Factors Affecting Contraceptive Use in Sub-Saharan Africa (1993) / Chapter Skim
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2 Levels and Trends in Contraceptive Use
2 Levels and Trends in Contraceptive Use
Pages 19-51
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From page 19... ...
SOURCES OF DATA ON CONTRACEPTIVE USE There are three main sources of data on contraceptive use in Africa based on representative samples at the national level: the World Fertility Surveys (WFS) , the Contraceptive Prevalence Surveys (CPS)
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From page 20... ...
DEFINITION OF CONTRACEPTIVE USE In the DHS studies conducted in sub-Saharan countries between 1986 and 1990, at least half the current users of contraception in 5 of the 12 countries were relying on traditional methods, such as withdrawal and rhythm. There is little literature on the effectiveness of such methods, but they are considered much less effective than modern methods; thus the convention has emerged of differentiating between modern and traditional (or modern versus all methods)
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From page 21... ...
1978-1979 1989-1990 Somaliad 1983 Uganda 1988-1989 Zimbabwe 1984 1988-1989 Central Africa Cameroone 1978 1991 Zaired 1982- 1984 Southern Africa Botswana 1984 1988 Lesotho 1977 South Africa 1975- 1976 1981 Swazilandf 1988 aWorld Fertility Survey. bContraceptive Prevalence Survey.
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From page 22... ...
is. In sum, throughout this volume, the proportion currently using contraceptives refers to the proportion of women currently married or in union, aged 15-49 years, who are using a contraceptive method at the time of the survey (unless otherwise stated)
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From page 23... ...
For example, data from the Swaziland Family Health Survey show prevalence rates for modern methods of almost 14 percent, suggesting that this nation may be following the path of the three high-use countries (Warren et al., 1992~.7 However, there are still too few high-prevalence countries in sub-Saharan Africa to be able to attribute differentials to geographical factors or different colonial histories. Moreover, these geographical or historical distinctions may be proxies for other determinants of demand for children and use of contraception discussed in Chapters 3 to 5, including socioeconomic factors, infant and child mortality rates, levels of female education, and the strength of family planning pro grams.
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From page 24... ...
8.6 5.5 3.9 0.7 0.1 0.0 0.1 TOgoa 12.1 3.1 0.4 0.8 0.2 0.6 0.4 Uganda 4.9 2.5 1.1 0.2 0.4 0.0 0.0 Zimbabwe 43.1 36.1 31.0 1.1 0.3 0.0 1.2 Ever Use Botswanaa 61.7 60.1 49.4 17.4 15.0 1.3 10.1 Burundia 23.8 2.3 0.8 0.6 0.9 0.1 0.3 Ghana 37.0 22.5 14.9 1.3 10 8.3 4.5 Kenya 45.0 29.0 18.0 8.4 6.7 2.1 4.3 Liberia 18.8 15.9 13.5 2.8 1.7 1.0 1.7 Malia 7.6 3.4 2.7 0.5 0.2 0.4 0.4 Nigeria 14.0 8.4 4.8 1.7 1.9 0.6 2.0 Senegala 11.9 5.7 3.5 1.5 0.4 0.8 1.4 Sudan (northern) 25.2 18.6 17.3 1.6 1.1 0.3 1.9 TOgoa 33 0 10.1 3.8 1.6 1.1 3.7 3.3 Uganda 21.5 7.0 5.0 0.5 1.3 0.2 0.7 Zimbabwe 79.0 63.0 57.1 3.4 14.5 0.3 17.0 aAlthough abstinence is included as a traditional contraceptive method in these country surveys, it is not included as a method in this report (see this chapter for rationale)
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From page 25... ...
LEVELS AND TRENDS IN CONTRACEPTIVE USE Traditional Methods Sterilization Any Periodic Other Female Male Traditional Abstinence Withdrawal Method 25 4.3 0.3 0.80.2 0.3 0.3 0.1 0.0 5.54.8 0.7 0.0 1.0 0.0 7.76.2 0.9 1.6 4.7 0.0 9.07.5 0.2 1.3 1.1 0.0 0.90.6 0.1 0.2 0.1 0.0 1.91.3 0.1 0.5 0.3 0.0 2.51.4 0.5 0.6 0.2 0.0 2.20.9 0.1 1.2 0.8 0.0 3.12.2 0.3 0.6 0.6 0.0 9.06.4 2.3 0.3 0.8 0.0 2.41.6 0.3 0.4 2.3 0.2 7.00.3 5.1 1.6 4.3 0.3 9.45.1 5.8 0.6 0.1 0.0 22.618.8 8.2 0.5 1.0 0.0 25.119.7 8.3 3.0 5.0 0.1 24.220.9 3.0 3.2 1.1 0.0 6.73.3.
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From page 26... ...
Trends in method mix to date suggest that as countries move from low contraceptive prevalence to higher levels, the use of traditional methods gives way to an increase in oral contraception (particularly in the 10-45 percent CPR range) followed by a rapid rise in female sterilization in countries above the 45 percent level (Destler et al., 1990~.
