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Long acting reversible contraceptive utilization and its associated factors among modern contraceptive users in high fertility sub-Saharan Africa countries: a multi-level analysis of recent demographic and health surveys

Archives of Public Health volume 80, Article number: 224 (2022) Cite this article

Abstract

Background

Long-acting reversible contraceptives (LARC) have been hailed as one of the safest and most effective methods of contraception. However, the use of LARC is low in the world, including Sub Saharan Africa; therefore, the aim of this study was to assess LARC utilization and associated factors among modern contraceptive users in high fertility SSA countries.

Methods

Data for this study was obtained from the most recent Demographic and Health Surveys. A total weighted sample of 14,828 reproductive age women was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of long acting reversible contraception utilization. Finally, the Adjusted Odds Ratio (AOR) with 95% confidence interval was used to declare as statistical significance.

Results

Overall prevalence of LARC utilization was observed to be 20.1% (19.45, 20.74). The factors significantly associated with the utilization were women’s age ≥ 35 years (AOR = 1.42; 95% CI: 1.19,1.68), having media exposure (AOR = 1.13; 95% CI: 1.05, 1.28), number of alive children: 1–2 (AOR = 2.35; 95% CI: 1.38, 4.01), 3–4 (AOR = 2.98; 95% CI: 1.74, 5.10), \(\ge\) 5 (AOR = 2.82; 95% CI:1.63, 4.86), have no history of abortion (AOR = 1.33; 95% CI: 1.17,1.51) and who have no big problem with distance to the health facility (AOR = 1.29; 95% CI: 1.16, 1.43).

Conclusion

The use of long acting reversible contraception in this study was relatively low. To improve the utilization of long acting reversible contraceptives governments, policymakers, and stakeholders should implement health promotion strategies through media and improve accessibilities of health facilities.

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Background

The Family Planning (FP) services provide information, counseling, and birth control methods that help people in making decisions about when and if to have children [1]. It is also the best investment for the health and wellbeing of women, children, and communities in health care [2]. Providing women and girls with affordable, high-quality reproductive health services and information is essential to ensuring their rights and well-being [3].

Contraceptive methods used for family planning can be categorized into modern contraception and traditional methods that are used to limit or postpone childbearing [4]. Modern contraception refers to short-acting, long-acting, and permanent methods of contraception that exclude traditional methods [5, 6]. Long-acting reversible contraception (LARC) has been hailed as one of the safest and most effective methods of contraception [7]. The hormonal contraceptive implant is a reversible, long-acting contraceptive that releases a progestin hormone. Depending on the type, it can provide 3 to 5 years of protection. The intrauterine contraceptive device (IUCD) is also a reversible long-acting contraceptive, which is a small device placed in the uterus to prevent pregnancy [8].

Globally, fewer than 15% of women used LARCs [9]. For example, Europe has a varied prevalence of LARC use; the prevalence of LARC use in Poland is 2.9%, while France has a prevalence of about 16%, which is higher than the global proportion of women using LARCs [10]. Different regions, like Latin America and Asia, have recorded a high prevalence of utilization of LARC [11]. However, in Sub-Saharan Africa (SSA), there was a 3% prevalence of LARC use among women [12]. Low utilization of modern contraceptive methods is a major challenge in most low-resource settings. Due to the low level of LARC method utilization, a large number of maternal deaths are occurring in low and middle-income countries [13]. According to studies conducted in SSA [14,15,16], 20% of married women in reproductive age use family planning, but less than one in seven also uses long-acting or permanent contraception [14,15,16]. The low use of reversible long-acting methods of contraception may contribute to an increased number of unintended pregnancies [17, 18]. Due to the factors mentioned above, Sub-Saharan Africa has the highest fertility in the world (5.4 births per woman on average), which is twice higher than that of Asia (excluding China) and more than three times higher than that of Europe [19].

A study conducted in Nigeria found that higher education, over three children, previous LARC use, and the good knowledge and positive attitude of the women about LARC were significant determinants of utilization [20]. The existing studies also revealed that socio-cultural beliefs and practices, level of knowledge, fear of side effects, partner’s objection, convenience, fertility intentions, accessibility, providers’ skill, and competence were determinants of their usage [14, 21]. In addition, different predictors have been identified as being associated with LARC methods. These predictors include socio-demographic aspects, behavioral characteristics, and institutional, and service factors [8, 22].

