Jane T. Bertrand and Margaret Farrell-Ross. Supported by a grant from the Bill and Melinda Gates Foundation (#OPP )

Transcription

1 Jane T. Bertrand and Margaret Farrell-Ross T l Tulane S School h l off Public P bli Health H l h and d Tropical T i lm Medicine di i Supported by a grant from the Bill and Melinda Gates Foundation (#OPP )

2 What do we already know about the dynamics of contraceptive use dynamic? Widely recognized: Contraceptive rates are lower in Francophone Africa Contraceptive rates are lower in Francophone Africa than in almost any other part of the developing world.

3 Many DHS surveys are now outdated Prevalence may have increased Method mix may have changed (e.g., implants, injections) Some countries have had only one survey No possibility to study trends Some countries defined LAM as traditional, others as modern: For consistency, we defined d LAM as modern

4 CPR (all methods) Ranges from 7.9% (Mauritania) to 33.8% (Gabon) 11 of 15 countries have a CPR < 20% Exceptions: Gabon (2000): 33.8% Cameron (2004): 25.9% Togo (1998): 23.5% DRC (2007): 20.7%

5 West Africa -- Contraceptive Prevalence Rate by Country Among MWRA Togo Benin Cote d'ivoire Burkina Faso Senegal Modern CPR Niger Traditional CPR Guinea Mali Mauritania Contraceptive Prevalence Rate

6 Central Africa -- Contraceptive Prevalence Rate by Country Among MWRA Gabon Cameroon DR-Congo Modern CPR CAR Traditional CPR Chad Burundi Contraceptive Prevalence Rate

7 Modern methods: Pill, IUD, implant, injection, condoms, sterilization In 7 of 15 countries, at least half of CPR is traditional method use: West: Benin, Togo, Cote d Ivoire Central: Burundi, CAR, DRC, Gabon Modern contraceptive prevalence (MCPR): Ranges from 1.3% (Burundi) to 13.4% (Gabon)

8 9 of 15 countries had more than one survey Most show some increase But Increases were small (average of 0.5 % per year) 3 of 9 countries plateaued or slightly decreased No country attained higher than 13 percent modern contraceptive use

9 West and Central Africa -- Modern Contraceptive Prevalence Rate Over Time ce Rate Modern Contrac ceptive Prevalen Benin Burkina Faso Cote d'ivoire Guinea Mali Niger Senegal Cameroon Chad Year

10 Mod dern Contraceptiv ve Prevalence Ra ate Benin 2006 Burkina 2003 Cote 1998 Guinea 2005 Mali 2006 Mauritania 2000 Niger 2006 Senegal 2005 Togo 1998

11 What modern methods are most widely used among married women: West Africa? Senegal Niger Burkina Faso Pill Injections Cote d'ivoire Condom IUD Togo LAM Implant Rest Mali Benin Percent

12 What modern methods are most widely used among married women: Central Africa? Gabon Cameroon Chad Pill Injections Condom DR-Congo LAM Female Sterilization Rest CAR Burundi Percent

13 West Africa Multiple Logistic Regression Dependent Variable = Modern vs. Traditional/No Contraceptive Use Benin Burkina Faso Cote d'ivoire Guinea Mali Mauritania Niger Senegal Togo Socio dem factors MCPR=6.1 MCPR=8.8 MCPR=7.3 MCPR=5.7 MCPR=6.9 MCPR=5.4 MCPR=9.7 MCPR=10.3 MCPR=7.0 Education: None+ Primary 1.544** 2.057** 0.274** 1.633* 1.914** 0.490** 1.595** 2.829** 0.763* Secondary/Higher 2.134** 3.613** 0.175** 2.753** 3.152** 0.277** 2.337** 4.098** 0.520** Wealth quintile: Poorest+ Poorer 1.528* 2.517** * N/A N/A N/A Middle 2.058** 3.398** * 2.103** Richer 2.526** 3.438** 1.937* 2.141** ** Richest 4.054** 7.116** 2.329* 3.873** ** Age: * * ** * * ** ** * * 2.450** * 0.514* 3.237** 2.336** 0.532** * 1.871* ** 0.374* 2.856** 3.104** 0.629* ** 2.390** 0.498* * ** 2.873** 0.472** * Residence: Rural+ Urban ** 0.488** ** 1.981* 1.609* Adjusted Odds ratio *p value < Reference group **p value < 0.001

14 West Africa Benin Burkina Faso Cote d'ivoire Guinea Mali Mauritania Niger Central Africa Burundi Cameroon CAR Chad DR Congo Gabon Senegal Togo

15 Are married or unmarried/sexually active women more likely to use modern contraception? 4 countries that show the extremes Burkina Faso Cameroon Chad Unmarried Sexually Active MWRA Mauritania Contraceptive Prevalence Rate

16 Do unmarried sexually active women favor modern or traditional methods? West Africa Burkina Faso 2003 (n=295) Cote d'ivoire 1998 (n=362) Benin 2006 (n=672) Togo 1998 (n=630) Guinea 2005 (n=283) Modern CPR Senegal 2005 (n=50) 43.3 Traditional CPR Niger 2006 (n=16) 42.1 Mali 2006 (n=113) Mauritania 2000 (n=22) Contraceptive Prevalence Rate

17 Do unmarried sexually active women favor modern or traditional methods? Central Africa Cameroon 2004 (n=597) Gabon 2000 (n=977) DR-Congo 2007 (n=653) Modern CPR Burundi 1987 (n=17) Traditional CPR CAR 1994 (n=492) Chad 2004 (n=70) Contraceptive Prevalence Rate

18 Which modern methods do unmarried sexually active women use? West Africa Burkina Faso 2003 (n=295) Senegal 2005 (n=50) Niger 2006 (n=16) Guinea 2005 (n=283) Male Condom Female Condom Benin 2006 (n=672) Foam/Jelly IUD Cote d'ivoire 1998 (n=362) Injections Pill Togo 1998 (n=630) Rest Mali 2006 (n=113) Mauritania 2000 (n=22) Percent

19 Which modern methods do unmarried sexually active women use? Central Africa Cameroon 2004 (n=597) Gabon 2000 (n=977) DR-Congo 2007 (n=653) Male Condom Injections Burundi 1987 (n=17) LAM Pill Rest Chad 2004 (n=70) CAR 1994 (n=492) Percent

20 Low overall use of contraception More demand among unmarried sexually active than married women in many countries Correlates of CPR (among married women): Education, wealth index, urban/rural Method preference differs by marital status: Method preference differs by marital status: Married: pill, injection Unmarried: condom, traditional

21 Is CPR low because of limited access to services? How quickly would CPR increase if FP services were available nearby at low cost? What explains the widespread use of condoms? Most readily available method in countries with Most readily available method in countries with strong HIV programs, weak FP programs? (e.g. DRC) Client preference or provider bias?

22 Questions?