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From page 27... ...
LEVELS AND TRENDS IN CONTRA CEPTIVE USE TABLE 2-3 Regional Variations in Modern Contraceptive Prevalence Rates, DHS, 1986-1990 (average prevalence) Country and Region/Province Prevalence Rate Burundi Imbo Mumirwra/Mugamba Plateau Lowlands Range Ghana Western Central Greater Accra Eastern Volta Ashanti Brong Ahafo Other regions Range Kenya Nairobi Central Coast Eastern Nyanza Rift Valley Western Range Liberia Since Grand Gedeh Montserrado Rest of country Range Mali Kayes, Koulikoro Sikasso, Segou Mpoti, Gao, Tombouctou Bamako Range Nigeria Northeast Northwest Southeast Southwest Range 27 (1.2)
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From page 28... ...
The figures for each region represent percentage point deviations from the national average. The range indicates the difference between the highest and the lowest regional rates.
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From page 29... ...
Second, even at these very low levels of prevalence, there was greater use of traditional than modern methods in all countries except Ethiopia and South Africa. For example, Rwanda reported an overall prevalence of 11 percent, but only 1 percent of women were using a modern method.
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From page 30... ...
Baydhaba 0.5 0.5 0.3 0.2 0.0 0.0 0.0 13urco 0.3 0.3 0.3 0.0 0~0 0~0 0 0 Hargeisa 2.6 0.8 0.7 0.1 0.0 0.0 0.0 Kismayo 0.5 0.5 0.3 0.0 0.0 0.2 0.0 Mogadishu 0.6 0.5 0.4 0.0 0.0 0.0 0.1 South Africa 1975-1976 37.0 35.0 1 1.0 4.0 1 1.0 0.0 2.0 1981 48 0 45.0 15.0 6.0 14.0 3 0b Sudan (northern) d 4.6 3.9 3.1 0.1 0.2 0.1 0.1 Zaire (urban)
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From page 31... ...
LEVELS AND TRENDS IN CONTRACEPTIVE USE 3 Traditional Methods Sterilization Any Periodic Other Female Male Traditional Abstinence Withdrawal Method 0.0 0.0 5.4 1.7 3.1 0.6 1.5 0.0 0.7 0.3 0.3 0.1 0.0 0.0 1.8 1.2 0.4 0.2 0.0 0.0 2.4 1.8 0.1 0.5 0.2 0.0 0.6 0.5 0.1 0.0 0.5 0.0 0.9 0.7 0.2 0.0 0.9 0.0 1.3 1.1 0.2 0.0 2.6 0.0 4.6 3.8 0.6 0.2 0.9 0.0 2.6 0.1 2.5 0.0 a a 2.4 0.1 0.2 2.1 0.2 0.0 0.5 0.0 0.4 0.1 0.1 0.0 0.4 0.3 0.1 0.0 0.0 0.0 9.9 8.4 1.4 0.1 0.0 0.0 0.7 0.4 0.0 0.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.8 0.1 0.0 1.7 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.1 6.0 0.0 3.0 0.0 0.0 3.0 8.0 0.0 3.0 0.3c 0.0 0.3 0.0 0.5 0.4 0.1 0.0 1.3 0.0 2.0 1.6 0.4 0.0 0.4 0.0 21.5 13.9 6.9 0.7 0.4 0.0 7.9 4.5 2.5 0.9 1.1 0.0 11.3 8.8 1.4 1.1 0.7 0.0 8.5 8.3 0.2 0.0 6.1 0.0 8.1 3.6 4.5 0.0 1.6 0.1 9.7 0.6 6.5 2.6
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From page 32... ...
Central, Western Greater Accra, Eastern Volta Ashanti, Brong Ahafo Northern, Upper Kenya (1978, 1988-1989) Nairobi Central, Eastern Rift Valley Coast Western, Nyanza Nigeria (1981 - 1982, 1990)
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From page 33... ...
However, evidence from the three higher use countries is mixed. Data from Zimbabwe tend to support this substitution hypothesis: Between 1984 and 1988 the use of modern methods increased by almost 10 points, while the use of traditional methods decreased by about 3 points.
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From page 34... ...
Except in Botswana, Kenya, and Zimbabwe, the use of modern methods remains an essentially urban and periurban phenomenon in the region. Elsewhere in the western and eastern African countries studied, less than 5 percent of married women in rural areas report modern contraceptive use.
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From page 35... ...
Other explanations for these regional differences in modern contraceptive use are explored in Chapter 6. For traditional methods, there is less regional variation than is the case with modern methods (data not shown)
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From page 36... ...
· The use of modern contraception generally increases, then decreases, with aged The variation in contraceptive prevalence by age is similar in the higher prevalence countnes: The use of a modern method among married women is lowest among women aged 15-19, gradually increases, and then decreases again toward the end of the reproductive years. The peak in the curve differs somewhat by country.
