Akinyemi Akanni Ibukun, Mobolaji Jacob Wale, Abe John Olugbenga, Ibrahim Elhakim, Ikuteyijo Olutoyin
Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria.
Department of Demography, The University of Texas at San Antonio, San Antonio, TX, United States.
Front Glob Womens Health. 2021 Jun 16;2:656062. doi: 10.3389/fgwh.2021.656062. eCollection 2021.
Inequalities in health care utilisation and outcomes vary significantly across geographies. Though available evidence suggests disparity in contraceptive uptake in favour of urban compared with rural geographies, there are unassessed nuances among women in urban communities. This study examines some of these disparities within the context of socioeconomic deprivations and family planning utilisation among urban women in West Africa. A secondary analysis of the most recent Demographic and Health Survey dataset of five selected West African countries was conducted, using pooled data of 21,641 women aged 15-49 years. Associations between family planning utilisation and women's deprivation status were investigated using a binary logistic regression model. The findings show that more than one-quarter of the women were severely deprived across the countries except Senegal (17.4%), and the severely deprived consistently have relatively low contraceptive prevalence rates (CPR) (16.0-24.3%) compared with women with no/low deprivation across the countries except Senegal (39.8%). The results for long-acting reversible contraceptives (LARC) were not consistent across the five countries: whereas, LARC utilisation was lower among severely deprived women in Nigeria (9.1%), Guinea (9.6%), and Mali (19.3%), utilisation was similar across the deprivation groups in Benin and Senegal. In the multivariable analyses, the log-odds of modern contraceptive utilisation decreases by 0.27 among the moderately deprived (ß = -0.27, SE = 0.05, < 0.01) and by 0.75 among the severely deprived women (ß = -0.75, SE = 0.05, < 0.01) compared with those with no/low deprivation, with variations across the countries. Similarly, the log-odds of LARC utilisation decreases by 0.44-0.72 among the severely deprived women compared with those with no/low deprivation across the countries except Senegal. This study concluded that family planning intervention programmes and policies need to underscore the deprivation context of urban geographies, particularly among women living in informal settlements.
医疗保健利用和结果方面的不平等在不同地区存在显著差异。尽管现有证据表明，与农村地区相比，城市地区的避孕药具使用情况存在差异，但城市社区女性中仍存在一些未被评估的细微差别。本研究在社会经济贫困和西非城市女性计划生育利用的背景下，考察了其中一些差异。对五个选定西非国家的最新人口与健康调查数据集进行了二次分析，使用了21,641名15至49岁女性的汇总数据。使用二元逻辑回归模型研究了计划生育利用与女性贫困状况之间的关联。研究结果表明，除塞内加尔（17.4%）外，各国超过四分之一的女性处于严重贫困状态，与除塞内加尔外各国无/低贫困女性（39.8%）相比，严重贫困女性的避孕普及率（CPR）一直相对较低（16.0 - 24.3%）。长效可逆避孕药（LARC）的使用情况在五个国家并不一致：在尼日利亚（9.1%）、几内亚（9.6%）和马里（19.3%），严重贫困女性的LARC使用率较低，而在贝宁和塞内加尔，不同贫困组的使用率相似。在多变量分析中，与无/低贫困女性相比，中度贫困女性（β = -0.27，SE = 0.05，< 0.01）和严重贫困女性（β = -0.75，SE = 0.05，< 0.01）现代避孕方法使用的对数几率分别降低0.27和0.75，各国情况有所不同。同样，与除塞内加尔外各国无/低贫困女性相比，严重贫困女性LARC使用的对数几率降低0.44 - 0.72。本研究得出结论，计划生育干预计划和政策需要强调城市地区的贫困背景，特别是居住在非正规住区的女性。