In countries with high fertility rates and an unmet need for family planning, shifting toward long-acting family planning methods (LAFPMs) is an important strategy to ensure continuity of services [23,24,25]. However, currently; modern contraceptive use is dominated by short-term methods [26,27,28]. Even though the utilization of family planning methods in countries with high birth rates and limited resources has the potential for improving maternal and child health, the proportion of users of long-acting contraceptive methods is very low in high fertility countries [29]. Although studies were conducted in specific countries like Nigeria [20], Congo [30], and Burkina Faso [31]. There have not been any studies combined these high fertility countries (Niger, Democratic Republic Congo, Mali, Chad, Angola, Burundi, Nigeria, Gambia, and Burkina Faso).

Despite LARC utilization was conducted in 26 SSA countries [32]; the current study used multilevel analysis to model the hierarchical nature of the data which is differed from the previous study in SSA. In which the former study was not include community level variables such as, community level poverty, distance to the health facility, community level media exposure, and community level education where these variables were incorporated in this study. Moreover, the current study tried to assess additional factors such as number of living children, ever had history of abortion, sex of household head, decision maker for using LARC methods. Evidences revealed that all the aforementioned factors were important to determine LARC utilization [33,34,35,36].

Therefore, this study aimed to determine whether LARC is utilized by women in high fertility countries and whether they are associated with other factors. It is hoped that the results of the study will help policymakers to make interventions that will help reduce maternal mortality and morbidity through speeding up the utilization of the LARC method.

Methods

Study settings and data source

The study was a cross-sectional assessment of data from Demographic and Health Surveys (DHSs) conducted between January 2010 and December 2018 in high fertility countries in SSA. Countries (Niger, Democratic Republic Congo, Mali, Chad, Angola, Burundi, Nigeria, Gambia, and Burkina Faso) were included in this study. These countries were selected because they are the top ten countries with high fertility rates in SSA with fertility rates above 5.0, a higher value than the rate of 4.44 in SSA and 2.47 worldwide [37]. One country (Somalia) with no DHS data was excluded from the analysis. The data for these countries were obtained from the official database of the DHS program, www.measuredhs.com after authorization was granted via online request by explaining the purpose of our study. We used the woman’s record (IR file) data set and extracted the dependent and independent variables. The DHS is a nationally representative household survey that uses face-to-face interviews on a wide range of population, health, nutrition tracking, and effect assessment measures. Study participants were selected using a two-stage stratified sampling technique. Enumeration Areas (EAs) were randomly selected in the first stage, while households were selected in the second stage. For the sample data to be representative, weighting was conducted before analysis of the DHS dataset since households are not selected uniformly. We used the individual weight for women (v005), which is the household weight (hv005), multiplied by the inverse of the individual response rate. Individual sample weights are generated by dividing (v005) by 1,000,000 before analysis to approximate the number of cases [38, 39]. Finally, a total weighted sample of 14,828 reproductive- age women was included from all nine countries in this study (Table 1).

Table 1 Description of Surveys and sample size characteristics in high fertility countries in SSA (n = 14,828)
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Study variables

Outcome variable

The outcome variable of this study is long-acting reversible contraceptive use. Long-acting reversible contraceptives include intrauterine device (IUCD) and Implants. Finally, the outcome variable was categorized as yes for those who used one of the above methods, otherwise no and coded as 1 and 0, respectively.

Explanatory variables

Both the individual and community level independent variables were included in this study.

Individual level variables; age, marital status, educational status, occupation, wealth status, media exposure, number of living children, ever had a terminated pregnancy, husband’s education, Sex of household head, and decision making for using LARC methods.

Community level variables; residence, and some of were generated from the individual level data of all community members in primary sampling unit (PSU), which includes the community level poverty, distance to the health facility, and community level media exposure that was defined as the proportion of women who had media exposure in a cluster. The aggregate of individual women’s media exposure can show the overall media exposure of women within the cluster.

Data analysis

Stata version 16 software was used for data analysis. The data were weighted to ensure the representativeness of the DHS sample and get reliable estimates and standard errors before data analysis.

