Estimating the levels and trends of family planning indicators in 436 sub-national areas across 26 countries in sub-Saharan Africa

BackgroundScaling up access to safe, effective, and voluntary family planning (FP) services to achieve universal access for women and families will require increased commitment by countries and international organizations. On the way toward universal access, quantitative family planning goals have also been established by the United Nations through the sustainable development goals (SDGs). Here, we present a model-based framework that can help monitor progress toward these goals at the sub-national and demographic subgroup scale. MethodsWe utilize 90 demographic health surveys for 26 countries that contain associated geographic position system data. We extract survey cluster level data to fit multiple small area estimation models that estimate FP indicators by administrative unit one and two regions as well as different demographic subgroups. FindingsWe find significant variation of modern contraceptive prevalence rates (mCPR), unmet need, and demand satisfied by country, sub-national region, and demographic subgroup. Our model-based estimates show that on average for 436 administrative unit one regions, mCPR has increased at a rate of 0.75% per year and unmet need has decreased by 0.26% per year. There are also striking differences of FP indicators by demographic subgroup; for example, unmet need can be up to 40% different based on age and parity. InterpretationWe have developed a framework to help monitor progress, provide insights about the inequitable progress by region and demographic groups, and account for the sparsity of available data. These results and framework can help policy-makers better allocate and target interventions to help achieve family planning goals. FundingThis publication is based on models and data analysis performed by the Institute for Disease Modeling at the Bill & Melinda Gates Foundation.