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DISPARITIES IN MODERN CONTRACEPTION USE AMONG WOMEN IN THE DEMOCRATIC REPUBLIC OF CONGO: A CROSS-SECTIONAL SPATIAL ANALYSIS OF PROVINCIAL VARIATIONS BASED ON HOUSEHOLD SURVEY DATA

Published online by Cambridge University Press:  09 June 2014

NGIANGA-BAKWIN KANDALA*
Affiliation:
Division of Health Sciences, Warwick Medical School, University of Warwick, UK KEMRI-University of Oxford-Wellcome Collaborative Programme, Nairobi, Kenya Division of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
FELLY KINZIUNGA LUKUMU
Affiliation:
Department of Population and Development Studies, University of Kinshasa, DRC
JOCELYN NZINUNU MANTEMPA
Affiliation:
Department of Population and Development Studies, University of Kinshasa, DRC
JOSEPH DESIRE KANDALA
Affiliation:
Direction d'inventaires et Aménagement Forestières (DIAF), Ministère de l'Environnement, Conservation de la Nature et Tourisme, DRC
TOBIAS CHIRWA
Affiliation:
Division of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
*
1Corresponding author. Email: N-B.Kandala@warwick.ac.uk

Summary

This study investigates inequalities at the province level of the use of modern contraception and the proportion of short birth intervals among women in the DRC using data from the 2007 Demographic and Health Survey. Logistic regression and Bayesian geo-additive models were used. The posterior odds ratio and the associated 95% credible interval (95% CI) were estimated using Markov Chain Monte Carlo (MCMC) techniques. Posterior spatial effects were mapped at the province level with the associated posterior probability maps showing statistical significance at 5%. The overall rates of modern contraception use among the entire sample of women (15–49 years old; N=7172) and youth (15–24 years old; N=1389) were 5.7% and 6.0% respectively. However, there was striking variation in contraceptive use between the two groups across provinces with a clear east-to-west gradient. The highest use in the total sample was in Nord-Kivu (OR 1.32; 95% CI 1.12, 1.55) and Bas Congo provinces (1.47; 1.22, 1.78). For the youth, the highest use was observed in Nord-Kivu (1.19; 0.92, 1.65). In multivariate Bayesian geo-additive regression analyses among the entire sample of women, factors consistently associated with lower use of modern contraception were living in rural areas (0.71; 0.62, 0.82), living in low-income households (0.67; 0.54, 0.80) and having no education (0.83; 0.67, 0.97). For the youth sample, living in low-income households (0.57; 0.41, 0.84) and no breast-feeding (0.64; 0.47, 0.86) were consistently associated with a lower use of modern contraception. The study shows a distinct geographic pattern in the use of modern contraception in youth and the entire sample of women in the DRC, suggesting a potential role for socioeconomic factors, such as accessibility, affordability and availability, as well as environmental factors at the province level beyond individual-level risk factors.

