Individual, community and service environment factors associated with modern contraceptive use in five Sub-Saharan African countries: A multilevel, multinomial analysis using geographically linked data from PMA2020

PMA2020 Principal Investigators Group

Research output: Contribution to journalArticle

Abstract

The importance of the family planning service environment and community-level factors on contraceptive use has long been studied. Few studies, however, have been able to link individual and health facility data from surveys that are nationally representative, concurrently fielded, and geographically linked. Data from Performance Monitoring and Accountability 2020 address these limitations. To assess the relative influences of the service delivery environment and community, household, and individual factors on a woman’s likelihood of using a modern contraceptive in five geographically and culturally diverse sub-Saharan African countries. Nationally representative, cross-sectional data from PMA2020 were linked at the household and service delivery level. Country-specific and pooled multilevel multinomial logistic models, comparing non-users, short- and long-acting method users were used. The variables elected for inclusion in our multivariate analyses were guided by the conceptual framework to profile the different levels of influences on individual use of modern contraception. Average marginal effects were calculated to improve interpretability. We find that the effect of contextual factors varies widely but that being visited by a health worker who spoke about family planning in the past 12 months was consistently and positively associated with individual use of short-acting and long-acting contraception. Characteristics of the nearest health facility did not generally exercise their own independent influences on a woman’s use of contraception, except in the case of Burkina Faso, where the average distance between individuals and the nearest family planning provider was significantly greater than other countries. Inclusion of country fixed effects in the pooled models and the relevance of covariates at different levels in the country-specific models demonstrate that there is significant variation across countries in how community, individual, and service delivery environment factors influence contraceptive use and method choice. Context must be taken into account when designing family planning programs.

Original languageEnglish (US)
Article numbere0218157
JournalPloS one
Volume14
Issue number6
DOIs
StatePublished - Jun 1 2019

Fingerprint

family planning
Multilevel Analysis
contraceptives
Social Welfare
Family Planning Services
Contraceptive Agents
Contraception
contraception
Planning
environmental factors
Health Facilities
Health
households
Burkina Faso
Social Responsibility
logit analysis
health care workers
Logistics
exercise
Multivariate Analysis

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

@article{b260a768e0214705befa999d8c584293,
title = "Individual, community and service environment factors associated with modern contraceptive use in five Sub-Saharan African countries: A multilevel, multinomial analysis using geographically linked data from PMA2020",
abstract = "The importance of the family planning service environment and community-level factors on contraceptive use has long been studied. Few studies, however, have been able to link individual and health facility data from surveys that are nationally representative, concurrently fielded, and geographically linked. Data from Performance Monitoring and Accountability 2020 address these limitations. To assess the relative influences of the service delivery environment and community, household, and individual factors on a woman’s likelihood of using a modern contraceptive in five geographically and culturally diverse sub-Saharan African countries. Nationally representative, cross-sectional data from PMA2020 were linked at the household and service delivery level. Country-specific and pooled multilevel multinomial logistic models, comparing non-users, short- and long-acting method users were used. The variables elected for inclusion in our multivariate analyses were guided by the conceptual framework to profile the different levels of influences on individual use of modern contraception. Average marginal effects were calculated to improve interpretability. We find that the effect of contextual factors varies widely but that being visited by a health worker who spoke about family planning in the past 12 months was consistently and positively associated with individual use of short-acting and long-acting contraception. Characteristics of the nearest health facility did not generally exercise their own independent influences on a woman’s use of contraception, except in the case of Burkina Faso, where the average distance between individuals and the nearest family planning provider was significantly greater than other countries. Inclusion of country fixed effects in the pooled models and the relevance of covariates at different levels in the country-specific models demonstrate that there is significant variation across countries in how community, individual, and service delivery environment factors influence contraceptive use and method choice. Context must be taken into account when designing family planning programs.",
author = "{PMA2020 Principal Investigators Group} and Linnea Zimmerman and Suzanne Bell and Qingfeng Li and Antonia Morzenti and Philip Anglewicz and Tsui, {Amy Ong}",
year = "2019",
month = "6",
day = "1",
doi = "10.1371/journal.pone.0218157",
language = "English (US)",
volume = "14",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "6",

