Performances of bayesian structured additive regression and logistic models in assessing factors associated with modern contraceptive use among ever-in-union women in Nigeria – BMC Women’s Health

Report on Factors Influencing Modern Contraceptive Use in Nigeria and Alignment with Sustainable Development Goals (SDGs)

Introduction: Contraceptive Use as a Catalyst for Sustainable Development

Understanding the determinants of modern contraceptive use is critical for designing effective strategies that align with global development targets. Increased access to and use of modern contraception directly supports the achievement of several Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), by ensuring universal access to sexual and reproductive healthcare services, and SDG 5 (Gender Equality), by empowering women to make autonomous decisions about their reproductive health. This report analyzes the factors influencing contraceptive uptake in Nigeria to inform policies that can accelerate progress on these goals and reduce population growth rates.

Key Determinants of Contraceptive Uptake and Linkages to SDGs

The study identifies significant disparities in the use of modern contraceptive methods among ever-in-union women in Nigeria. A multifaceted analysis reveals that uptake is influenced by a combination of demographic, socio-economic, and cultural factors, each with direct implications for various SDGs.

• Demographic Factors:
  • Age: The highest rate of use is observed among women aged 30–39, often after achieving their desired family size. This highlights the role of contraception in family planning, a key component of SDG 3.7.
  • Age at Marriage: Women married between the ages of 20–24 demonstrate higher usage compared to those married younger (15–19), a group whose lower uptake may be linked to a lack of maturity and education, impacting SDG 4 (Quality Education) and SDG 5.
  • Family Size and Intention: Usage is more common among women with more children and those who intend to have smaller families (four or fewer children). This underscores women’s agency in managing their reproductive lives, a core principle of SDG 5.6.
• Socio-Economic Factors:
  • Education: A strong positive correlation exists between the educational attainment of a woman and her partner and the use of modern contraceptives. This reinforces the transformative power of SDG 4 in promoting health-seeking behaviors and gender equality.
  • Economic Status: Women in higher wealth quintiles are more likely to use modern contraceptives, exposing a critical inequality that hinders progress towards SDG 1 (No Poverty) and SDG 10 (Reduced Inequalities).
  • Residence and Employment: Higher usage is reported in urban areas and among currently working women, linking contraceptive access to SDG 11 (Sustainable Cities and Communities) and SDG 8 (Decent Work and Economic Growth).
• Socio-Cultural and Informational Factors:
  • Ethnicity and Religion: Cultural and religious beliefs significantly influence contraceptive practices, with some groups (e.g., Hausa) showing lower usage. Addressing these barriers is essential for achieving SDG 10 by ensuring equitable access for all.
  • Knowledge and Media Exposure: Awareness of contraceptive methods and exposure to media are significant predictors of use. This highlights the need for effective public health communication to support SDG 3.

Regional Disparities: A Challenge to SDG 10 (Reduced Inequalities)

A pronounced geographical divide exists, with women in northern Nigeria exhibiting the lowest levels of contraceptive use. This spatial disparity is linked to a combination of factors prevalent in the region, including lower levels of education, limited media exposure, and distinct socio-cultural norms. These regional inequalities represent a significant obstacle to achieving national family planning goals and ensuring that the benefits of development, as outlined in the SDGs, are distributed equitably across the country.

Conclusion and Recommendations for Accelerating SDG Progress

The findings confirm that a woman’s location, combined with socio-demographic and economic factors, profoundly impacts her use of modern contraceptives. Despite past interventions, population growth continues unabated, suggesting a misalignment of resources and strategies. To effectively advance the 2030 Agenda for Sustainable Development, targeted and evidence-based actions are required.

1. Targeted Resource Allocation: Government and non-governmental organizations must channel modern contraceptive initiatives, resources, and funding to regions with the greatest need, particularly the northern states. This spatial approach is crucial for addressing geographical disparities and advancing SDG 10.
2. Integrate Education and Health Services: Interventions must go beyond the free supply of contraceptives to include robust educational programs. Enhancing female education, in line with SDG 4, is proven to increase receptiveness to modern methods, thereby promoting SDG 3 and SDG 5.
3. Utilize Advanced Data Analytics: Policymakers should adopt advanced analytical models, such as the Bayesian approach identified in this study, to better understand spatial and nonlinear effects. Using such data-driven insights to guide the distribution of family planning resources will ensure more efficient progress toward national goals and SDG 3.7.
4. Develop Culturally Sensitive Campaigns: Implement regionally adapted education and outreach campaigns that respect local cultural and religious contexts while promoting the health benefits of family planning. This will help ensure that all women, regardless of background, have equitable access to services, supporting SDG 5 and SDG 10.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article on modern contraceptive use in Nigeria connects to several Sustainable Development Goals (SDGs) by addressing issues of health, gender equality, education, and inequality.

