Contributed equally to this work with: Anthony Mark Ochen, Che Chi Primus Roles Conceptualization, Formal analysis, Methodology, Writing – original draft, Writing – review & editing * E-mail: markochen@rocketmail.com Affiliation Department of Health Services, Alebtong District Local Government, Lira, Uganda
Contributed equally to this work with: Anthony Mark Ochen, Che Chi Primus Roles Methodology, Visualization, Writing – original draft, Writing – review & editing Affiliation KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya ⨯
Despite the government efforts to reduce the high fertility levels and increase the uptake of family planning services in Uganda, family planning use was still low at 30% in 2020 which was the lowest in the East African region. This study was undertaken to determine the prevalence and factors associated with the uptake of family planning methods among women of reproductive age in Uganda. This community-based cross-sectional study utilized secondary data from the Uganda Demographic and Health Survey (UDHS) of 2016. The survey data was downloaded from the Measure Demographic Health Survey website after data use permission was granted. Data was collected from a representative sample of women of the reproductive age group (15–49 years) from all 15 regions in Uganda. A total of 19,088 eligible women were interviewed but interviews were completed with 18,506 women. Data analysis was performed using SPSS statistical software version 32.0 where univariable, bivariable, and multivariable analyses were conducted. The prevalence of family planning use was found to be 29.3% and that of modern contraceptive use was found to be 26.6%. Multivariable analysis showed higher odds of current family planning use among older women (40–44 years) (aOR = 2.09, 95% CI: 1.40–3.12); women who had attained the secondary level of education (aOR = 1.91, 95% CI: 1.32–2.76); those living in households with the highest wealth index (aOR = 1.87, 95% CI: 1.29–2.72); and awareness of the availability of family planning methods (aOR = 1.41, 95% CI: 1.17–1.72). In conclusion, the study suggests improving women’s education attainment, socio-economic position, and awareness may help increase use in the population.
Citation: Ochen AM, Primus CC (2023) Family planning uptake and its associated factors among women of reproductive age in Uganda: An insight from the Uganda Demographic and Health Survey 2016. PLOS Glob Public Health 3(12): e0001102. https://doi.org/10.1371/journal.pgph.0001102
Editor: Claire E. von Mollendorf, Murdoch Children's Research Institute, AUSTRALIA
Received: August 29, 2022; Accepted: November 9, 2023; Published: December 6, 2023
Copyright: © 2023 Ochen, Primus. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: The dataset used is openly available upon permission from the MEASURE DHS website (URL. http://www.dhsprogram.com/data/available.datasets.cmf).
Funding: The authors received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Reducing the number of unplanned pregnancies can be achieved through better birth spacing, as children born less than two years before or after the birth of their siblings have been found to have a higher rate of mortality during their first five years of life [1]. In addition, it will lower the number of infants born at extremely high mortality risk because their mothers died during or soon after delivery. Uganda has one of the fastest-growing populations in the sub-Saharan Africa (SSA) region at a rate of 3.2% per annum [2]. It has a persistently high fertility rate of 5.4 children born per woman which is higher than the total wanted fertility rate of 4.3 [3]. The use of family planning (FP) among women increased from 23% in 2000 to 39% in 2016, however, the increase was most pronounced for the use of modern methods which rose from 18% in 2001 to 35% in 2016 [3]. The total population of Uganda was 34.6 million persons in 2014 representing an average annual growth rate of 3.0% between 2002 and 2014 [4]. Uganda aspires to become a middle-income Country by 2025, however, the country has only managed a decline in poverty levels from 24.3% in 2010 to 19.7% in 2015 [5]. The 2002 health financing strategy estimated that for the sector to be able to provide the Uganda National Minimum Health Care Package, USD 28 per capita expenditure would be required. However, for the Financial Year 2013/14, only USD 12.0 per capita (which includes donor projects and Global Health Initiatives) was available [6]. The Total Fertility rate in Uganda declined from 7.1 children per woman in 1991 to 5.8 children per woman in 2014 [4].
The Uganda Demographic and Health Survey (UDHS) 2016 estimates that the total demand for family planning in Uganda among women increased from 58% in 2000–01 to 67% in 2016, and the proportion of demand satisfied by modern methods increased from 18% to 35% over the same period. The unmet need has decreased slightly since 2000, from 35% to 28% in 2016 [3]. Despite these slight gains, there were still 336 maternal deaths per 100,000 live births and an infant mortality rate of 43 deaths per 1,000 live births [3]. This poses a great threat to the development and well-being of the Ugandan population as reflected in the high infant mortality rates and maternal mortality ratios. High birth rates not only affect maternal and child mortality but also frustrate governments’ efforts in the provision of social and health services to communities.
