birhanu Teshale, 2022. "Factors associated with unmet need for family planning in sub-Saharan Africa: A multilevel multinomial logistic regression analysis," PLOS ONE, Public Library of Science, vol. 17(2), pages 1-15, February.
    2. John Bongaarts, 2020. "United Nations Department of Economic and Social Affairs, Population Division World Family Planning 2020: Highlights, United Nations Publications, 2020. 46 p," Population and Development Review, The Population Council, Inc., vol. 46(4), pages 857-858, December.
    3. repec:plo:pone00:0223389 is not listed on IDEAS
    4. Adeniyi Francis Fagbamigbe & Rotimi Felix Afolabi & Erhabor Sunday Idemudia, 2018. "Demand and Unmet Needs of Contraception Among Sexually Active In-Union Women in Nigeria: Distribution, Associated Characteristics, Barriers, and Program Implications," SAGE Open, , vol. 8(1), pages 21582440177, February.
    5. Ruth Alsop & Mette Bertelsen & Jeremy Holland, 2006. "Empowerment in Practice : From Analysis to Implementation," World Bank Publications - Books, The World Bank Group, number 6980.
    6. Hebe N Gouda & Andrew Hodge & Raoul Bermejo III & Willibald Zeck & Eliana Jimenez-Soto, 2016. "The Impact of Healthcare Insurance on the Utilisation of Facility-Based Delivery for Childbirth in the Philippines," PLOS ONE, Public Library of Science, vol. 11(12), pages 1-15, December.
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