Four models were fitted in this study: the null model, which had no explanatory variables, model I, which had individual-level factors, model II, which had community-level factors, and model III, which had both individual and community-level components. Since the models were nested, the Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), and, deviance (-2LLR) values were used for model comparison and fitness, respectively. Model III was the best-fitted model since it had the lowest deviance. Variables having a p-value less than 0.2 in bivariable analysis were used for multivariable analysis. Finally, in the multivariable analysis, adjusted odds ratios with 95% confidence intervals and a p-value of less than 0.05 were utilized to identify factors of LARC use.

Results

Individual level factors

About 6739 (45.5%) of the women were aged between 25 and 34 years. Majority (83.8%) of the participants were married. Regarding their educational status, 6177 (41.7%) respondents were reported with secondary and above educational levels and 7365 (49.7%) respondents’ husband attained secondary and higher educational levels. Among the participants 5014 (33.8%) had more than three living children. In this study one sixth (17.1%) of the participants experienced abortion. Moreover, the majority of respondents (76.0%) were exposed to media. In addition, 9268 (62.9%) participants jointly made decision with their husbands about LARC utilization. With regard to their economic level, 3502 (23.6%) women were in the poor quintiles and 8854 (59.7%) were in the rich quintiles (Table 2).

Table 2 Individual characteristics of respondents in high fertility countries in Sub-Saharan Africa (n = 14,828)
Full size table

Community level factors

About 7916 (53.4%) of the study participants resided in rural areas. Of the respondents, 7998 (53.9%) were from communities with low proportion poverty level. Majority (70.8%) of respondents had no a big problem with related to health facility distance. More than half (53.0%) of the participants were under high proportion community education level (Table 3).

Table 3 Community level characteristics of respondents in high fertility countries in Sub-Saharan Africa (n = 14,828)
Full size table

Prevalence of long acting contraceptive use

Overall, the prevalence of LARC use among reproductive age women in Sub Saran Africa high fertility countries was 20.1% (19.45, 20.74). The LARC use was ranged from 3.0% in Niger to 44.3% in Mali (Fig. 1).

Fig. 1
figure 1

Prevalence of LARC utilization in high fertility SSA countries

Full size image

Factors associated with long acting reversible contraception utilization

From all independent individual and community level factors, maternal age, educational status of women, wealth index, media exposure, number of living children, ever had terminated pregnancy, sex of household head, community level poverty, distance to the health facility, community level media exposure, and community level education were eligible variables for multivariable multilevel analysis. Among eligible individual and community level factors, age, media exposure, number of living children, ever had terminated pregnancy, and distance to the health facility were factors associated with LARC utilization.

Accordingly, individuals aged 35 and above had 1.42 (AOR = 1.42; 95% CI: 1.19, 1.68) higher odds for LARC use compared to those aged 15–24. Individuals exposed to media had 1.13 (AOR = 1.13; 95% CI: 1.05, 1.28) higher odds for LARC use compared to non-exposed. Women who had 1–2 children had 2.35 (AOR = 2.35; 95% CI: 1.38, 4.01) higher odds for LARC use, 3–4 children had 2.98 (AOR = 2.98; 95% CI: 1.74, 5.10) higher odds for LARC use, and 5 + chidren had 2.82 (AOR = 2. 82; 95% CI: 1.63, 4.86) higher odds for LARC use compared to no child. Moreover, individuals who had not terminated pregnancy had 1.33 times higher odds for use of LARC (AOR = 1.33; 95% CI: 1.17, 1.51) than who had terminated pregnancy.

With regard to the community level factors, women who did not have perceived distance to the health facility as not a big problem had 1.29 (AOR = 1.29; 95% CI = 1.16, 1.43) higher odds compared to those perceived as a big problem (Table 4).

Table 4 Multivariable analyses for factors affecting LARC use (n = 14,828)
Full size table

Null model: adjusted for individual-level characteristics,

Model 2: Adjusted for community-level characteristics,

Model 3: adjusted for both individual and community level characteristics.

Discussion

The study was conducted to examine the prevalence of LARC utilization and associated factors among modern contraceptive users in high fertility Sub Saharan Africa countries. According to this study, age of respondents, number of living children, history of terminated pregnancy, media exposure, and distance to the health facility were associated with LARC utilization.

According to this study, only one from five, 20.1% (19.45, 20.74), of reproductive age women uses LARC in high fertility SSA countries. This finding is comparable to those of a studies conducted among reproductive age women in SSA countries with prevalence of (20.73%) [40] and a cross-sectional study conducted in Kenya (20.6%) [41]. The similarities could be attributed to the similar social and political settings of countries in Sub Saharan Africa.

