Amoako Johnson Fiifi, Madise Nyovani J
GeoData Institute, School of Geography, University of Southampton, UK.
J Biosoc Sci. 2009 Mar;41(2):249-67. doi: 10.1017/S0021932008003179. Epub 2008 Oct 31.
After a decade of fertility decline, Ghana's fertility and the level of unmet need for contraception stalled in mid-transition in the late 1990s. Although the literature acknowledges this, the geographical patterns in unmet need have not been adequately documented. Spatial analysis of unmet need can reveal differences in usage and provision of contraceptive commodities, thereby pointing to geographical areas where contraceptive programmes should be strengthened. This study examines the geographical variation of the risk of mistimed and unwanted pregnancies between rural communities and also between urban communities of the three ecological zones of Ghana. The study also investigates if geographical differences in the risks of mistimed and unwanted pregnancies changed during the period when unmet need stalled at the national level. A multilevel regression model was applied to pooled data from the 1998 and 2003 Ghana Demographic and Health Surveys to examine the determinants of the risk of unintended pregnancies, while controlling for clustering of outcomes within communities. The results show that between the two surveys, there was no significant change in the levels of risk of mistimed and unwanted pregnancy. However, geographical heterogeneity in the risk of mistimed and unwanted pregnancy was observed, after controlling for relevant predictors. This showed concentration of mistimed pregnancies in some rural communities relative to others, and variation in the risk of unwanted pregnancies between urban communities. The results give a clear indication that bridging the inequality gap in contraceptive use requires programmes that are area-specific.
经过十年的生育率下降，加纳的生育率以及未满足的避孕需求水平在20世纪90年代后期处于过渡中期时停滞不前。尽管文献承认这一点，但未满足需求的地理模式尚未得到充分记录。对未满足需求进行空间分析可以揭示避孕用品使用和供应方面的差异，从而指出应加强避孕计划的地理区域。本研究考察了加纳三个生态区农村社区之间以及城市社区之间时机不当和意外怀孕风险的地理差异。该研究还调查了在全国层面未满足需求停滞期间，时机不当和意外怀孕风险的地理差异是否发生了变化。应用多水平回归模型对1998年和2003年加纳人口与健康调查的汇总数据进行分析，以检验意外怀孕风险的决定因素，同时控制社区内结果的聚集性。结果表明，在两次调查之间，时机不当和意外怀孕的风险水平没有显著变化。然而，在控制了相关预测因素后，观察到时机不当和意外怀孕风险存在地理异质性。这表明相对于其他一些农村社区，某些农村社区存在时机不当怀孕的集中情况，并且城市社区之间意外怀孕的风险存在差异。结果清楚地表明，缩小避孕使用方面的不平等差距需要针对特定地区的计划。
