Theory-based determinants of modern contraceptive use in sub-Saharan Africa: an analysis of demographic and health surveys

IntroductionDespite improved access to modern contraceptives in sub-Saharan Africa (SSA), the region has the highest fertility rate. Although modern contraceptive usage and its determinants in SSA have been assessed, most authors were not guided by behavioral change theories. This study sought to assess the modern contraceptive coverage in SSA and identify the theory-based determinants that need to be considered in demand creation interventions. MethodsData was obtained from the most recent demographic and health surveys conducted across 37 countries in SSA. Estimates of country-specific and pooled Regional modern contraceptive coverage were generated from 501,324 responses. Logistic regression was used to assess the relationship between modern contraceptive use and determinants selected based on the Health Belief and Social-Ecological behavior change models. ResultsModern contraceptive coverage in SSA was 22.26% (95% CI: 17.91, 26.60). The health belief model determinants of modern contraceptive use included last birth by caesarian section (AOR=1.44, 95% CI:1.31,1.59), hearing of family planning at the health facility (AOR=1.18, 95% CI:1.12,1.24), or from at least one media source, being able to negotiate condom use (AOR=1.65, 95% CI: 1.55,1.76), and having a previous terminated pregnancy (AOR=0.76, 95%CI: 0.71, 0.81). The social ecological model determinants of modern contraceptive use included being above 24 years, having at least primary education, non-urgent need for a last child, and being involved in decision-making concerning personal health (AOR=1.81,95% CI:1.71,1.92). DiscussionModern contraceptive coverage in SSA is low. Age, educational status, past obstetric history, exposure to family planning information, ability to negotiate condom use or make personal health-related decisions, and the need for a child were the determinants for modern contraceptive use in the region. Countries need to develop context-specific interventions considering these determinants to help improve coverage and reduce the poor maternal and child health outcomes and the developmental gaps resulting from unplanned pregnancies.