Socio-economic related inequalities in the utilization of family planning services among women of childbearing age in Zambia: a cross-sectional study

Abstract

Background: There is a large literature that has documented inequalities in utilization of healthcare in Zambia, and the rest of sub-Saharan Africa. However, there is little or no literature that is focussing on inequalities in utilization of family planning services and decomposition of the factors driving differences in family planning use. Zambia is particularly interesting because there has been documented increase in healthcare utilization in many dimension but also increases in inequality. Although utilization of family planning services has increased from 15% in 1992 to 48% in 2018, it is not clear if this progress is benefiting everyone or only restricted to the well-off. This paper examines socio-economic related inequalities in the utilization of family planning services among women of childbearing age in Zambia. Methods: Using secondary data from the 2013-2014 Zambia Demographic and Health Survey, Concentration curves and indices are applied to the 12,498 women of childbearing age to examine how pro-poor and pro-rich the distribution of family planning is. A Blinder-Oaxaca decomposition analysis is conducted to decompose the rural-urban differences in use of family planning services among women of reproductive age. Results: Of the 12,498 participants, 5,662 (45%) used family planning and 6,836 (55%) did not. Among these participants, 8,173 (65.39%) were married and 4,325 (34.61%) were not married with an average of two children. Although the resulting concentration curves and index show that there is inequality in family planning utilization in Zambia (CI=0.590, P=0.055) and rural areas (CI=0.4009, P=0.0730), there is equality in utilization of family planning services in urban areas (CI=0.049, P=0.159). Utilization of this service among urban women is 5.16 percentage points higher than rural areas. Some of the factors driving this gap with positive contribution are the richest group (54.79%), women with 1-3 children (30.36%), tertiary education (79.46%) and age group of 45-49 years (53.68%) while those with negative contribution were women with 7 and more children (-48.22%), with 4-6 children (-16.96%), being married (-43.45%), primary education (-33.93%), middle wealth group (-43.75%) and poorer (-22.34%). Conclusion: Despite progress in use of family planning services, it is imperative to note that socioeconomic inequalities in use have persisted. Based on the findings, the study suggests that interventions to increase family planning use should aim at addressing rural socioeconomic disadvantage, with programs targeting poor women and those with low levels of education.