A multilevel analysis of the factors associated with the use of different types of modern contraceptive methods: permanent methods, LARCs, MARCs, and SARCs, among married or in-union Nigerian women with a demand for family planning

Abstract

BACKGROUND: This study aimed to investigate the factors associated with the use of different modern contraceptives (MCs) by Nigerian married or in-union women of reproductive age with a demand for family planning (DFP). These MCs are permanent methods and long-acting reversible contraceptives (PLARCs), medium-acting reversible contraceptives (MARCs), and short-acting reversible contraceptives (SARCs). METHODS: An unweighted sample size of 9,983 women nested in a total of 1,118 communities was extracted from the 2024 Nigeria Demographic and Health Survey. A multilevel multivariable multinomial logistic regression analysis was carried out using Stata 17.0. Two levels of analysis were utilised: the individual and the community level, with the accompanying variables adjusted for. RESULTS: The DFP satisfied by modern methods (DFPSM) was approximately 33.9%, with the DFP satisfied by PLARCs, MARCs, and SARCs estimated as approximately 17.1%, 9.1%, and 7.8%, respectively. We found large remaining significant between-community variances in the odds of women satisfying their DFP with the different MCs. This was shown by the various estimated median odd ratios for the DFP satisfied by PLARCs, MARCs, and SARCs: approximately 3.870, 4.830, and 4.532, respectively. These remaining between-community variances were of greater relevance than the associated effects of most of the adjusted individual and household-level variables. This was with the exception of only the regression effects on DFP satisfied with MARCs of women in households with 1 to 2 dejure children at most 5 years old (aOR = 5.514, 95%CI = 2.226 to 13.658, p < 0.001); and those in households with no children at most 5 years old (aOR = 9.359, 95%CI = 3.656 to 23.954, p < 0.001). However, other variables that significantly increased the use of the different types of MCs by women with a DFP were their formal education level and women being usual residents of communities with high age at first marriage/cohabitation, low fertility clusters, and low polygyny clusters. CONCLUSION: To increase the very low DFPSM in Nigeria using different types of MCs, government policies/interventions aimed at improving the educational level of girls beyond the primary level should be implemented. A greater concentration should be within communities with low age at first marriage/cohabitation, high polygyny, and high fertility clusters.