Predictors of Unmet Need for Contraception among Urban and Rural Women in Anambra State, Nigeria: A Mixed Method Survey

Aims: To assess the levels of unmet need for contraception and the various factors that influence these levels among rural and urban populations of currently married women of reproductive age in Anambra State, Nigeria.

Study Design: Mixed method survey.

Place and Duration of Study: Anambra State in South-Eastern Nigeria. The study was carried out from March 2017 to July 2017.

Methodology: The study participants were currently married women of reproductive age (15-49 years) who had resided in the Local Government Areas of interest for at least one year prior to the survey and who consented to the study. Excluded from the study were women who were homeless, living in institutional homes or were too sick to participate in the survey. Multistage sampling technique was used to select 208 urban and 210 rural participants and quantitative data obtained using pre-tested, semi-structured, interviewer-administered questionnaires. Qualitative data were obtained from focus group discussions (FGD) among current non-users of contraception and key informant interviews (KII) among Primary Health Care staff in selected Local Government Areas. Binary logistic regression was done for quantitative data analysis using SPSS software and content analysis of qualitative data was done using the Atlas.ti software.

Results: Response rate was 96.8%. There was a significantly higher level of awareness of at least 3 modern methods of contraception among urban (52.5%) compared to rural women (47.5%) (P ˂ 0.001). The overall contraceptive prevalence among participants was 44.5% (29.7% for modern methods and 14.8% for traditional methods). The overall level of unmet need for contraception was very high (26.3%), but much higher was the unmet need for modern contraception (41%). The independent predictors of unmet need for contraception among urban women were health insurance and cost of contraceptives; while that among rural women was perceived the risk of pregnancy. Only 2 rural participants had a form of health insurance. The commonest reasons for contraceptive non-use were side effects-related for urban women and opposition to use for rural women.

Conclusion: The level of unmet need for contraception remains very high and its predictors vary between urban and rural women in Anambra State, Nigeria.