COMMUNITY AND INDIVIDUAL LEVEL FACTORS INFLUENCING MODERN CONTRACEPTIVE USE AMONG MARRIED WOMEN OF REPRODUCTIVE AGE GROUP (15-49) IN NIGERIA

Abstract

The prevalence of modern contraceptive use still remains low in Nigeria with wide variations in different geopolitical zones. While researchers have devoted considerable attention to the impact of individual-level factors on contraceptive use, not much is known about how community characteristics affect contraceptive use in married women. The objective of this study was to assess the effects of community level variables on family planning use using a multilevel modeling approach. "'The study is based on data collected from Nigeria Demographic and Health Survey (NDHS) 2008. Random effects multilevel logistic regression analyses of 23479 married women of reproductive age nested within 888 clusters was carried out to assess the role of selected individual (socio demographic and other family planning related factor) and community level factors (childbearing, wealth index, education, high parity, exposure to family planning messages) in the use of modern contraceptives. The regression model was fitted to analyze the variable using GLLAMM command in STATA-10. Level of significance was at 5% level. The mean age of the women studied was 31.2 years (8.8), with about 72.6% in rural areas. Only about 10% of married women were using a modern contraceptive method in 2008. In the individual only model there was a significant higher odds of contraception among those with exposure to family planning messages, secondary school or higher education, urban dwellers, respondents in highest wealth quantile, those with fewer number of children, Christian respondent, monogamous settings, southwest region, currently working respondents and those between age group 20-29.In the community only model, the odds of modern contraceptive use was higher among those in the upper wealth index (OR=1.55,CI=1.2-2.0), those with at least primary school education (OR=9.67,CI=7.l-13.07) and those with an ideal family size of ≥4 children (OR=5.25,CI=3.29-8.37). In the model which included both individual and community level variables proportion of women with an ideal family size of :≥4 children(OR=2.02,CI=1.14- 3.58) and proportion with at least primary school education (OR=l.67,CI=l.05-2.92) remained significant. Also significant variation in family planning use between communities remained after adjusting for individual and community variables. The community contraceptive use was lowest in communities with low level of education and communities with ideal number of more than four children. Overall, the results of this study suggest that the challenge to increase contraceptive use goes beyond addressing individual factors, and requires a better understanding of contextual factors. Special attention needs to be paid, in particular to the communities, while formulating family planning policies in Nigeria, for better success rate of modern contraceptive use.