What are the drivers of the change in modern contraceptive use among women in sub-Saharan Africa? A repeated cross-sectional multivariable Blinder-Oaxaca decomposition analysis
Abstract
Objective To identify the drivers of changes in modern contraceptive use (MCU) among women of reproductive age in three selected sub-Saharan African countries. Design This is a secondary analysis of cross-sectional Demographic and Health Survey (DHS) data using a multivariable Blinder-Oaxaca decomposition approach. Setting and participants The sample consisted of 73 777 women aged 15–49 years from the two most recent DHSs conducted in Gabon (2012, 2019–2021), Senegal (2018, 2023), and Tanzania (2015, 2022). Pregnant women were excluded from the sample. Main outcome measure We assessed the change in MCU over the two most recent DHS waves for the three countries. Results MCU declined in Gabon from 26.5% to 18.4%, in Senegal from 20.5% to 18.5% and in Tanzania from 29.7% to 27.6%. Across the three countries, the contributions of compositional changes to trends in MCU varied significantly. In Senegal, characteristics explained 181% of the change, driven by reduced exposure to family planning information (157%), high parity (147%) and employment (9%), while education, urbanisation, union type and lower parity mitigated the decline. In Gabon, the overall characteristics included led to an increase in MCU (−44%), rather than a decline, reflecting the effect of favourable changes toward higher education (−19%) and urban residence (−10%). However, the behavioural effect was predominant (144%). This suggests that modifications in individual attitudes, practices and preferences…
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