The World Health Organisation (WHO) refers to family planning (FP) as a process that allows people to attain their desired number of children and determine the spacing of pregnancies, which is achieved through the use of family planning methods and treatment of infertility [7]. Of the 1.9 billion women of reproductive age group (15–49 years) worldwide in 2019, 1.11 billion needed to space/cease future pregnancy; of these, 842 million used modern contraception, and 270 million had an unmet desire to space/cease future pregnancy [8]. The modern contraceptive prevalence among women of reproductive age increased worldwide between 2000 and 2019 by 2.1% from 55.0% to 57.1% [8]. Some of the sustained preferences for the large family size are a result of limited choice of methods; limited access to services particularly among young, poorer, and unmarried people; fear or experience of side effects; cultural or religious opposition; poor quality of available services; users and providers bias against some methods; and gender-based barriers to accessing services [8].
The United Nations (UN) estimates the total fertility rate (TFR) of the sub-Saharan Africa region at 4.7 births per woman in 2015–2020 which is more than twice the level of any other world region [9]. Consequentially, the population of sub-Saharan Africa is expected to grow from 1 billion in 2015 to about 2 billion in 2050 and nearly 4 billion in 2100 [9]. Therefore, family planning services are voluntary but access to the wide range of contraceptive methods for women to choose from may enhance their health prospects and have comprehensive benefits for their societies’ social and economic development. There are great benefits to investing in family planning including reduced maternal and neonatal mortality through decline in abortions and pregnancies [10]. For this reason, numerous scholars have pointed out that promoting voluntary access to a wide variety of contraceptive methods for women is an important component of countries’ strategies to advance social and economic development [11, 12]. This is well articulated in the Sustainable Development Goals (SDG) 3, target 3.7 calls on countries “by 2030, to ensure universal access to sexual and reproductive health-care services, including for FP, information and education, and the integration of reproductive health into national strategies and programs”; with specifically 3.7.1 which calls for universal access to FP services to ensure healthy lives and well-being [13].
Despite the government efforts to reduce high fertility levels and increase uptake of FP services in Uganda, the prevalence rate was only 30% in 2020 among married women which was the lowest in the East African region [14]. The known factors contributing to the low use of family planning methods are multi-factorial and include; limited accessibility to contraceptives, long distance to the health facility, few qualified health experts, fear of side effects, limited male involvement, religion or cultural beliefs, polygamous marriage, and lack of awareness [15–20]. Monitoring factors influencing the uptake of FP services is important to target scarce public resources to those with more need and enhance the progress towards achieving the global targets. Family Planning is central to gender equality and women’s empowerment and is a key driver of all 17 Sustainable Development Goals. Family planning saves lives, improves maternal and child health outcomes, and lifts families out of poverty by helping women have fewer children and freeing them to participate in the labor force [21]. Furthermore, family planning remains the low-cost, high-dividend investment option for addressing Uganda’s high Total Fertility Rate (TFR), high school drop-out rates as a result of teenage pregnancy, and high Maternal Mortality Ratio (MMR), as well as improving the health and welfare of women and girls including families [21]. Similarly, the 2020 Demographic Dividend Report demonstrates that investing in family planning will accelerate fertility decline; coupled with mortality decline, the ratio of working-age adults would significantly increase relative to young dependents, thus propelling Uganda towards a middle-income country [22] Thus far, a recent study that has been published in Uganda only focussed on factors associated with modern contraceptives among female adolescents [23]. Therefore, this study was undertaken to examine the prevalence and factors associated with the current family planning uptake among women of reproductive age in Uganda using the 2016 Uganda Demographic and Health Survey data.
The survey was approved by the Uganda National Council for Science and Technology (UNCST). Respondents were informed about the survey and informed consent was obtained from participants. The authors received the survey data from the USAID DHS program database after a request to download the dataset was granted. After data access was authorized, the authors of this study maintained the confidentiality of the dataset [24].
This study utilized secondary data from the Uganda Demographic and Health Survey (UDHS) 2016. The UDHS 2016 is a part of the global program implemented by the Uganda Bureau of Statistics (UBOS) in collaboration with the Ministry of Health (MoH). The funding for the UDHS 2016 was provided by the Government of Uganda, the United States Agency for International Development (USAID), the United Nations Children’s Fund (UNICEF), and the United Nations Population Fund (UNFPA). The DHS is undertaken every five years and the 2016 survey is the sixth DHS in Uganda, the first one was conducted in 1988.
To generate statistics that were representative of the country as a whole in the 15 regions, the number of women surveyed in each region contributed to the size of the total sample in proportion to the population size of each region. This is because some regions had small populations and others had large populations. The 15 regions of Uganda where the UDHS 2016 was implemented were; South-Central, North-Central, Kampala, Busoga, Bukedi, Bugisu, Teso, Karamoja, Lango, Acholi, West-Nile, Bunyoro, Tooro, Kigezi, and Ankole Regions ""Fig 1,""