Intra-urban inequalities in modern family planning use in Ugandas urban settings: the role of place of residence, socio-economic, family, and individual factors

Evidence of how intra-urban inequalities could steer the use of modern family planning (mFP) services remains elusive. In this study, we examined the role of residence, socio-economic, family, and individual factors in shaping access to mFP use in Iganga Municipality and Jinja city, in central eastern Uganda. We used cross-sectional household survey data that were collected between November-December 2021 from 1023 women aged 15-49 years. We used logistic regression to assess the factors associated with mFP use and Stata user written command - iop, to assess the inequality in mFP due to different factors. We considered unfair circumstances as socio-economic status (wealth quartile, education level, and working level), place of residence, age, religion affiliation, and authority. The time of sexual intercourse was considered as fair circumstance. Overall mFP use was estimated at 48.8%, with close to 60% using long-term acting reversible methods. Overall, 24% of all heterogeneity in modern FP use was due to the observed circumstances and 18% was due to differential in unfair circumstances. An increase in age was inversely associated with mFP use [adjusted Odds Ratio (aOR) [95% Confidence Interval (95%CI)] =0.976[0.966-0.986]), while an increase in parity was positively associated with mFP use (aOR [95%CI]=1.404[1.249-1.578]). Compared to mainland non-slum and landing site residents, mainland slum residents were two-fold (aOR[95%CI]=2.065[1.735-2.458]) and three-fold (aOR[95%CI]=2.631[1.96-3.531]) more likely to use mFP, respectively. Whereas the odds of using mFP increased with the wealth status (Middle: aOR[95%CI]=1.832[1.52-2.209] and Better: aOR[95%CI]=5.276[4.082-6.819]), an interaction between the place of residence and wealth index showed that wealth index mattered only in non-slum mainland areas. Women with secondary or higher level of education and whose decisions to use mFP were independent of other authorities were more likely to use mFP. Lastly, there were region affiliation and type of work differential in the use of mFP. In conclusion, about one-fifth of all heterogeneity in mFP use was due to differentials in unfair circumstances. The findings highlight the need for intervention that are tailored to the different groups of urban residents. For instance, the package of interventions should consider the places of work and places of residences regardless of socioeconomic status.