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Need and Use of FPA secondary analysis of the 2008 Nigeria DHS
Nigerian Urban Reproductive Health Initiative
• Goal: In 5 years, increase the contraceptive prevalence rate (CPR) by 20 percentage points in six selected cities in Nigeria
• Three approaches for increasing CPRa. Increase the proportion of women that want to
delay or limit childbearingb. Convert unmet need to met need for FPc. Reduce method discontinuation
Need for, and use of, FP among sexually active, non-menopausal women, 2008 NDHS
Urban Rural0
20
40
60
80
100
59.8
41.449
2325.6
10.610.53.7
Wants to delay or end childbearingEver used a modern FP methodCurrently using a modern FP methodCurrently using a modern FP method consistently for at least 2 years
% o
f sex
ually
acti
ve, n
on-
men
opau
sal w
omen
Conceptual Approach to Analysis
DISTAL FACTORS1. Poverty2. Cultural norms
PROXIMATE FACTORS1. Desired family size2. Female autonomy3. Gender preference4. Knowledge
OUTCOMES1. Need for FP2. Use of FP3. Duration of use of FP
EDUCATIONEXPOSURE TO FP MESSAGESQUALITY OF FP COUNSELING
Do proximate factors affect outcomes?
DISTAL FACTORS1. Poverty2. Cultural norms
PROXIMATE FACTORS1. Desired family size2. Female autonomy3. Gender Preference4. Knowledge
OUTCOMES1. Need for FP2. Use of FP3. Duration of use of FP
EDUCATIONEXPOSURE TO FP MESSAGESQUALITY OF FP COUNSELING
Percent of sexually active, non-menopausal urban women with a stated need for FP, by proximate factors
% with need to space
% with need to limit
N
IDEAL FAMILY SIZE4 or fewer children5 or more children
43.0***35.4
27.4***13.0
2,5954,018
FEMALE AUTONOMYParticipates in HH decisionsDoes not participate
48.8***33.5
18.4*14.0
4,0332,580
GENDER PREFERENCEWants same # of sons, daughtersWants more children of one sex
41.742.9
17.319.0
6,3733,733
KNOWLEDGEKnows at least 3 modern methodKnows fewer than 3 method
42.1***34.1
19.2***11.5
4,6511,962
Source: 2008 Nigeria DHSAdjusting for Age and ParityP-values: *p<0.05; **p<0.01; ***p<0.001
Percent of urban women with a need for FP currently using a modern FP method, by proximate factors
% of using a modern FP method
N
IDEAL FAMILY SIZE4 or fewer children5 or more children
47.6***37.1
1,7432,007
FEMALE AUTONOMYParticipates in HH decisionsDoes not participate
41.143.3
2,1421,608
GENDER PREFERENCEWants same # of sons, daughtersWants more children of one sex
41.845.4
2,2241,417
KNOWLEDGEKnows at least 3 modern methodKnows fewer than 3 method
45.9***29.8
2,854896
Source: 2008 Nigeria DHSAdjusting for Age and ParityP-values: *p<0.05; **p<0.01; ***p<0.001
Percent of urban women currently using a modern method for at least 2 years, by proximate factors
% of users using for at least 2 years
N
IDEAL FAMILY SIZE4 or fewer children5 or more children
41.040.2
868708
FEMALE AUTONOMYParticipates in HH decisionsDoes not participate
34.6**47.2
831745
GENDER PREFERENCEWants same # of sons, daughtersWants more children of one sex
40.941.3
623919
KNOWLEDGEKnows at least 3 modern methodKnows fewer than 3 method
39.944.1
1,303273
Source: 2008 Nigeria DHSAdjusting for Age and ParityP-values: *p<0.05; **p<0.01; ***p<0.001
Summary
• These analyses suggest which factors you may consider when seeking to increase contraceptive use among urban women in general.
• Both ideal family size and FP knowledge are important for both need for, and use of, FP
• HH decision-making may affect need for FP but does not appear to effect use.
• These analyses do not support the role of gender preference in FP decisions.
Do distal factors affect the outcomes through the proximate factors?
