Women's empowerment indicators and short- and long-acting contraceptive method use: evidence from DHS from 11 countries.

Background: With a population of about 1.1 billion, sub-Saharan Africa is projected to overtake Eastern, Southern and Central Asia to become the most populous region by 2060. One effective approach for slowing this rapid population growth is the use of modern contraception and this may be short-acting or long acting. Previous studies have explored the association between women empowerment indicators contraception use, however, there is limited evidence on how women empowerment indicators associate with type of contraception. Hence the present study investigated the association between women empowerment indicators and type of contraception used by women in 11 sub-Saharan African countries. Methods: We utilised Demographic and Health Survey data of 22,637 women from 11 countries, collected between 2018 and 2021. The outcome variable was type of contraception used. Descriptive and inferential analyses were executed. The descriptive analysis reflected women empowerment indicators and the proportion of women using contraceptives. Multinomial logistic regression was considered for the inferential analysis. The results for the multinomial logistic regression were presented as adjusted odds ratios (aORs) along with the respective 95% confidence intervals (CIs) signifying precision. The sample weight (wt) was used to account for the complex survey (svy) design. All the analyses were done with Stata version 13 and SPSS version 25. Results: The study showed that on the average, 15.95% of the women do not use modern contraceptives, whilst 30.67% and 53.38% use long-acting and short-acting contraceptives respectively. The adjusted models showed that women who were working had higher odds of using long-acting (aOR = 1.44, CI 1.28–1.62) and short-acting (aOR = 2.00, CI 1.79–2.24) methods compared with those who were not working. The analysis revealed higher likelihood of long-acting method use among women with high decision-making capacity (aOR = 1.27, CI 1.09–1.47) compared with women with low decision-making capacity. Women with medium knowledge level had a higher likelihood (aOR = 1.54, 1.09–2.17) of using long-acting methods than their counterparts with low knowledge level. Conclusion: Our findings show that most women in the 11 countries use modern contraceptives, however, different empowerment indicators align with different contraceptive type. It therefore behoves governments of the studied countries to review current interventions and embrace new ones that are more responsive to the peculiar contraception needs of empowered and non-empowered women. Plain Language summary: By 2060, sub-Saharan Africa is expected to have more population than Southern, Eastern, and Central Asia. Modern contraception is identified to be effective in reducing population growth. There is limited evidence on the association between women empowerment indicators and the type of contraception used by women in sub-Saharan Africa, either short or long-acting methods. Hence, this study investigated the relationship between women empowerment indicators and the type of contraception used by women in 11 sub-Saharan African countries. We performed both descriptive and inferential analyses. The descriptive analysis, being frequencies and percentages, focused on women empowerment indicators and the proportion of women who use contraception. The inferential analysis was multinomial logistic regression. The findings showed that 15.95% of women do not use modern contraception, however, 30.67% and 53.38% were using long-acting and short-acting contraception, respectively. Women who worked had higher odds of using long-acting and short-acting methods than those who did not work. Women with high decision-making capacity had high likelihood of using long-acting methods than women with low decision-making capacity. Women with medium knowledge level had a higher likelihood of using long-acting methods than their counterparts with low knowledge level. The study highlights the need for governments in the studied countries to review current interventions and adopt new ones to make the interventions more responsive to the contraception needs of women, irrespective of their empowerment status. [ABSTRACT FROM AUTHOR]

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