Salihu Tarif, Dadzie Louis Kobina, Gebremedhin Aster Ferede, Ahinkorah Bright Opoku, Yaya Sanni
Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
Cape Coast Teaching Hospital, Cape Coast, Ghana.
Contracept Reprod Med. 2024 Oct 25;9(1):52. doi: 10.1186/s40834-024-00305-8.
Unmet need for birth spacing can significantly impact maternal and child health outcomes, leading to unintended or mistimed births, neonatal mortality, pregnancy loss, induced abortions, small-sized births, and malnutrition. Considering the role of women empowerment in women's sexual and reproductive health, we examined the association between the survey-based women's empowerment index (SWPER) and unmet need for spacing in sub-Saharan Africa (SSA).
We used data from the Demographic and Health Surveys of 21 in SSA conducted between 2015 and 2021. In this study, the unit of analysis was women of reproductive age (15 to 49 years) who were married or living together and required family planning during the survey period. Multilevel logistic regression was fitted to examine the association between SWPER and the unmet need for spacing. The results were presented using adjusted odds ratios (AORs) with 95% confidence intervals (CIs).
The hotspot countries for unmet need for birth spacing were Angola, Benin, Liberia, Mauritania, and Sierra Leone. The findings showed that with the empowerment indicators, women with high attitude to violence (disagreement or rejection of violence) (AOR = 0.95; 95% CI 0.91, 0.99), and women with high decision-making (AOR = 0.90; 95% CI 0.85, 0.95) exhibited lower odds of unmet spacing need relative to women with low attitude to violence and those with low decision making. Women with high autonomy (AOR = 1.32; 95% CI 1.25, 1.39) were more likely to experience unmet need for spacing compared to those with low autonomy.
Unmet need for spacing has been linked to indices of women's empowerment such as attitudes toward violence, independence, and decision-making. Organizations such as UNICEF, UNFPA, and the Bill & Melinda Gates Foundation should consider incorporating SWPER indicators when planning interventions to address the high unmet need for spacing among women in SSA. Additionally, various governments and aid organizations must give women's empowerment a high priority as a tactical intervention strategy to increase access to contraception in the countries considered in this study. These programmes would contribute to attaining SDGs 3.1 and 3.7.
生育间隔需求未得到满足会对母婴健康结果产生重大影响，导致意外生育或生育时机不当、新生儿死亡、流产、低体重儿出生和营养不良。考虑到妇女赋权在妇女性健康和生殖健康中的作用，我们研究了基于调查的妇女赋权指数（SWPER）与撒哈拉以南非洲（SSA）未满足的生育间隔需求之间的关联。
我们使用了2015年至2021年在SSA进行的21次人口与健康调查的数据。在本研究中，分析单位是在调查期间已婚或同居且需要计划生育的育龄妇女（15至49岁）。采用多水平逻辑回归分析来研究SWPER与未满足的生育间隔需求之间的关联。结果以调整后的优势比（AOR）和95%置信区间（CI）呈现。
生育间隔需求未得到满足的热点国家有安哥拉、贝宁、利比里亚、毛里塔尼亚和塞拉利昂。研究结果表明，在赋权指标方面，对暴力持高态度（不同意或拒绝暴力）的妇女（AOR = 0.95；95% CI 0.91，0.99）以及决策能力强的妇女（AOR = 0.90；95% CI 0.85，0.95）与对暴力持低态度和决策能力弱的妇女相比，未满足生育间隔需求的几率更低。与自主性低的妇女相比，自主性高的妇女（AOR = 1.32；95% CI 1.25，1.39）更有可能存在未满足的生育间隔需求。
未满足的生育间隔需求与妇女赋权指标有关，如对暴力的态度、独立性和决策能力。联合国儿童基金会、联合国人口基金和比尔及梅琳达·盖茨基金会等组织在规划干预措施以解决SSA地区妇女中高比例的未满足生育间隔需求时，应考虑纳入SWPER指标。此外，各国政府和援助组织必须将妇女赋权作为一项战术干预策略高度优先考虑，以增加本研究中所涉及国家的避孕措施可及性。这些方案将有助于实现可持续发展目标3.1和3.7。