DISTAL FACTORS1. Poverty2. Cultural norms
PROXIMATE FACTORS1. Desired family size2. Female autonomy3. Gender preference4. Knowledge
OUTCOMES1. Need for FP2. Use of FP3. Duration of use of FP
EDUCATIONEXPOSURE TO FP MESSAGESQUALITY OF FP COUNSELING
Percent of urban women with favorable proximate factors, by wealth status
Low IFS***
Participate in HH Decisions***
No gender preference
High knowledge of methods***
0 1020304050607080
32.3
42.4
62.5
55.7
61.1
47.8
64.6
74.2
Upper two wealth quin-tilesLower three wealth quin-tiles
% of sexually active, non-menopausal urban women
Source: 2008 Nigeria DHSP-values: *p<0.05; **p<0.01; ***p<0.001
Percent of urban women with favorable proximate factors, by religion and region of residence
Low IFS***
High participation in HH decisions***
No gender preference***
High knowledge of methods***
0 20 40 60 80 100
56
47
59
68
52
43
65
64
57
52
68
77
15
39
71
50
North/MuslimSouth/MuslimNorth/Other religionSouth/Other religion
% of sexually active, non-menopausal urban women
Source: 2008 Nigeria DHSP-values: *p<0.05; **p<0.01; ***p<0.001
Direct and Indirect effects of Distal Factors on Need for FP
Wealth Status Religion Region
Total Effect -0.186* -0.237* -0.247*
Direct Effect -0.116* -0.186* -0.195*
Indirect Effect -0.070* -0.051* -0.052*
Ideal Family Size -0.050* -0.042* -0.041*
HH Decision-making 0.016* 0.021* 0.024*
Gender Preference 0.002 -0.005* -0.005*
Knowledge -0.038* -0.024* -0.030*
Proportion of total effect mediated 0.375 0.215 0.266
Source: 2008 Nigeria DHS* Significantly different from 0
Direct and Indirect effects of Distal Factors on Current use of a modern method
Wealth Status Religion Region
Total Effect -0.168* -0.167* -0.156*
Direct Effect -0.081* -0.105* -0.081*
Indirect Effect -0.087* -0.062* -0.074*
Ideal Family Size -0.028* -0.025* -0.023*
HH Decision-making -0.010* -0.004 -0.012*
Gender Preference 0.003* -0.006* -0.006*
Knowledge -0.052* -0.027* -0.034*
Proportion of total effect mediated 0.519 0.369 0.478
Source: 2008 Nigeria DHS* Significantly different from 0
Direct and Indirect effects of Distal Factors on use of a modern method for 2 or more years
Wealth Status Religion Region
Total Effect -0.097* -0.089* -0.031
Direct Effect -0.100* -0.080* -0.025
Indirect Effect 0.002 -0.009 -0.007
Ideal Family Size -0.005 -0.005 -0.005
HH Decision-making 0.010* -0.006* -0.001
Gender Preference 0.001 0.001 -0.001
Knowledge -0.003 0.002 -0.005
Proportion of total effect mediated 0.030 0.102 0.211
Source: 2008 Nigeria DHS* Significantly different from 0
Summary
• The analyses in this section suggest which factors you may consider when seeking to increase contraceptive use among wealth or cultural groupings.
• To increase need for FP among urban poor or muslim women in the North, focus on decreasing ideal family size
• To increase use of FP, among urban poor or muslim women in the North, focus on increasing knowledge of FP.
• However, many other factors exist that are unmeasured in these data.
• Wealth status and cultural norms do not have a strong effect on duration, once a woman adopts FP.
Does education and exposure moderate the effect of the distal factors on the proximate factors?
DISTAL FACTORS1. Poverty2. Cultural norms
PROXIMATE FACTORS1. Desired family size2. Female autonomy3. Son preference4. Knowledge
OUTCOMES1. Need for FP2. Use of FP3. Duration of use of FP
EDUCATIONEXPOSURE TO FP MESSAGESQUALITY OF FP COUNSELING
Percent of urban women with favorable proximate factors, by wealth status and exposure to FP messages
Low IFS
High participation in HH decisions*
No gender preference
High knowledge*
0 20 40 60 80 100
35
30
61
32
46
30
65
41
36
45
62
68
52
54
66
78
High wealth/exposedLow wealth/exposedHigh wealth/unexposedLow wealth/unexposed
% of sexually active, non-menopausal urban women
Source: 2008 Nigeria DHSP-values: *p<0.05; **p<0.01; ***p<0.001
Percent of urban women with favorable proximate factors, by religion and exposure to FP messages
Low IFS
High participation in household decisions***
No gender preference
High knowledge***
0 20 40 60 80
33
28
66
33
41
32
60
35
33
45
69
71
49
53
60
73
Other religion/exposedMuslim/exposedOther religion/unexposedMuslim/unexposed
Source: 2008 Nigeria DHSP-values: *p<0.05; **p<0.01; ***p<0.001
Percent of urban women with favorable proximate factors, by region and exposure to FP messages
Low IFS
High participation in HH decisions***
No gender preference
High knowledge***
0 10 20 30 40 50 60 70 80
37
30
66
35
49
30
58
33
34
44
68
70
49
54
60
74
South/exposedNorth/exposedSouth/unexposedNorth/unexposed
% of sexually active, non-menopausalurban women
Source: 2008 Nigeria DHSP-values: *p<0.05; **p<0.01; ***p<0.001
Summary
• The analyses in this section suggest that exposure to FP messages can have an effect on FP knowledge and possibly household decision-making.
• Given the importance of fertility preferences in the preceding analyses, it is important to learn whether prior messages sought to decrease ideal family size (and failed) or did not target this factor.
