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The changing nature of community level effects on contraceptive use over time in Sub-Saharan Africa: an analysis of 54 Demographic and Health Surveys

Nicholas Metheny, University of Miami
Rob Stephenson, University of Michigan

Rates of contraceptive use remain low across much of Sub-Saharan Africa (SSA). While individual determinants of contraceptive use are well known, less is understood about the role of community factors. Previous work has identified 15 relevant community norms, but these studies have all been conducted at single time points. Using data from 18 Sub-Saharan African countries at three time points (pre-2000, 2000-2010, and 2016-present), this analysis of 54 Demographic and Health Surveys will ascertain how the significance of these 15 community factors in shaping modern contraceptive use has changed over time. First, a three-level logistic regression model was fit for each time period, with women nested within primary sampling units (PSU-a proxy of community), PSU within country, and PSU as a random effect. A fourth model included all 54 datasets and introduced a country-time variable at level three to understand the significance of changes in community norms over time. Results suggest the waning importance of some norms, while others remain strongly associated with contraceptive use over time. As attention turns to FP2030, it is imperative to account for the ways in which community norms shift so that interventionists and policymakers can work toward universal access to family planning in SSA.

Keywords: Multi-level modeling, Family planning and contraception, Demographic and social surveys, Neighbourhood/contextual effect analysis

See extended abstract.

  Presented in Session 117. Global and Macro-level analysis of Contraceptive use Data