Predictors of unmet need for contraception among adolescent girls and young women in selected high fertility countries in sub-Saharan Africa: A multilevel mixed effects analysis
Predictors of unmet need for contraception among adolescent girls and young women in selected high fertility countries in sub-Saharan Africa: A multilevel mixed effects analysis
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DOI：
10.1371/journal.pone.0236352
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发表时间：
2020-08-06
期刊：
影响因子：
3.7
通讯作者：
Ahinkorah, Bright Opoku
中科院分区：
文献类型：
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作者：
Ahinkorah, Bright Opoku
尽管撒哈拉以南非洲的少女和年轻妇女希望使用避孕药具，但她们中的大多数人在获得避孕服务方面面临挑战。这在撒哈拉以南非洲的高生育率国家更为明显。本研究的目的是研究撒哈拉以南非洲某些高生育率国家的AGYW避孕需求未得到满足的预测因素。材料和方法对2010年至2018年在撒哈拉以南非洲10个国家进行的人口与健康调查（DHS）的数据进行了分析。使用了24，898名已婚或同居的AGYW样本。未满足的避孕需求是本研究的结局变量。解释变量为年龄、婚姻状况、职业、教育程度、阅读报纸/杂志的频率、听广播的频率、看电视的频率和均等（个人水平变量）和财富五分位数、户主性别、居住地和医疗保健决策者（家庭/社区水平变量）。进行描述性和多水平logistic回归分析。多水平logistic回归分析的结果采用95%置信区间的校正比值比报告。结果在本研究所考虑的所有国家中，避孕需求未得到满足的流行率为24.9%，其中安哥拉的流行率最高，为42.6%，而尼日尔的流行率最低，为17.8%。就个体水平预测因素而言，年龄在20-24岁的AGYW [aOR = 0.82; 95%CI = 0.76-0.88]、具有小学[aOR = 1.22; 95%CI = 1.13-1.31]和中学/高等正规教育水平[aOR = 1.18; 95%CI = 1.13-1.31]的人避孕需求未得到满足的可能性较低。95%CI = 1.08-1.28，p < 0.001]，同居AGYW [aOR = 1.52; 95%CI = 1.42-1.63]和AGYW有三个或更多的生育[aOR = 3.41; 95%CI = 3.02-3.85]。在家庭/社区一级，避孕需求未得到满足的几率最高的是较贫穷的AGYW [aOR = 1.36; 95%CI = 1.21-1.53]，女性户主家庭的AGYW [aOR = 1.22; 95%CI = 1.13-1.33]，城市AGYW [aOR = 1.21; 95%CI = 1.21 - 1.53]。95%CI = 1.11-1.32]和AGYW单独采取医疗保健决策[aOR = 1.10; 95%CI = 1.01-1.21]。结论本研究确定了撒哈拉以南非洲高生育率国家AGYW中避孕需求未得到满足的差异，安哥拉AGYW的流行率最高。在这项研究中，个人和家庭/社区一级的因素都预测AGYW的避孕需求未得到满足。然而，根据ICC值，家庭/社区层面的因素占主导地位的个人层面的因素。建议高生育率国家的政府和非政府组织加强较贫穷的青年男女、女户主家庭、城市地区和独自作出保健决定的人获得避孕药具的机会。
Introduction Despite the desire of adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) to use contraceptives, the majority of them have challenges with access to contraceptive services. This is more evident in high fertility countries in SSA. The purpose of this study was to examine the predictors of unmet need for contraception among AGYW in selected high fertility countries in SSA. Materials and methods Data from current Demographic and Health Surveys (DHS) carried out between 2010 and 2018 in 10 countries in SSA were analysed. A sample size of 24,898 AGYW who were either married or cohabiting was used. Unmet need for contraception was the outcome variable in this study. The explanatory variables were age, marital status, occupation, educational level, frequency of reading newspaper/magazine, frequency of listening to radio, frequency of watching television and parity (individual level variables) and wealth quintile, sex of household head, place of residence and decision-maker in healthcare (household/community level variables). Descriptive and multilevel logistic regression analyses were carried out. The results of the multilevel logistic regression analyses were reported using adjusted odds ratios at 95% confidence interval. Results The prevalence of unmet need for contraception in all the countries considered in this study was 24.9%, with Angola, recording the highest prevalence of 42.6% while Niger had the lowest prevalence of 17.8%. In terms of the individual level predictors, the likelihood of unmet need for contraception was low among AGYW aged 20-24 [aOR = 0.82; 95% CI = 0.76-0.88], those with primary [aOR = 1.22; 95% CI = 1.13-1.31] and secondary/higher levels of formal education [aOR = 1.18; 95% CI = 1.08-1.28, p < 0.001], cohabiting AGYW [aOR = 1.52; 95% CI = 1.42-1.63] and AGYW with three or more births [aOR = 3.41; 95% CI = 3.02-3.85]. At the household/community level, the odds of unmet need for contraception was highest among poorer AGYW [aOR = 1.36; 95% CI = 1.21-1.53], AGYW in female-headed households [aOR = 1.22; 95% CI = 1.13-1.33], urban AGYW [aOR = 1.21; 95% CI = 1.11-1.32] and AGYW who took healthcare decisions alone [aOR = 1.10; 95% CI = 1.01-1.21]. Conclusion This study has identified disparities in unmet need for contraception among AGYW in high fertility countries in SSA, with AGYW in Angola having the highest prevalence. Both individual and household/community level factors predicted unmet need for contraception among AGYW in this study. However, based on the ICC values, household/community level factors prevailed the individual level factors. Enhancing access to contraception among poorer AGYW, those in female-headed households, those in urban areas and those who take healthcare decisions alone by both governmental and non-governmental organisations in high fertility countries is recommended.