Spatial variations and determinants of modern contraceptive use among postpartum women in Sub-Saharan Africa: analysis of recent DHS data (2015–2023)

Abstract

The low uptake of postpartum family planning contributes to around 80 million unplanned pregnancies globally each year. Despite the postpartum period being crucial for preventing unintended pregnancies, modern contraceptive use remains low in Sub-Saharan Africa, with notable regional differences. This study aims to assess the pooled prevalence of modern contraceptive use, its spatial variation, and associated factors among postpartum women in Sub-Saharan Africa, utilizing data from recent Demographic Health Surveys (2015-2023). A cross-sectional analysis was conducted using data from 27 Sub-Saharan African countries, encompassing a total weighted sample of 73,205 postpartum women. Global spatial autocorrelation was evaluated through Moran's I to identify clustering of low modern contraceptive use at the cluster level. Multilevel mixed-effect logistic regression was applied to identify factors associated with modern contraceptive use, reporting adjusted odds ratios (AOR) and 95% confidence intervals (CI). Geographically Weighted Regression (GWR) was employed to analyze spatially varying factors influencing contraceptive utilization. The pooled prevalence of modern contraception use was 25% (95% CI 20-30%), exhibiting significant spatial variation (Global Moran's I = 0.32, p < 0.001). Low utilization areas were identified in parts of Mauritania, Senegal, Mali, Côte d'Ivoire, Ghana, Nigeria, Chad, Angola, Mozambique, Madagascar, Uganda, and Kenya. Factors positively associated with modern contraception use included postnatal care, antenatal visits, facility delivery, education, marital status, employment, media exposure, and urban residency. Conversely, having five or more children and residing in West Africa were linked to lower odds of modern contraception use. Geographically weighted regression revealed significant regional disparities, particularly concerning no media exposure, home delivery, and being unemployed women. This study reveals significant spatial and contextual disparities in postpartum modern contraceptive use in Sub-Saharan Africa. Targeted health policies, improved service access, and community-based education are essential to enhance maternal health outcomes. Limitations include the focus on postpartum women in the extended postpartum period, which may affect generalizability.