The finding of this study is higher than studies done in Ethiopia (13.1%, 16%) [14, 21], and Nepal 4.7% [34]. However, as the present study, the rate of LARC utilization is lower, compared to Gambia 89% [42], Chad 89% [43], Democratic of Congo 74% [43], and Nigeria 38.7% [44]. The difference can be due to variation in participants’ characteristics and individual and community based nature of our study.

Reproductive women who were ≥ 35 years of age were more likely to use LARCs compared with younger women. The reason could be that they may have enough children up to this age, at which point they will need to keep their family size under control until menopause. This result is supported by a study conducted in Kenya [33]. However, it is differ to a study conducted in Sub Saharan Africa [40].

Women who exposed to media were positively associated with LARC utilization. This result is in line with a study conducted in Ethiopia [44, 45]. A possible explanation is that the media has a powerful ability to explain different methods, their benefits and where they are available to women, enhancing women’s use of the contraceptive methods.

Women who have one to two, three to four, and five and above living children had 2.35, 2.98, and 2.82 times higher odds of LARC utilization respectively, as compared to women who have no living children. This finding is consistent with a study conducted in Ethiopia [46, 47] Uganda [48], Nigeria [49], Malawi [50], Ghana [51]. The possible reasons might be explained as those women who might have already attained their plan of fertility could use LARCs up to reaching menopause or need to space or limit births may choose effective long acting contraceptive methods from the available options.

The odds of using LARC methods were 1.33 times higher among women who did not terminate their pregnancy as compared to those who did. This could be explained by the fact that the individuals had no prior history of abortion and hence could have a sufficient number of children. Therefore, they need to limit the number of their children. This result is different from a study conducted in Ethiopia [52] and a study from Angola reported that women with history of abortion were more likely to use modern family planning compared to women who never had abortion [53].

The odds of using LARC methods were more among women who live near to the health facilities as compared to those who live far from health facilities. The reason might be as the health facility is nearer; the more they have contact time and get information about utilizing LARC, the more likely they use LARC methods.

This study used national representative data, a large sample size, and advanced model to make the results relevant. Because the study was cross-sectional, we could only measure associative rather than causal effects. Due to the fact that we employed secondary data, we were unable to account for certain important variables. It is also important to recognize that this study didn’t examine their beliefs, cultures, or attitudes regarding their use.

Conclusion

According to this study, the use of long acting reversible contraception in high fertility countries in SSA is relatively low. Age, number of living children, terminated pregnancy, media exposure, and distance to the health facility were independent predictors of LARC use among reproductive-age women in high fertility SSA countries. To improve the utilization of long acting reversible contraceptives governments, policymakers, and stakeholders should implement community and facility-level awareness creation and health promotion strategies through media and improve accessibility of health facilities.

Data availability

Data for this study were sourced from Demographic and Health surveys (DHS), which is freely available online at (https://dhsprogram.com).

References

  1. Cleland J, Bernstein S, Ezeh A, Faundes A, Glasier A, Innis J. Family planning: the unfinished agenda. The lancet. 2006;368(9549):1810–27.

    Article  Google Scholar 

  2. Kesetebirhan A. National guideline for family planning services in Ethiopia. Federal Democratic Republic of Ethiopia, Ministry of Health; 2011.

  3. Organization WH. Family planning: A global handbook for providers. 2018 Edition. World Health Organization. 2018.

  4. Ajong AB, Njotang PN, Kenfack B, Essi MJ, Yakum MN, Iballa FBS, et al. Contraceptive method mix and preference: A focus on long acting reversible contraception in urban Cameroon. PLoS ONE. 2018;13(8):e0202967.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Tibaijuka L, Odongo R, Welikhe E, Mukisa W, Kugonza L, Busingye I, et al. Factors influencing use of long-acting versus short-acting contraceptive methods among reproductive-age women in a resource-limited setting. BMC Womens Health. 2017;17(1):1–13.

    Article  Google Scholar 

  6. Ugaz JI, Chatterji M, Gribble JN, Banke K. Is household wealth associated with use of long-acting reversible and permanent methods of contraception? A multi-country analysis. Global Health: Science and Practice. 2016;4(1):43–54.

    Google Scholar 

  7. Fiato N. Family planning in Sub-Saharan Africa: a review of interventions in promotion of long. -acting reversible contraception: University of Pittsburgh; 2016.

