Osborne Augustus, Bangura Camilla, Sesay Umaru
Department of Biological Sciences, School of Basic Sciences, Njala University, PMB, Freetown, Sierra Leone.
African Field Epidemiology Network, Freetown, Sierra Leone.
Arch Public Health. 2025 Jun 18;83(1):158. doi: 10.1186/s13690-025-01653-w.
Family planning, through access to safe and effective contraception, empowers women to make informed choices about their reproductive health. It is crucial in reducing unintended pregnancies, maternal mortality, and improving overall well-being. However, achieving equitable access to contraception remains a challenge in many low- and middle-income countries, including Sierra Leone. This study investigated the inequalities in contraceptive prevalence among married women of reproductive age (15-49 years) in Sierra Leone in 2008, 2013 and 2019.
This study employed time-trend study design utilizing data from three rounds of the Sierra Leone Demographic Health Survey conducted in 2008, 2013, and 2019. The health equity assessment toolkit software, developed by the World Health Organisation, was utilised to calculate various inequality measures. These include simple measures such as difference and ratio, as well as complex measures such as population attributable risk and fraction.
The prevalence of contraceptive use among reproductive-aged married women in Sierra Leone increased from 8.2% in 2008 to 21.2% in 2019. The inequality in married women's age in contraceptive prevalence between older and younger women decreased slightly from 7.5 percentage points in 2008 to 7.2 percentage points in 2019. The ratio also decreased, indicating a narrowing gap in contraceptive prevalence between the age groups over time. Inequality in economic status in contraceptive prevalence between married women in the richest and poorest wealth index decreased from 15.7 percentage points in 2008 to 9.9 percentage points in 2019. The population attributable fraction and population attributable risk decreased notably, suggesting that economic status became less of a determinant factor in contraceptive prevalence over time. The educational inequality in contraceptive prevalence between married women with secondary or higher education and those with no education experienced a decline from 16.5 percentage points in 2008 to 12.6 percentage points in 2019. Place of residence inequality in contraceptive prevalence between married women in urban and rural areas decreased from 11.2 percentage points in 2008 to 7.4 percentage points in 2019. Provincial inequality in contraceptive prevalence between married women in the Western area and Northwestern province decreased from 16.7 percentage points in 2008 to 8.6 percentage points in 2019.
The prevalence of contraceptive use among reproductive-aged married women in Sierra Leone has notably increased over the past decade, accompanied by notable reductions in inequalities across age, economic status, education, place of residence, and geographic provinces. While inequalities persist, the narrowing gaps underscore progress in improving equitable access to contraceptive services. These findings underscore the importance of sustained efforts to address remaining inequalities and further enhance access to family planning resources for all women, particularly those in underserved populations.
计划生育通过提供安全有效的避孕措施，使女性能够就自身生殖健康做出明智选择。这对于减少意外怀孕、孕产妇死亡率以及改善整体健康状况至关重要。然而，在包括塞拉利昂在内的许多低收入和中等收入国家，实现避孕措施的公平获取仍然是一项挑战。本研究调查了2008年、2013年和2019年塞拉利昂15至49岁育龄已婚妇女避孕普及率的不平等情况。
本研究采用时间趋势研究设计，利用2008年、2013年和2019年进行的三轮塞拉利昂人口与健康调查的数据。使用世界卫生组织开发的健康公平评估工具软件来计算各种不平等指标。这些指标包括差异和比率等简单指标，以及人群归因风险和分数等复杂指标。
塞拉利昂育龄已婚妇女的避孕普及率从2008年的8.2%上升至2019年的21.2%。老年妇女与年轻妇女在避孕普及率方面的年龄不平等从2008年的7.5个百分点略有下降至2019年的7.2个百分点。该比率也有所下降，表明随着时间推移，各年龄组之间避孕普及率的差距在缩小。最富有和最贫穷财富指数组已婚妇女在避孕普及率方面的经济状况不平等从2008年的15.7个百分点降至2019年的9.9个百分点。人群归因分数和人群归因风险显著下降，表明随着时间推移，经济状况在避孕普及率方面的决定因素作用减弱。受过中等及以上教育的已婚妇女与未受过教育的已婚妇女在避孕普及率方面的教育不平等从2008年的16.5个百分点降至2019年的12.6个百分点。城市和农村已婚妇女在避孕普及率方面的居住地不平等从2008年的11.2个百分点降至2019年的7.4个百分点。西部地区和西北省已婚妇女在避孕普及率方面的省级不平等从2008年的16.7个百分点降至2019年的8.6个百分点。
在过去十年中，塞拉利昂育龄已婚妇女的避孕普及率显著提高，同时在年龄、经济状况、教育程度、居住地和地理省份等方面的不平等显著减少。尽管不平等现象仍然存在，但差距的缩小凸显了在改善避孕服务公平获取方面取得的进展。这些发现强调了持续努力解决剩余不平等问题并进一步增加所有妇女，特别是服务不足人群获得计划生育资源的重要性。
