A Multilevel Logit Estimation of Factors Associated With Modern Contraception in Urban Nigeria

• DOI: http://doi.org/10.1002/wmh3.215
• Date: 01 March 2017
• Published date: 01 March 2017

A Multilevel Logit Estimation of Factors Associated

With Modern Contraception in Urban Nigeria

Chinelo Okigbo, Ilene Speizer, Marisa Domino, and Sian Curtis

This study aimed to estimate the multilevel determinants of modern contraceptive use among

reproductive-age women living in six cities in Nigeria (Abuja, Benin, Ibadan, Ilorin, Kaduna, and

Zaria). Data from cross-sectional surveys conducted between 2010 and 2011 were linked to provide

information on f‌ive hierarchical levels of the Socioecological Framework. Multilevel logit models

estimated the odds of modern contraceptive use among 9,473 non-pregnant married/cohabiting

women aged 15–49 years living in 488 clusters. About 25 percent of the women reported using

modern contraceptive methods at the time of survey. Individual-level factors found to have a positive

association with modern contraceptive use were parity, family planning self-eff‌icacy, and partner

discussion about fertility desires while perception of negative attitudes from community member

about contraceptive use was negatively associated with modern contraceptive use (p <0.05). At the

community level, media exposure to family planning messages and city of residence were

signif‌icantly associated with modern contraceptive use in the studied sample (p <0.05). The positive

association between parity and modern contraceptive use was modif‌ied by the community’s ideal

family size. The results of this study support the evidence for multilevel interventions as a way to

improve the prevalence of modern contraceptive use in urban Nigeria.

KEY WORDS: modern contraceptive use, urban Nigeria

Introduction

Currently, a woman of childbearing age in Nigeria—a west African country—

will have on average 5.5 children during her lifetime (NPC Nigeria & ICF Macro,

2014). According to the 2015 World Population Data, Nigeria is currently the

most populous country in Africa with a population of 182 million people

(PRB, 2015). With an annual population growth rate of about 3 percent,

demographers postulate that Nigeria’s population will rise to 400 million, making

it the fourth most populous country by 2050 (Fotso et al., 2011; PRB, 2015).

Currently, about one-half of Nigeria’s population lives in urban areas (United

Nations, 2015). Urbanization in Nigeria is said to be driven by high fertility more

so than rural-to-urban migration and according to the United Nations, two-thirds

of urban residents live in slums (UNFPA, 2007). Although evidence suggests that

World Medical & Health Policy, Vol. 9, No. 1, 2017

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urban women are more likely to practice family planning compared to their rural

counterparts, recent studies f‌ind that this urban advantage may be misleading

given low levels of contraceptive use among the urban poor. Within urban

settings, the poor have been shown to have more social and health disadvantages

compared to their wealthier counterparts and, in some cases, compared to those

living in rural areas (Ezeh, Kodzi, & Emina, 2010; Magadi, Zulu, & Brockerhoff,

2003). For instance, in several sub-Saharan African countries including Nigeria,

Magadi et al. (2003) found that the urban poor women experienced more adverse

maternal health outcomes compared to the urban rich women while Ezeh et al.

(2010) found that the level of modern contraceptive use among the poorest

married women in urban areas was close to or less than that of their counterparts

in rural areas. The urban population in Nigeria is expected to triple by 2050,

making it the third largest absolute increase in urban population globally, after

China and India (United Nations, 2015). To curb the rapid urban population

growth and possibly urban poverty in Nigeria, there is a need to improve access

to and use of modern contraceptive methods.

Family planning improves maternal and child health through prevention of

unwanted pregnancies and prolongation of the inter-pregnancy interval, increases

women’s empowerment through education and subsequent participation in the

workforce, and sustains the environment through population control (Bongaarts,

Mauldin, & Phillips, 1990; Canning & Schultz, 2012; Cleland, Conde-Agudelo,

Peterson, Ross, & Tsui, 2012). Despite these benef‌its, not all women who want to

avoid getting pregnant use effective contraceptive methods. The modern

contraceptive prevalence rate, def‌ined as the percentage of reproductive-age

women (ages 15–49) who are using a modern contraceptive method at a specif‌ied

time, is a commonly used indicator for assessing family planning at the

population level (MEASURE Evaluation, 2014). Several studies in the family

planning literature have assessed the determinants of modern contraceptive

use (Campbell, Sahin-Hodoglugil, & Potts; Welsh, Stanback, & Shelton, 2006).

However, there are gaps in the current literature. One such gap is on the

community-level determinants of modern contraceptive use. Many studies focus

on the effects of individual-level factors such as the women’s age, education, and

parity on the probability of using modern contraceptive methods with very few

studies examining the effects of the household and/or community factors on

modern contraceptive use. In the last decade, however, there has been a surge in

studies assessing contextual effects on health behaviors. Researchers have found

that the characteristics of a community inf‌luence the practice of health behaviors

including modern contraceptive use (Dereuddre, Van de Velde, & Brackle, 2016;

Janevic, Pallas, Ismayilova, & Bradley, 2012; Kaggwa, Diop, & Storey, 2008;

Stephenson, Baschieri, Clements, Hennink, & Madise, 2007). For example,

Dereuddre et al. (2016) found that country-level gender equality was positively

associated with modern contraceptive use among European women. Also, Janevic

et al. (2012) found that among women living in 10 European and Asian countries,

women who live in poor communities were less likely to report modern

contraceptive use compared to those who live in wealthier communities.

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