Determinants of Modern Contraceptive Utilization Among Married Women in Sub-saharan Africa: Multilevel Analysis Using Recent Demographic and Health Survey

Abstract Background: Family planning is a low-cost, high-impact public health and development strategy to improve child and maternal health. However, there is a lack of evidence on modern contraceptive use and determinants in sub-Saharan Africa. Hence, this study was aimed at determining the pooled prevalence and determinants of modern contraceptive utilization in Sub-Saharan Africa. Methods: Thirty-six sub-Saharan African countries' demographic and health survey (DHS) data were used for pooled analysis. A total weighted sample of 322,525 married women were included. Cross tabulations and summary statistics were done using STATA version 14 software. The pooled prevalence of modern contraceptive utilization with a 95% Confidence Interval (CI) was reported. Four models were fitted to select the best-fitted model using Likelihood Ratio (LLR) and Deviance test. Finally, the model with the highest LLR and the smallest deviance was selected as a best fitted model. Results: The pooled estimate of modern contraception use in sub–Saharan African countries was 18.36% [95% CI: 18.24, 18.48], with highest in Lesotho (59.79%) and the lowest in Chad (5.04%). The odds of modern contraception utilization among women living in East Africa was (AOR=1.47 (1.40, 1.54)), urban (AOR=1.18 (1.14, 1.24)), women primary and secondary and above educational level (AOR=1.49 (1.44, 1.55)), and (AOR=1.66 (1.58, 1.74)), respectively. Moreover, husband primary (AOR=1.38 (1.33, 1.42)), middle (AOR=1.17, (1.14, 1.21)), rich wealth status (AOR=1.29 (1.25, 1.34)), media exposure (AOR=1.25 (1.22, 1.29)), and postnatal care (PNC) utilization (AOR=1.25 (1.22, 1.29)) had higher odds of modern contraceptive utilization compared with their counter parts. Furthermore, deliver at health facility (AOR=1.74 (1.69, 1.79)) and birth order 2-4 (AOR=1.36 (1.31, 1.41)) had higher odds of modern contraceptive utilization. On the otherhand, women living in Central (AOR=0.23 (0.22, 0.24)), Western regions (AOR=0.46 (0.40, 0.54)), women decided with husband (AOR=0.90 (0.87, 0.93)), and husband alone (AOR=0.73 (0.71, 0.75)) were decreased the odds of modern contraceptive utilization. Conclusion: The uptake of modern contraception in sub-Saharan Africa is low. Modern contraceptive utilization is affected by different factors. More attention need to be given to rural residents, illiterate women, and communities with low wealth status.