Shifting Trends in Contraceptive Choice in Sub-Saharan Africa
Published in Social Sciences and General & Internal Medicine

What is contraceptive method mix and what does it tell us?
Contraceptive method mix describes the variety of contraceptive methods used by the population and indicates the percentage each method contributes to the total usage. Studying contraceptive method mix dynamics provides insights into the factors influencing contraceptive choices from both the demand and supply sides. A method mix predominated by a particular contraceptive method suggests either restricted access to alternative options or a strong preference for that method.
About our study
Our paper Contraceptive use and method mix dynamics in Sub-Saharan Africa: time trends and the influence of the HIV pandemic examines the changing landscape of contraceptive method mix over three decades in Sub-Saharan Africa, focusing on the influence of the HIV pandemic on these trends. The study used data from Demographic and Health Surveys across 32 countries.
Findings
Trends in contraceptive method mix
For both males and females, contraceptive method mix has evolved over time. Initially, the pill was the most commonly used method, but its usage has declined. Similarly, the use of IUDs has decreased. In contrast, the use of implants as a long-term contraceptive option has increased, replacing sterilization, which has also seen a decline.
Use of barrier versus non-barrier methods
Condom usage increased substantially compared to non-barrier methods from the late 1980s to the mid-2000s, coinciding with the height of the HIV pandemic. This trend was more pronounced among unmarried women and men, reflecting a heightened awareness of HIV risk during the peak period of the pandemic.There was a decline in condom use observed from the late 2000s, which could be attributed to the introduction of antiretroviral therapy programs likely reducing commitment to HIV prevention behaviors.
The increased use of barrier methods during the peak of the pandemic suggests that sexually active adults were more concerned about protecting themselves from HIV and other sexually transmitted infections rather than for prevention of unwanted pregnancies. However, the decline in condom use after the year 2000 indicates changing perceptions of the severity of the consequences of contracting HIV .
Differences by gender
There are notable gender differences in contraceptive method mix over time. The use of contraceptive injectables among women has increased and is currently the most commonly used method reported by women. In contrast, condoms are consistently the most frequently used contraceptive choice for men.
Our findings point to some discordance in reported contraceptive methods among matched partners which may explain the observed gender differences. Over a fifth of couples provided conflicting reports, primarily because one partner (more often the husband) reported using contraception while the other did not. Focusing on cases where one partner reported not using contraception, we observed that wives most frequently cited injectables, while husbands predominantly mentioned condoms. The discrepancy in wives’ reports likely indicates clandestine use of contraception, as there is no physical evidence after using injectables. Conversely, the discrepancy in husbands’ reports suggest extramarital relationships, where husbands may use condoms with other partners but not with their wives.
Implications of the findings
Follow the Topic
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Contraception and Reproductive Medicine
This journal is designed to promote the advancement of contraceptive technology and general reproductive medicine particularly in the areas of education, effectiveness, safety, research interest, improved or new technologies, non-contraceptive benefits, and long-term health.
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