Differential effect of wealth quintile on modern contraceptive use and fertility: evidence from Malawian women

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Abstract

Background

High fertility and wide inequality in wealth distribution are phenomenal problems in sub-Saharan Africa. Modern Contraceptives (MC) are useful for limiting fertility, but are not always easily accessible in Malawi. This study examines the gap in MC use and fertility between women in the richest and poorest Wealth Quintile (WQ).

Methods

The study was cross-sectional in design and utilized Malawi DHS dataset, 2010. It focused on women of reproductive age. The dependent variables are ever and current use of MC. Chi-square and multinomial logistic regression were used for the analysis.

Results

Mean children ever born by women in the poorest and richest WQs were 3.94 ± 2.7 and 2.82 ± 2.3 respectively (p < 0.001). The adjusted total fertility rate (Adj.TFR) was higher among women in the poorest (Adj.TFR = 7.60) WQ than the richest (Adj.TFR = 4.45). The prevalence of ever use of MC was higher among women in the richest WQ (82.4%) than the poorest (66.8%) (p < 0.001). Similar pattern exists for current use of MC; 58.5% and 45.9% for women in the richest and poorest WQs respectively (p < 0.001). Women in the richest WQ were more likely to ever use (OR = 2.36; C.I = 2.07-2.69, p < 0.001) and currently using (OR = 1.66; C.I = 1.40-1.97, p < 0.001) MC than their counterparts in the poorest WQ. Slight reduction in odd-ratio of MC use among women in richest WQ resulted when socio-demographic variables were used as control.

Conclusion

Fertility was higher and the use of MC was lower among women in the poorest than their counterparts in the richest WQ. Ensuring availability of MC at little or no cost may bridge the gap in contraceptive use between women in the poorest and richest WQ in Malawi.

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Most cited references 7

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Women's empowerment and choice of contraceptive methods in selected African countries.

Mai Do, Nami Kurimoto (2012)

It is generally believed that women's lack of decision-making power may restrict their use of modern contraceptives. However, few studies have examined the different dimensions of women's empowerment and contraceptive use in African countries. Data came from the latest round of Demographic and Health Surveys conducted between 2006 and 2008 in Namibia, Zambia, Ghana and Uganda. Responses from married or cohabiting women aged 15-49 were analyzed for six dimensions of empowerment and the current use of female-only methods or couple methods. Bivariate and multivariate multinomial regressions were used to identify associations between the empowerment dimensions and method use. Positive associations were found between the overall empowerment score and method use in all countries (relative risk ratios, 1.1-1.3). In multivariate analysis, household economic decision making was associated with the use of either female-only or couple methods (1.1 for all), as was agreement on fertility preferences (1.3-1.6) and the ability to negotiate sexual activity (1.1-1.2). In Namibia, women's negative attitudes toward domestic violence were correlated with the use of couple methods (1.1). Intervention programs aimed at increasing contraceptive use may need to involve different approaches, including promoting couples' discussion of fertility preferences and family planning, improving women's self-efficacy in negotiating sexual activity and increasing their economic independence.

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Low use of contraception among poor women in Africa: an equity issue.

Duff Gillespie, Sabrina Karklins, Amy Tsui … (2011)

To examine the use of contraception in 13 countries in sub-Saharan Africa; to assess changes in met need for contraception associated with wealth-related inequity; and to describe the relationship between the use of long-term versus short-term contraceptive methods and a woman's fertility intentions and household wealth. The analysis was conducted with Demographic and Health Survey data from 13 sub-Saharan African countries. Wealth-related inequities in the use of contraception were calculated using household wealth and concentration indices. Logistic regression models were fitted for the likelihood of using a long-term contraceptive method, with adjustments for: wealth index quintile, fertility intentions (to space births versus to stop childbearing), residence (urban/rural), education, number of living children, marital status and survey year. The use of contraception has increased substantially between surveys in Ethiopia, Madagascar, Mozambique, Namibia and Zambia but has declined slightly in Kenya, Senegal and Uganda. Wealth-related inequalities in the met need for contraception have decreased in most countries and especially so in Mozambique, but they have increased in Kenya, Uganda and Zambia with regard to spacing births, and in Malawi, Senegal, Uganda, the United Republic of Tanzania and Zambia with regard to limiting childbearing. After adjustment for fertility intention, women in the richest wealth quintile were more likely than those in the poorest quintile to practice long-term contraception. Family planning programmes in sub-Saharan Africa show varying success in reaching all social segments, but inequities persist in all countries.

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Prevalence and determinants of the use of modern contraceptive methods in Kinshasa, Democratic Republic of Congo.

Patrick Kayembe, Alphonsine Busangu Fatuma, Mala Ali Mapatano … (2006)

In 2003, a cross-sectional study was carried out in Kinshasa to determine the prevalence and to identify the correlates of the use of modern contraceptive methods among sexually active females. Five hundred females of childbearing age (15-49 years) who were selected through a stratified sampling procedure were interviewed with a standardized questionnaire. The interview collected sociodemographic data, knowledge, perception and current use of modern contraceptive methods. Condoms appear to be the most widely known modern contraceptive method since it was cited by 43% of women; the pill was cited by only 28%, injectables were cited by 16.2%, IUD was cited by 8%, spermicidal foam was cited by 2% and the diaphragm was cited by <2%. Teenagers and young adults (15-24 years) were less knowledgeable of modern methods, while a noticeable proportion reported unwanted pregnancies. The prevalence of the utilization of modern contraceptive methods (barrier and hormonal methods) was estimated at 7%, with the male condom being the most commonly used method (reported by 74.3% of those using a modern method). Hormonal methods were used less often (the pill, 0.2%; others, <1% each). The current use of a modern contraceptive method correlated with having discussed contraception with someone [odds ratio (OR)=3.18; 95% confidence interval (95% CI)=1.52-6.64] and having ever used a modern contraceptive method (OR=11.57; 95% CI=2.71-49.48). An increase in the level of knowledge on modern contraceptive methods through mass and interpersonal communications could be one of the key strategies to increase the utilization rate of modern contraceptive methods in the Democratic Republic of Congo. Teenagers should be considered a priority group since there is evidence of unmet needs among them.

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Author and article information

Contributors

Stephen A Adebowale

Sunday A Adedini

Latifat D Ibisomi

Martin E Palamuleni

Journal

Journal ID (nlm-ta): BMC Womens Health

Journal ID (iso-abbrev): BMC Womens Health

Title: BMC Women's Health

Publisher: BioMed Central

ISSN (Electronic): 1472-6874

Publication date Collection: 2014

Publication date (Electronic): 7 March 2014

Volume: 14

Page: 40

Affiliations

[1 ]Population Training and Research Unit, Faculty of Humanities and Social Sciences, North-West University, Mafikeng, South Africa

[2 ]Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria

[3 ]Department of Demography and Social Statistics, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria

[4 ]Demography and Population Studies Programme, School of Social Sciences, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa

Article

Publisher ID: 1472-6874-14-40

DOI: 10.1186/1472-6874-14-40

PMC ID: 3973841

PubMed ID: 24602452

SO-VID: 72413a22-e2bc-4e6c-965a-e4d438b70b41

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.

Differential effect of wealth quintile on modern contraceptive use and fertility: evidence from Malawian women

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Abstract

Background

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Most cited references 7

Women's empowerment and choice of contraceptive methods in selected African countries.

Low use of contraception among poor women in Africa: an equity issue.

Prevalence and determinants of the use of modern contraceptive methods in Kinshasa, Democratic Republic of Congo.

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