    Google Scholar 

  8. Tilahun A, Yoseph A, Dangisso MH. Utilization and predictors of long acting reversible contraceptive methods among reproductive age women in Hawassa city, South Ethiopia: a community based mixed methods. Contracept reproductive Med. 2020;5(1):1–11.

    Article  Google Scholar 

  9. Secura G. Long-acting reversible contraception: a practical solution to reduce unintended pregnancy. Minerva Ginecol. 2013;65(3):271–7.

    PubMed  CAS  Google Scholar 

  10. Abiye AA, Fekede B, Jemberie AM, Molla BA, Tolla BK, Tefera BS, et al. Modern contraceptive use and associated factors among reproductive age group women in three Peri-Urban Communities in Central Ethiopia. J Drug Delivery Ther. 2019;9(6-s):93–102.

    Article  Google Scholar 

  11. Ampt FH, Willenberg L, Agius PA, Chersich M, Luchters S, Lim MS. Incidence of unintended pregnancy among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. BMJ open. 2018;8(9):e021779.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Adedini SA, Omisakin OA, Somefun OD. Trends, patterns and determinants of long-acting reversible methods of contraception among women in sub-Saharan Africa. PLoS ONE. 2019;14(6):e0217574.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Organization WH. Trends in maternal mortality: 1990–2015: estimates from WHO, UNICEF, UNFPA, World Bank Group. and the United Nations Population Division: World Health Organization; 2015.

    Google Scholar 

  14. Taye A, Woldie M, Sinaga M. Predictors of long acting reversible contraceptive use among married women visiting health facilities in Jimma Town. J Women’s Health Care. 2014;4(217):2167 – 0420.1000.

    Google Scholar 

  15. Tarekegn SM, Lieberman LS, Giedraitis V. Determinants of maternal health service utilization in Ethiopia: analysis of the 2011 Ethiopian Demographic and Health Survey. BMC Pregnancy Childbirth. 2014;14(1):1–13.

    Article  Google Scholar 

  16. Tafese F, Woldie M, Megerssa B. Quality of family planning services in primary health centers of Jimma Zone, Southwest Ethiopia. Ethiop J health Sci. 2013;23(3):245–54.

    PubMed  PubMed Central  Google Scholar 

  17. Joshi R, Khadilkar S, Patel M. Global trends in use of long-acting reversible and permanent methods of contraception: seeking a balance. Int J Gynecol Obstet. 2015;131:60-S3.

    Article  Google Scholar 

  18. Gultie T, Hailu D, Workineh Y. Predictors of long acting contraceptives utilization among reproductive age women in Arba Minch Zuria district, Ethiopia. Qual Prim Care. 2016;24(1):17–22.

    Google Scholar 

  19. Ajuwon A, Denloye O, Adisa A, Olapade-Olaopa E. Nigeria’s Health Security: A situation analysis, forecasts and suggested interventions. Afr J Med Med Sci. 2019;48(Supplement 1):13–21.

    Google Scholar 

  20. Aduloju OP, Akintayo AA, Adefisan AS, Aduloju T. Utilization of Long-Acting Reversible Contraceptive (LARC) Methods in a tertiary hospital in southwestern Nigeria: A Mixed Methods Study. J Obstet Gynecol India. 2021;71(2):173–80.

    Article  Google Scholar 

  21. Getinet S, Abdrahman M, Kemaw N, Kansa T, Getachew Z, Hailu D, et al. Long acting contraceptive method utilization and associated factors among reproductive age women in Arba Minch Town, Ethiopia. Greener J Epidemiol public health. 2014;2(1):23–31.

    Article  Google Scholar 

  22. Tebeje B, Workneh D. Prevalence, perceptions and factors contributing to long acting reversible contraception use among family planning clients, Jimma Town, Oromiya Region, South-West Ethiopia. J Women’s Health Care. 2017;6(1):1–10.

    Google Scholar 

  23. Dasa TT, Kassie TW, Roba AA, Wakwoya EB, Kelel HU. Factors associated with long-acting family planning service utilization in Ethiopia: a systematic review and meta-analysis. Contracept reproductive Med. 2019;4(1):1–14.

    Article  Google Scholar 

  24. Habtamu A, Tesfa M, Kassahun M, Animen S. Determinants of long-acting contraceptive utilization among married women of reproductive age in Aneded district, Ethiopia: a case–control study. BMC Res Notes. 2019;12(1):1–6.

