Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
PLoS One. 2020 Nov 18;15(11):e0242345. doi: 10.1371/journal.pone.0242345. eCollection 2020.
In Nigeria, unmet need for contraception is high despite improved access to modern contraception. To identify factors that support Nigerian women's contraceptive decisions to achieve their reproductive goals, in the presence or absence of their partner's support, we seek to identify individual/couple and community level determinants of a spectrum of contraceptive practices, from non-use to covert and overt use of contraception.
Data were drawn from a national probability survey conducted by Performance Monitoring and Accountability 2020 in Nigeria in 2017-2018. A sample of 12,948 women 15-49 years was included, 6433 of whom were in need of contraception at the time of the survey. We conducted bivariate and multivariate analysis to identify individual/couple and community level factors associated with covert use relative to non-use and to overt use of contraception.
Altogether, 58.0% of women in need of contraception were non-users, 4.5% were covert users and 37.5% used contraception overtly. Covert users were more educated and wealthier than non-users, but less educated and less wealthy than overt users. Covert users were less likely to cohabitate with their partner compared to non-users [AOR = 4.60 (95%CI: 3.06-6.93)] and overt users [AOR = 5.01 (95%CI: 3.24-7.76)] and more likely to reside in urban areas. At the community level, covert users were more likely to live in communities with higher contraceptive prevalence and higher levels of female education relative to non-users. They were also more likely to live in communities with higher female employment [AOR = 1.62, (95%CI: 0.96-2.73)] compared to overt users.
By identifying individual and community level factors associated with the spectrum from non-use to covert use and overt use of contraception, this study highlights the importance of integrating individual and community interventions to support women's realization of their reproductive goals.
在尼日利亚，尽管现代避孕药具的可及性有所提高，但避孕需求仍未得到满足。为了确定支持尼日利亚妇女实现其生殖目标的避孕决策的因素，无论其伴侣是否支持，我们试图确定个体/夫妇和社区层面决定避孕措施范围的因素，从非使用到秘密和公开使用避孕措施。
数据来自 Performance Monitoring and Accountability 2020 于 2017-2018 年在尼日利亚进行的全国概率调查。调查包括 12948 名 15-49 岁的妇女，其中 6433 名妇女在调查时需要避孕。我们进行了单变量和多变量分析，以确定与非使用相比，与秘密使用和公开使用避孕措施相关的个体/夫妇和社区层面的因素。
共有 58.0%需要避孕的妇女是非使用者，4.5%是秘密使用者，37.5%公开使用避孕措施。秘密使用者比非使用者受教育程度更高，更富有，但比公开使用者受教育程度更低，更贫穷。与非使用者相比，秘密使用者更不可能与伴侣同居[AOR=4.60（95%CI：3.06-6.93）]和公开使用者[AOR=5.01（95%CI：3.24-7.76）]，更有可能居住在城市地区。在社区层面，与非使用者相比，秘密使用者更有可能居住在避孕药具使用率更高和女性教育程度更高的社区。与公开使用者相比，他们也更有可能居住在女性就业水平更高的社区[AOR=1.62（95%CI：0.96-2.73）]。
通过确定与从不使用到秘密使用和公开使用避孕措施的范围相关的个体和社区层面的因素，本研究强调了整合个体和社区干预措施以支持妇女实现其生殖目标的重要性。