Type
Articles
Copyright
Copyright © Cambridge University Press 2014 

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References

Amin, S., Malwade, B. A. & Stephenson, R. B. (2002) Spatial variation in contraception use in Bangladesh: looking beyond the borders. Demography 39(2), 251267.Google Scholar
Borgoni, R. & Billari, F. C. (2003) Bayesian spatial analysis of demographic survey data: an application to contraceptive use at first sexual intercourse. Demographic Research 8, 6192.Google Scholar
Brezger, A., Kneib, T., Lang, S. & Bayes, X. (2005) Software for Bayesian Inference based on Markov Chain Monte Carlo simulation techniques. Journal of Statistical Software 14, 11.Google Scholar
Byrne, A., Morgan, A., Soto, E. J. & Dettrick, Z. (2012) Context-specific, evidence-based planning for scale-up of family planning services to increase progress to MDG 5: health systems research. Reproductive Health 9, 27.Google Scholar
Conde-Agudelo, A. & Belizán, J. M. (2000) Maternal morbidity and mortality associated with interpregnancy interval: cross sectional study. British Medical Journal 321, 12551259.CrossRefGoogle ScholarPubMed
Conde-Agudelo, A., Rosas-Bermúdez, A. & Goeta, K. (2007) Effects of birth spacing on maternal health: a systematic review. American Journal of Obstetrics & Gynecology 196(4), 297308.Google Scholar
Emina, J. B. O., Chirwa, T. & Kandala, N. B. (2014) Trend in the use of modern contraception in sub-Saharan Africa: does women's education matter? Contraception doi:10.1016/j.contraception.2014.02.001.Google Scholar
Ettarh, R. R. (2011) Spatial Analysis of Contraceptive Use and Unmet Need in Kenya. MEASURE Evaluation PRH, Working Paper Series, April 2011 WP-11-118, 26.Google Scholar
Feldman, B. S., Zaslavsky, A. M., Ezzati, M., Peterson, K. E. & Mitchell, M. (2009) Contraceptive use, birth spacing, and autonomy: an analysis of the oportunidades program in rural Mexico. Studies in Family Planning 40(1), 5162.CrossRefGoogle ScholarPubMed
Gauthier, A. (2002) Les politiques de planification familiale dans les pays en développement: du mathusianisme au féminisme? Lien social et politique 47, 6781.Google Scholar
Institut National de la Statistique (INS) (2005) Rapport de l'enquête 1-2-3 sur l'emploi, le secteur informel et la consommation des ménages de 2004–2005. INS, Kinshasa, DRC.Google Scholar
Kalambayi, B. (2007) Sexualité des jeunes et comportement sexuel à risque dans la ville de Kinshasa. PhD thesis in demography, Louvain la beuve, Academia-Bruylan.Google Scholar
Kamau, R. K., Karanja, J., Sekadde-Kigondu, C., Ruminjo, J. K., Nichols, D. & Liku, J. (1996) Barriers to contraceptive use in Kenya. East African Medical Journal 73(10), 651659.Google ScholarPubMed
Kandala, N. B. & Stones, R. W. (2005) Birth intervals and injectable contraception in sub-Saharan Africa. Contraception 71, 353356.Google Scholar
Khan, S., Mishra, V., Arnol, F. & Abderrahim, N. (2007) Contraceptive trends in developing countries. DHS Comparative Report No. 16, Macro International, p. 86.Google Scholar
Khan, A. & Shaikh, B. T. (2013) An all-time low utilization of intrauterine contraceptive device as a birth spacing method: a qualitative descriptive study in district Rawalpindi, Pakistan. Reproductive Health 10, 10.Google Scholar
Kravdal, O. (2002) Education and fertility in sub-Saharan Africa: individual and community effects. Demography 39, 233250.Google Scholar
Mathe, J. K., Kasonia, K. K. & Maliro, A. K. (2011) Barriers to adoption of family planning among women in Eastern Democratic Republic of Congo. African Journal of Reproductive Health 15(1), 6977.Google ScholarPubMed
Ministry of Planning & Macro International (2008) Enquête Démographique et de Santé (EDS–RDC 2008), Final Report 2008. Ministry of Planning, Kinshasa, DRC and Macro International, Calverton.Google Scholar
Ngondo, S. & Pishandenge, A. (1994) Politiques et programmes en matière de population en Afrique: Précision des objectifs et adéquation des moyens. AUPELF-UREF, John Libbey Eurotext, Paris, pp. 99110.Google Scholar