    Article  Google Scholar 

  25. Mekash B. Assessment of Factors Associated with Long-Acting Family Planning Utilization among Married Women of Reproductive Age Group:. a Multilevel and Spatial Data Analysis; 2021.

  26. Eshete A. Contraceptive method mix utilization and its associated factors among married women in Gedeo zone, southern nations, nationality and people region-Ethiopia: a community based cross sectional study. Epidemiol (sunnyvale). 2015;5(212):2161-1165.1000212.

    Google Scholar 

  27. Gebremariam A, Addissie A. Knowledge and perception on long acting and permanent contraceptive methods in Adigrat town, Tigray, northern Ethiopia: a qualitative study. International journal of family medicine. 2014;2014.

  28. O’Regan A, Thompson G. Indicators of young women’s modern contraceptive use in Burkina Faso and Mali from Demographic and Health Survey data. Contracept reproductive Med. 2017;2(1):1–8.

    Article  Google Scholar 

  29. Kamuyango A, Yu T, Ao C-K, Hu SC, Hou W-H, Tseng C-C, et al. The public-sector family planning program impact scores in association with long acting reversible contraceptive use among young women in 22 Sub-Saharan African countries; A pooled multi-level analysis. Contraception. 2022.

  30. Casey SE, Gallagher MC, Kakesa J, Kalyanpur A, Muselemu J-B, Rafanoharana RV, et al. Contraceptive use among adolescent and young women in North and South Kivu, Democratic Republic of the Congo: a cross-sectional population-based survey. PLoS Med. 2020;17(3):e1003086.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Bado AR, Badolo H, Zoma LR. Use of modern contraceptive methods in Burkina Faso: what are the obstacles to male involvement in improving indicators in the centre-east and centre-north regions? Open Access Journal of Contraception. 2020;11:147.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Bolarinwa OA, Nwagbara UI, Okyere J, Ahinkorah BO, Seidu A-A, Ameyaw EK, et al. Prevalence and predictors of long-acting reversible contraceptive use among sexually active women in 26 sub-Saharan African countries. International health. 2022.

  33. Kungu W, Khasakhala A, Agwanda A. Use of long-acting reversible contraception among adolescents and young women in Kenya. PLoS ONE. 2020;15(11):e0241506.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. Bhandari R, Pokhrel KN, Gabrielle N, Amatya A. Long acting reversible contraception use and associated factors among married women of reproductive age in Nepal. PLoS ONE. 2019;14(3):e0214590.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  35. Luo Z, Gao L, Anguzu R, Zhao J. Long-acting reversible contraceptive use in the post-abortion period among women seeking abortion in mainland China: intentions and barriers. Reproductive health. 2018;15(1):1–9.

    Article  Google Scholar 

  36. Gashaye KT, Tsegaye AT, Abebe SM, Woldetsadik MA, Ayele TA, Gashaw ZM. Determinants of long acting reversible contraception utilization in Northwest Ethiopia: An institution-based case control study. PLoS ONE. 2020;15(10):e0240816.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  37. African countries with the highest fertility rate |. Statista https://worldpopulationreview.com/countries/total-fertility-rate. cited on December 8, 2021.

  38. Croft TN, Marshall AM, Allen CK, Arnold F, Assaf S, Balian S. Guide to DHS statistics. Rockville: ICF. 2018;645.

  39. Eshete T, Kumera G, Bazezew Y, Mihretie A, Marie T. Determinants of inadequate minimum dietary diversity among children aged 6–23 months in Ethiopia: secondary data analysis from Ethiopian Demographic and Health Survey 2016. Agric Food Secur. 2018;7(1):1–8.

  40. Bolarinwa OA, Nwagbara UI, Okyere J, Ahinkorah BO, Seidu A-A, Ameyaw EK, et al. Prevalence and predictors of long-acting reversible contraceptive use among sexually active women in 26 sub-Saharan African countries. International health. 2021.

  41. Ahinkorah BO. Predictors of modern contraceptive use among adolescent girls and young women in sub-Saharan Africa: a mixed effects multilevel analysis of data from 29 demographic and health surveys. Contracept reproductive Med. 2020;5(1):1–12.