}

TY - JOUR

T1 - Individual, community and service environment factors associated with modern contraceptive use in five Sub-Saharan African countries

T2 - A multilevel, multinomial analysis using geographically linked data from PMA2020

AU - PMA2020 Principal Investigators Group

AU - Zimmerman, Linnea

AU - Bell, Suzanne

AU - Li, Qingfeng

AU - Morzenti, Antonia

AU - Anglewicz, Philip

AU - Tsui, Amy Ong

PY - 2019/6/1

Y1 - 2019/6/1

N2 - The importance of the family planning service environment and community-level factors on contraceptive use has long been studied. Few studies, however, have been able to link individual and health facility data from surveys that are nationally representative, concurrently fielded, and geographically linked. Data from Performance Monitoring and Accountability 2020 address these limitations. To assess the relative influences of the service delivery environment and community, household, and individual factors on a woman’s likelihood of using a modern contraceptive in five geographically and culturally diverse sub-Saharan African countries. Nationally representative, cross-sectional data from PMA2020 were linked at the household and service delivery level. Country-specific and pooled multilevel multinomial logistic models, comparing non-users, short- and long-acting method users were used. The variables elected for inclusion in our multivariate analyses were guided by the conceptual framework to profile the different levels of influences on individual use of modern contraception. Average marginal effects were calculated to improve interpretability. We find that the effect of contextual factors varies widely but that being visited by a health worker who spoke about family planning in the past 12 months was consistently and positively associated with individual use of short-acting and long-acting contraception. Characteristics of the nearest health facility did not generally exercise their own independent influences on a woman’s use of contraception, except in the case of Burkina Faso, where the average distance between individuals and the nearest family planning provider was significantly greater than other countries. Inclusion of country fixed effects in the pooled models and the relevance of covariates at different levels in the country-specific models demonstrate that there is significant variation across countries in how community, individual, and service delivery environment factors influence contraceptive use and method choice. Context must be taken into account when designing family planning programs.

AB - The importance of the family planning service environment and community-level factors on contraceptive use has long been studied. Few studies, however, have been able to link individual and health facility data from surveys that are nationally representative, concurrently fielded, and geographically linked. Data from Performance Monitoring and Accountability 2020 address these limitations. To assess the relative influences of the service delivery environment and community, household, and individual factors on a woman’s likelihood of using a modern contraceptive in five geographically and culturally diverse sub-Saharan African countries. Nationally representative, cross-sectional data from PMA2020 were linked at the household and service delivery level. Country-specific and pooled multilevel multinomial logistic models, comparing non-users, short- and long-acting method users were used. The variables elected for inclusion in our multivariate analyses were guided by the conceptual framework to profile the different levels of influences on individual use of modern contraception. Average marginal effects were calculated to improve interpretability. We find that the effect of contextual factors varies widely but that being visited by a health worker who spoke about family planning in the past 12 months was consistently and positively associated with individual use of short-acting and long-acting contraception. Characteristics of the nearest health facility did not generally exercise their own independent influences on a woman’s use of contraception, except in the case of Burkina Faso, where the average distance between individuals and the nearest family planning provider was significantly greater than other countries. Inclusion of country fixed effects in the pooled models and the relevance of covariates at different levels in the country-specific models demonstrate that there is significant variation across countries in how community, individual, and service delivery environment factors influence contraceptive use and method choice. Context must be taken into account when designing family planning programs.

UR - http://www.scopus.com/inward/record.url?scp=85067401868&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85067401868&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0218157

DO - 10.1371/journal.pone.0218157

M3 - Article

C2 - 31220114

AN - SCOPUS:85067401868

VL - 14

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 6

M1 - e0218157

ER -