Shifting Trends in Contraceptive Choice in Sub-Saharan Africa

Contraceptive method mix is changing in sub-Saharan Africa with divergent trends observed by gender
Shifting Trends in Contraceptive Choice in Sub-Saharan Africa
Like

Share this post

Choose a social network to share with, or copy the URL to share elsewhere

This is a representation of how your post may appear on social media. The actual post will vary between social networks

Explore the Research

BioMed Central
BioMed Central BioMed Central

Contraceptive use and method mix dynamics in Sub-saharan Africa: time trends and the influence of the HIV pandemic - Contraception and Reproductive Medicine

Background Contraceptive use dynamics continue to be of priority in sub-Saharan Africa because of persistently high levels of fertility. This paper focuses on the use of barrier versus non-barrier contraceptive use in sub-Saharan Africa hypothesizing that the HIV pandemic in the region would be responsible for increases in the use of barrier methods over time. Methods This paper uses Demographic and Heath Survey (DHS) data from 32 countries to conduct extensive analysis of trends in contraceptive use and method mix that refers to the distribution of contraceptive methods use among the sexually active population. The paper examines how contraceptive method mix dynamics have changed over time and whether the trends differ by marital status and gender using cross-tabulations. It furthers examines the determinants of method choice using logistic regressions. Results The findings indicate that the use of barrier methods, most markedly for unmarried women and men, rose substantially between the late 1980s and late 2000s in the region in tandem with trends in HIV prevalence. The results further show marked differences in method mix by gender with men being more likely to report barrier method use than women. Conclusions The findings indicate shifting preferences in contraceptive choice. The time trend analyses highlight the importance of expanding the focus of contraceptive use studies beyond women in this context as the study finds differing trends for men. Graphical Abstract

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

The study findings underscore the importance of considering both demand and supply-side factors in family planning initiatives in sub-Saharan Africa. As the region continues to navigate the challenges of high fertility, these findings can inform more effective and inclusive strategies for promoting reproductive health.

Please sign in or register for FREE

If you are a registered user on Research Communities by Springer Nature, please sign in

Follow the Topic

Population and Demography
Humanities and Social Sciences > Society > Population and Demography
Maternal and Child Health
Life Sciences > Health Sciences > Clinical Medicine > Gynecology > Maternal and Child Health
Gender and Health
Humanities and Social Sciences > Society > Gender Studies > Gender and Health