Coverage and determinants of modern contraceptive use in sub-Saharan Africa: further analysis of demographic and health surveys

BACKGROUND: The use of modern contraceptives (MC) in most African countries has been low despite the high fertility rate and unmet need for family planning. This study sought to determine the coverage and determinants of modern contraceptive use among women of reproductive age (15-49 years) in sub-Saharan Africa (SSA). METHODS: Data for the study were obtained from the Demographic and Health Surveys (DHS) conducted between 1995-2020 across 37 SSA countries. Women of reproductive age (15-49 years) was the unit of analysis. Analysis of data was done using STATA version 16 for windows. A bivariate Rao Scott's Chi-square test of independence was done to determine factors associated with the use of modern contraceptives. Factors that showed significance (p < 0.05) were included in a multilevel logistic regression to determine significant predictors of modern contraceptives. Clustering, stratification and sample weighting were accounted for in the analyses. RESULTS: The overall prevalence of the use of MC was found to be 22.0%. This ranged from 3.5% in the Central Africa Republic to 49.7% in Namibia. The most common type of MC used were injections (39.4%), condoms (17.5%) and implants (26.5%). Women were less likely to use modern contraceptive if they: had no education (aOR = 0.4, 95% CI 0.38-0.44), had no children (aOR = 0.27-0.42), not told of family planning at a health facility (aOR = 0.69, 95% CI 0.67-0.71), not heard of family planning in the media (aOR = 0.77, 95% CI 0.74-0.79) and being poor (aOR = 0.76, 95% CI 0.73-0.79). On the other hand, women were more likely to use modern contraceptive if they were between the age of 35-39 years (aOR = 1.69, 95% CI 0.73-0.79), married (aOR = 2.66, 95% CI 2.50-2.83), had seven or more children (aOR = 1.27, 95% CI 1.17-0.38), had knowledge of any method of contraceptives (aOR = 303.8, 95% CI 89.9-1027.5) and when field worker visited and talked about family planning (aOR = 1.53, 95% CI 1.39-0.68). CONCLUSION: The study showed a low prevalence of modern contraceptive use in sub-Saharan Africa. Findings from the study highlight the need to provide education to women to increase uptake of modern contraceptive and also re-enforce contraceptive interventions to improve women's health and well-being.