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From page 37... ...
BDI GHA KEN LBA MLI SEN SUD TGO UGA ZWE Country - Limping ~3 Spacing FIGURE 2-4 Use of modern contraception for spacing versus limiting, women in union (age 15-49) , selected countries of sub-Saharan Africa.
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From page 38... ...
OTHER INDICATORS RELATED TO CONTRACEPTIVE PRACTICE Current use of a modern contraceptive method is the aspect of contraceptive practice that is of greatest interest both to demographers (as a proximate determinant of fertility) and to family planning policymakers (as a measure of the coverage of their programs)
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From page 39... ...
In Zimbabwe, Botswana, and Kenya, at least half the women who have ever used any method are currently using one. Despite a very low prevalence rate, the data in Table 2-2 suggest that in Burundi, more than half the "ever users" of modern methods are currently using one.
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From page 40... ...
Knowledge of a Modern Contraceptive Method The DHS surveys report "knowledge of a contraceptive method." This phrase is somewhat of a misnomer, in that the surveys measure re iOThe denominators of the proportions in Tables 2-7 and 2-S are women aged 15-49 who have ever been in a union. This denominator is used because ever use and knowledge of contraception attempt to give measures for all women who have been exposed to the risk of becoming pregnant, both now and in the past.
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From page 41... ...
Generally, women aged 15-19 are less likely to have heard of a modern contraceptive method than are women aged 20-39. However, among women 40 and over, the percentage drops markedly, reflecting perhaps the lower educational attainment and lower need for contraception over the life cycle among this age group.
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From page 42... ...
aThe Nigeria DHS of 1990 is not included because the standard recode data tape was not available during the writing of this report. TABLE 2-8 Women Who Know Any Modern Method (percent)
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From page 43... ...
Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 92.4 96.7b96.9 95.9 95.7b 9o.9b 84.2b 61.3 61.4b71.0b 62.9b b b 50.6b 70.5 78.7.81.4 77.8 77.5 73.8 66.9b 86.9 94.594.2 93.1 92.8 85.2 82.8b 54.2 73.772.8 74.4 69.5 67.2 63.2 32.7 33.0b34.1b 30.7b 24.3b 22.0b 14.1 40.9 52.257.4 55.5 52.5 46.2 34.2 51.2 72.671.1 74.3 71.0 65.3 66.4 67.9 75.0b72.7 73.1 69.6 67.6 65.0 76.1 82.4b84.1b 83.sb 80.6b 8o.sb 74.9b 75.3 79.5b83.4 77.5 81.2 75.4b 69.5b 96.0 98.798.4 99.1 98.0 94.9b 96.5b CFor Mali, the logistic regression omits cases in which the woman had secondary schooling or more.
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From page 44... ...
Far more women know of government than private sources in 11 of the 12 countries. One can assume that the relatively low levels of knowledge of private sources in Botswana, Kenya, and Zimbabwe simply reflects the extent to which family planning services are delivered through government facilities.
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From page 45... ...
They define unmet need as the proportion who are exposed to the risk of conception, are not using a contraceptive method, and say they want to delay or stop childbearing. The total demand for family planning is the proportion of women with unmet need plus the women who are currently using contraception.
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From page 46... ...
46 "s° o o Cat en .~ no 3 be so o o o Cut C)
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From page 48... ...
In all countries, use of modern methods is associated with urban residence and greater education, perhaps indicating that future changes in the composition of the population might be associated with increased use. The knowledge of modern contraceptives is greater i3In Kenya, there was little difference in use between men with no education and those with primary education.
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From page 49... ...
49 ~'e to two is: .
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From page 50... ...
bFor Mali, the logistic regression omits cases in which the woman was age 45-49. than their use, and the knowledge of government sources of supply in the three higher use countries indicates the importance of government family planning programs in those countries.
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From page 51... ...
LEVELS AND TRENDS IN CONTRA CEPTI VE USE Age 51 i5-19 20-24 25-29 30-34 35-39 40-44 45-49 14.5 25.2a 36.0 33.7 37.5 35.0 14.7a 0.6 o.7a l.4a 1.sa l.3a 1 oa 1 6a 2.3 3.4a 4.3a 6.9 5 pa 9 0 4.2a 6.7 11.8 16.8 22.2 22.9 21.2 17.5 2.0 4.9a 6.7 6.3 5.1 5.7 7.1 1.4 l.4a 1.6a 1.6a l.4a 0 ga 0.0 1.7 2. la 3.oa 4.6 5.4 4.2 3.5 0.5 0.8a 25a 4.8a 3.8 1 la 2~4a 2.2 42a 5 oa 7 9 5.7 7.7 4~4 2.1 1 ga 2 sa 3.7a 4.7a 42a 3.4a 1.2 1 1a 1 ga 2.6 6.0 5.2 2.5 28.3 41.5 43.8 42.9 30.8a 261a lima
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