    Google Scholar 

  42. Anyanwu M, Alida BWN. Uptake of long-acting reversible contraceptive devices in Western region of The Gambia. Afr Health Sci. 2017;17(2):409–17.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Rattan J, Noznesky E, Curry DW, Galavotti C, Hwang S, Rodriguez M. Rapid contraceptive uptake and changing method mix with high use of long-acting reversible contraceptives in crisis-affected populations in Chad and the Democratic Republic of the Congo. Global Health: Science and Practice. 2016;4(Supplement 2):5–20.

    Google Scholar 

  44. Mohammed-Durosinlorun A, Adze J, Bature S, Abubakar A, Mohammed C, Taingson M, et al. Uptake and predictors of long-acting reversible contraceptives among women in a tertiary health facility in northern Nigeria. Journal of Basic and Clinical Reproductive Sciences. 2017;6(2).

  45. Hibstu DT, Alemayehu A. Long acting reversible contraceptives utilization and associated factors among women of reproductive age in Arsi Negele town, Southeastern Ethiopia. Contracept Reproductive Med. 2020;5(1):1–7.

    Article  Google Scholar 

  46. Abdu Muhammed M, Abdo R. Long-acting Reversible Contraceptive Utilization and its Associated Factors among Family Planning Users in Pastoral Communities of Afar Region, Ethiopia: A Facility-based Cross-sectional Study. J Midwifery Reproductive Health. 2020;8(1):2022–32.

    Google Scholar 

  47. Gujo AB, Kare AP. Utilization of long-acting reversible contraceptives and associated factors among reproductive age women attending governmental health institutions for family planning services in Wondo Genet District, Sidama, National Regional State, Southern Ethiopia. Health services research and managerial epidemiology. 2021;8:23333928211002401.

  48. Anguzu R, Sempeera H, Sekandi JN. High parity predicts use of long-acting reversible contraceptives in the extended postpartum period among women in rural Uganda. Contracept reproductive Med. 2018;3(1):1–7.

    Article  Google Scholar 

  49. Okafor II. Uptake of long-acting reversible contraceptive methods in Enugu State University Teaching Hospital Enugu, South-East, Nigeria. Divers Equal Health Care. 2016;13(3):216–20.

    Google Scholar 

  50. Palamuleni ME, Adebowale AS. Women empowerment and the current use of long acting and permanent contraceptive: Evidence from 2010 Malawi Demographic and Health Survey. Malawi Med J. 2014;26(3):63–70.

    PubMed  PubMed Central  CAS  Google Scholar 

  51. Dassah ET, Odoi AT, Owusu-Asubonteng G. Prevalence and factors predictive of long-acting reversible contraceptive use in a tertiary hospital in urban Ghana. Eur J Contracept Reproductive Health Care. 2013;18(4):293–9.

    Article  Google Scholar 

  52. Dake SK, Abiso TL. Reversible Long Term Contraceptives Utilization among Married Women of Reproductive Age Group in Areka Town, Southern Ethiopia. Ethiopian Journal of Health Sciences. 2020;30(6).

  53. Morris N, Prata N. Abortion history and its association with current use of modern contraceptive methods in Luanda, Angola. Open access journal of contraception. 2018;9:45.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We are grateful to the DHS programs, for the permission to use all the relevant DHS data for this study.

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

    Wubshet Debebe Negash & Tadele Biresaw Belachew

  2. Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

    Desale Bihonegn Asmamaw

Authors
  1. Wubshet Debebe Negash
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  2. Tadele Biresaw Belachew
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  3. Desale Bihonegn Asmamaw
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Contributions

WDN and DBA conceived the idea, extract the data, data analyzed, drafted, and revised the manuscript. TBB participate in the draft of the manuscript and interpretation. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Tadele Biresaw Belachew.

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Ethical approval and consent to participate

The study does not involve the collection of information from subjects. Consent to participants is not applicable since the data is secondary and is available in the public domain. All the methods were conducted according to the Helsinki declarations. More details regarding DHS data and ethical standards are available online at (http://www.dhsprogram.com).

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Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Negash, W.D., Belachew, T.B. & Asmamaw, D.B. Long acting reversible contraceptive utilization and its associated factors among modern contraceptive users in high fertility sub-Saharan Africa countries: a multi-level analysis of recent demographic and health surveys. Arch Public Health 80, 224 (2022). https://doi.org/10.1186/s13690-022-00977-1

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Keywords

Archives of Public Health

ISSN: 2049-3258