Determinants of Modern Contraceptive Utilization Among Married Women in sub-Saharan Africa; Multilevel Analysis of Recent Demographic and Health Survey

Abstract Background Family planning is a low-cost, high-impact public health and development strategy. Planned pregnancies are essential for both the child and mother’s health. However, there is a lack of evidence on modern contraceptive use and determinants in sub-Saharan Africa, hence this study aimed to determine the pooled prevalence and determinants of modern contraceptive utilization across 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 was included in the study. 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 for sub- Saharan Africa countries. Four models were fitted to select the best-fitted model for the data using Likelihood Ratio (LLR) and Deviance. Model III was selected because of its highest LLR and Smallest deviance. Results The pooled estimate of modern contraception use in sub–Saharan African countries were 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 were increased; women living in East Africa (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, husband primary and secondary and above educational level (AOR = 1.38 (1.33, 1.42)) and (AOR = 1.38 (1.36, 1.47)), wealth status middle and rich (AOR = 1.17, (1.14, 1.21)) and (AOR = 1.29 (1.25, 1.34)) respectively, media exposure (AOR = 1.25 (1.22, 1.29)), Postnatal care(PNC) utilization (AOR = 1.25 (1.22, 1.29)), deliver at health facility (AOR = 1.74 (1.69, 1.79)), and birth order 2–4 and 5+ (AOR = 1.36 (1.31, 1.41)) and (AOR = 1.35 (1.28, 1.43)) whereas the odds of contraception use were decreased among women living in Central, and Western regions (AOR = 0.23 (0.22, 0.24)), and (AOR = 0.46 (0.40, 0.54)) respectively, women decided with husband and husband alone (AOR = 0.90 (0.87, 0.93)) and (AOR = 0.73 (0.71, 0.75)). Conclusion The uptake of modern contraception in sub-Saharan Africa is low compared to other developing region. Therefore, family planning program activities need to give attention to the rural resident, illiterate women and low wealth status community.