Department of Epidemiology, UMDNJ School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA.
Int J Equity Health. 2012 Nov 16;11:69. doi: 10.1186/1475-9276-11-69.
Little is known regarding the association between socioeconomic factors and contraceptive use in the Newly Independent States (NIS), countries that have experienced profound changes in reproductive health services during the transition from socialism to a market economy.
Using 2005-2006 data from Demographic Health Surveys (Armenia, Azerbaijan, and Moldova) and Multiple Indicator Cluster Surveys (Belarus, Georgia, Kazakhstan, Kyrgyzstan, Tajikistan, Ukraine, and Uzbekistan), we examined associations between individual and community socioeconomic status with current modern contraceptive use (MCU) among N = 55,204 women aged 15-49 married or in a union. Individual socioeconomic status was measured using quintiles of wealth index and education level (higher than secondary school, secondary school or less). Community socioeconomic status was measured as the percentage of households in the poorest quintile of the nationals household wealth index (0%, 0-25%, or greater than 25%). We used multilevel logistic regression to estimate associations adjusted for age, number of children, urban/rural, and socioeconomic variables.
MCU varied by country from 14% (in Azerbaijan) to 62% (in Belarus). Overall, women living in the poorest communities were less likely than those in the richest to use modern contraceptives (adjusted odds ratio (aOR) = 0.82, 95% Confidence Interval = 0.76, 0.89). Similarly, there was an increasing odds of MCU with increasing individual-level wealth. Women with a lower level of education also had lower odds of MCU than those with a higher level of education (aOR = .75, 95%CI = 0.71, 0.79). In country-specific analyses, community-level socioeconomic inequalities were apparent in 4 of 10 countries; in contrast, inequalities by individual-level wealth were apparent in 7 countries and by education in 8 countries. All countries in which community-level socioeconomic status was associated with MCU were in Central Asia, whereas at the individual-level inequalities of the largest magnitude were found in the Caucasus. There were no distinct patterns found in Eastern European countries.
Community-level socioeconomic inequalities in MCU were most pronounced in Central Asian countries, whereas individual-level socioeconomic inequalities in MCU were most pronounced in the Caucasus. It is important to consider multilevel contextual determinants of modern contraceptive use in the development of reproductive health and family planning programs.
在新独立国家（NIS）中，人们对社会经济因素与避孕措施使用之间的关系知之甚少。这些国家在从社会主义向市场经济过渡期间，生殖健康服务经历了深刻的变革。
利用 2005-2006 年人口与健康调查（亚美尼亚、阿塞拜疆和摩尔多瓦）和多指标类集调查（白俄罗斯、格鲁吉亚、哈萨克斯坦、吉尔吉斯斯坦、塔吉克斯坦、乌克兰和乌兹别克斯坦）的数据，我们研究了个体和社区社会经济地位与 N=55204 名 15-49 岁已婚或同居的女性当前现代避孕措施使用（MCU）之间的关联。个体社会经济地位使用财富指数和教育水平（高于中学、中学或以下）的五分位数来衡量。社区社会经济地位以国民家庭财富指数中最贫困五分位数的家庭比例（0%、0-25%或大于 25%）来衡量。我们使用多水平逻辑回归来估计调整年龄、子女数量、城乡和社会经济变量后的关联。
MCU 因国家而异，范围从 14%（阿塞拜疆）到 62%（白俄罗斯）。总体而言，生活在最贫困社区的女性使用现代避孕药具的可能性低于生活在最富裕社区的女性（调整后的优势比（aOR）=0.82，95%置信区间=0.76，0.89）。同样，个体层面的财富水平越高，使用现代避孕药具的几率也随之增加。受教育程度较低的女性使用现代避孕药具的几率也低于受教育程度较高的女性（aOR=0.75，95%CI=0.71，0.79）。在特定国家的分析中，有 4 个国家存在社区层面的社会经济不平等；相比之下，有 7 个国家存在个体层面财富不平等，8 个国家存在教育不平等。与 MCU 相关的社区社会经济地位的所有国家都在中亚，而个体层面最大的不平等则存在于高加索地区。东欧国家没有明显的模式。
MCU 方面的社区层面社会经济不平等在中亚国家最为明显，而 MCU 方面的个体层面社会经济不平等在高加索地区最为明显。在制定生殖健康和计划生育方案时，考虑现代避孕药具使用的多层次背景决定因素非常重要。