Nwakeze, N. M. & Kandala, N. B. (2011) The spatial distribution of health establishments in Nigeria. African Population Studies 25(2), 680696.Google Scholar
Pradelles de Latour, C. H. (2001) Quand la sexualité et la procréation sont séparées. Cliniques méditerranéennes 63, 89101. doi: 10.3917/cm.063.0089CrossRefGoogle Scholar
Rutstein, S. O. (2008) Further evidence of the effects of preceding birth intervals on neonatal, infant, and under-five-years mortality and nutritional status in developing countries: evidence from the Demographic and Health Surveys. DHS Working Papers No. 41, USAID.Google Scholar
Rwenge, M. (1994) Déterminants de la fécondité des mariages selon le milieu d'habitat au Bénin: examen par les variables intermédiaires. Cahier de l'IFORD, No. 7.Google Scholar
Saifuddin, A., Qingfeng, L., Liu, L. & Tsui, A. O. (2012) Maternal deaths averted by contraceptive use: an analysis of 172 countries. Lancet 380, 111125.Google Scholar
Sala-Diakanda, D. M. (1994) L'évaluation de l'objectif de maîtrise de la croissance démographique en Afrique. AUPELF–UREF, John Libbey Eurotext, Paris, pp. 7785.Google Scholar
Sala-Diakanda, M. (2000) Les positions des gouvernements africains vis-à-vis des politiques en matière de fécondité. In Virnard, P. & Zanou, B. (eds) Politiques démographiques et transition de la fécondité en Afrique. L'Harmattan, Paris, pp. 1345.Google Scholar
Secura, G. M., Allsworth, J. E., Madden, T., Mullersman, J. L. & Peipert, J. F. (2010) The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception. American Journal of Obstetrics and Gynecology 203(2), 115.e1115.e7.Google Scholar
Singh, S. & Darroch, J. E. (2012) Adding It Up: Costs and Benefits of Contraceptive Services – Estimates for 2012. Guttmacher Institute and United Nations Population Fund (UNFPA), New York.Google Scholar
Smith, D. P. (1985) Breastfeeding, contraception and birth intervals in developing countries. Studies in Family Planning 16, 154163.Google Scholar
Stephenson, R. B., Baschieri, A., Clements, S., Hennink, M. & Madise, N. (2007) Contextual influences on modern contraceptive use in sub-Saharan Africa. American Journal of Public Health 97, 12331240.CrossRefGoogle ScholarPubMed
Stephenson, R. B., Beke, A. & Tshibangu, D. (2008) Community and health facility influences on contraceptive method choice in the Eastern Cape, South Africa. International Family Planning Perspectives 34(2), 6270.Google Scholar
Stephenson, R. B. & Tsui, A. O. (2002) Contextual influences on reproductive health service use in Uttar Pradesh, India. Studies in Family Planning 3, 309320.CrossRefGoogle Scholar
Stover, J. & Ross, J. (2010) How increased contraceptive use has reduced maternal mortality. Maternal Child Health Journal 14, 687695.Google Scholar
Tambashe, O. (1984) Niveaux et corrélats de la fécondité des mariages à Kinshasa: examen par les variables intermédiaires. Cabay, Louvain-la-Neuve, p. 364.Google Scholar
United Nations (2011a) 2011 Update for the MDG Database: Unmet Need for Family Planning. POP/DB/CP/B/MDG2011, Department of Economic and Social Affairs, Population Division.Google Scholar
United Nations (2011b) 2011 Update for the MDG Database: Contraceptive Prevalence. POP/DB/CP/A/MDG2011, Department of Economic and Social Affairs, Population Division.Google Scholar
UNDP (United Nations Development Programme) (2009) Resumé du profil, Pauvreté et conditions de vie des Ménages dans la province du Kasaï Orientale. United Nations.Google Scholar
Westoff, C. F. & Cross, A. R. (2006) The stall in the fertility transition in Kenya. DHS Analytical Studies No. 9. ORC Macro, Calverton, MD.Google Scholar
Wood, K. & Jewkes, R. (2006) Blood blockages and scolding nurses: barriers to adolescent contraceptive use in South Africa. Reproductive Health Matters 14(27), 109118.CrossRefGoogle ScholarPubMed
World Health Organization (2009) Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. Department of Health Statistics and Informatics, WHO, Geneva.Google Scholar
Zah, B. T. (2010) Variations socio-économiques de la fécondité en Côte d'Ivoire: quels groupes ont commencé à réguler leurs naissances? Cahiers québécois de démographie 39(1), 115143.Google Scholar