• SDG 3: Good Health and Well-being: The core topic of the article is the use of “modern methods of contraception” to manage family size and reduce “the rate of population growth.” This directly relates to ensuring healthy lives and promoting well-being, particularly in the area of reproductive health. The article emphasizes how contraceptive use allows women to preserve their health and that of their children.
• SDG 5: Gender Equality: The article focuses on “ever-in-union women” and their ability to make decisions about their reproductive health. Access to and use of modern contraceptives is a key component of women’s empowerment, allowing them to control their fertility, plan their families, and pursue education and economic opportunities. The article notes factors like early marriage (“married between the ages of 15–19”) and the partner’s level of education, which are critical aspects of gender dynamics and equality.
• SDG 4: Quality Education: A strong link between education and contraceptive use is established. The article states, “the more educated these women were, the more they knew the importance and benefits of these methods, which led to their increased usage.” It recommends putting a “proper education system… in place for the women” as a key intervention, highlighting education’s role in enabling informed health choices.
• SDG 10: Reduced Inequalities: The article extensively details the disparities in contraceptive use among different population groups. It highlights significant differences based on geographic location (“those in urban areas used it more,” with lower rates in “the northern region of Nigeria”), economic status (“those who were down the ladder of the wealth index used it less”), and ethnicity (“Hausa’s were the least users of these modern methods”). This focus on inequality within a country is central to SDG 10.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the issues discussed, the following specific SDG targets are relevant:

1. Target 3.7: “By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.” The entire article is an analysis of the factors affecting the use of modern contraceptives, which is a cornerstone of family planning and reproductive healthcare services.
2. Target 5.6: “Ensure universal access to sexual and reproductive health and reproductive rights…” This target is directly addressed as the article examines the barriers and facilitators for women in Nigeria to access and use modern contraception, which is a fundamental reproductive right.
3. Target 5.3: “Eliminate all harmful practices, such as child, early and forced marriage…” The article identifies that women “who got married between the ages of 15–19 used modern contraceptives less,” linking early marriage to lower uptake of family planning and implying it as a barrier to women’s reproductive health and autonomy.
4. Target 4.5: “By 2030, eliminate gender disparities in education and ensure equal access to all levels of education…” The article’s finding that “the respondent’s level of education and that of their partner were seen to have a major effect on the use of modern contraceptives” supports this target. It suggests that improving educational attainment, especially for women, is crucial for achieving better health outcomes.
5. Target 10.2: “By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.” The analysis of disparities in contraceptive use based on the “wealth index,” “ethnicity,” “religion,” and “residential type” directly relates to this target of reducing inequality and ensuring services reach all segments of the population.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

The article mentions and implies several indicators that can be used to measure progress:

• Indicator 3.7.1: Proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods. The central theme of the article is the “usage of modern contraceptive techniques.” The entire study analyzes the rate of use and non-use among “ever-in-union women,” which is a direct measure for this indicator.
• Indicator 5.3.1: Proportion of women aged 20-24 years who were married or in a union before age 15 and before age 18. The article implies this indicator by discussing the contraceptive use patterns of women who “got married between the ages of 15–19.” Measuring the rate of early marriage is essential to understanding this barrier to contraceptive use.
• Disaggregated Data for Contraceptive Use: The article strongly implies the need for disaggregating the primary indicator (contraceptive use) to monitor inequalities. Progress towards Target 10.2 and 4.5 would be measured by tracking the rate of modern contraceptive use broken down by:
  • Level of education: As the article states, usage increases with education.
  • Wealth index: The study found that women “down the ladder of the wealth index used it less.”
  • Geographic location: The analysis highlights major disparities between urban/rural areas and northern/southern regions.
  • Ethnicity and Religion: These were identified as “major factors contributing to the use of modern contraceptive methods.”

4. Summary Table of SDGs, Targets, and Indicators

Source: bmcwomenshealth.biomedcentral.com