Determinants of Unmet Need for Contraception Among Married Women in Uganda

Abstract

The unmet need for family planning is defined as the proportion of married women or those living in consensual union of reproductive age, presumed to be sexually active but are not using any method and would like to postpone the next pregnancy or who do not want any more children. In Uganda, fertility remains high at 6.2 births per woman (UDHS, 2011) and is currently stalling. Contraceptive use is low and women have an unmet need for family planning. Drawing on a sample of 4,188 married women who had children in the last five years with emphasis on the last child from the 2011 Uganda Demographic and Health Survey data, the study seeks to examine the determinants of unmet need for contraception among currently married women of age 15-49 years old in Uganda. Age, number of living children, wealth index, educational attainment, region of residence and religion were the strong indicators for the likelihood of unmet need for contraception. Women’s age is very significant in determining both unmet need for spacing births (OR=0.694, p<0.01) and unmet need for limiting births (OR=1.437; p<0.01). Women with 0-2 children were 33% (p<0.01) less likely to have unmet need for spacing births compared to women with five or more children. Respondents who reported their last child to be alive were 1.6 times (p<0.05) as likely as respondents who reported their last child dead to have unmet need for spacing births. Wealth index was significant (p<0.01) in determining unmet need for spacing births particularly for the poorer, middle and the richest wealth categories. On the other hand, the odds of unmet need for limiting births were negatively related to wealth index. Respondents who did not complete secondary education (p<0.05) were the only significant category in the model with respect to educational attainment for unmet need for limiting births. Under-five child survival status, women’s autonomy, type of place of residence and knowledge of any contraceptive methods did not matter very much in determining unmet need for contraception among married women in Uganda. It is recommended, based on the findings, that contraceptive services should be packaged to suit all women of different categories giving priority to the most vulnerable. This means that, family planning programmes should target women who need the contraceptives most rather than providing contraceptives to all women irrespective of their level of susceptibility. In this regard, the most vulnerable should have more attention than women who are less vulnerable. There is also need for the government of Uganda to provide an employment fund in a bid to boost income generating activities to especially the unemployed currently married women. This will increase their disposable income which would make them afford, access and utilize modern family planning services. These strategies could aid in increasing contraceptive usage and consequently bringing down the high fertility levels in Uganda. In addition, it is important that the government through the Ministry of Health (MoH) subsidizes the available modern contraceptives to give chance to the economically disadvantaged women to access them. This could also increase coverage with all its associated benefits.