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ORIGINAL ARTICLE
Open Access

Where Women Access Contraception in 36 Low- and Middle-Income Countries and Why It Matters

Sarah E. K. Bradley and Tess Shiras
Global Health: Science and Practice June 2022, 10(3):e2100525; https://doi.org/10.9745/GHSP-D-21-00525
Sarah E. K. Bradley
aAbt Associates, Rockville, MD, USA.
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Tess Shiras
aAbt Associates, Rockville, MD, USA.
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  • For correspondence: tess_shiras@abtassoc.com
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  • FIGURE 1
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    FIGURE 1

    Sources of Contraception Among Modern Contraceptive Users, by Country

    Abbreviation: DRC, Democratic Republic of the Congo.

  • FIGURE 2
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    FIGURE 2

    Private Sector Sources of Contraception, by Country

    Abbreviation: FBO, faith-based organization; NGO, nongovernmental organization; DRC, Democratic Republic of the Congo.

  • FIGURE 3
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    FIGURE 3

    Sources for Contraception Among Adolescent Users (Ages 15–19 Years) in Selected Countries

    Abbreviation: DRC, Democratic Republic of the Congo.

  • FIGURE 4
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    FIGURE 4

    Percentage of Users in the Poorest and Wealthiest Quintiles Obtaining Contraception from Each Sector, by Country

    Abbreviation: DRC, Democratic Republic of the Congo.

  • FIGURE 5
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    FIGURE 5

    Percentagea of Modern Contraceptive Method Users in Each Country Group That Obtain Contraception From Each Source, by Country Modern Contraceptive Prevalence Rate and Gross National Income per Capita

    Abbreviations: GNI, gross national income; mCPR, modern contraceptive prevalence rate.

    a Percentages may not add up to 100 due to rounding.

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    TABLE 1.

    Classifications for Family Planning Sources

    Private clinicalPrivate hospitals, clinics, doctors, nurses, midwives, health centers, maternity homes, and other private medical
    Private pharmacy or drug shopPharmacy, drug shop, dispensary, and chemist
    Private shop or marketShop, market, bar, disco, vending machine, gas station, grocery store, guest house/hotel, warehouse, and other private
    NGO/FBOMission hospital, mission health center/clinic, church, mosque, religious institution, NGO health facility, NGO mobile clinics, and NGO CHW
    PublicAll public sources including hospitals, clinics, and CHWs
    OtherFriend, relative, partner, parent, traditional healer, traditional birth attendant, school, the respondent, and other
    • Abbreviations: CHW, community health worker; FBO, faith-based organization; NGO, nongovernmental organization.

    • View popup
    TABLE 2.

    Sources of Contraception Among Modern Contraceptive Users, by Region, Method, and Select Demographic Characteristicsa

    CategoryPrivate, %Public, %Other, %Total, %No.
    Geography
        All 36 countries63343100380,244
        Asia41562100287,646
        East and Southern Africa2671310052,415
        West and Central Africa3165410021,910
    Method
        Condom61281110044,322
        Pill5247110056,189
        Injectable2673110055,731
        Implant1386110018,850
        IUD2970110023,987
        Sterilization24743100180,311
    Marital status
        Married30682100338,010
        Unmarried4743910010,450
    Residence
        Urban45513100130,214
        Rural27702100250,030
    Socioeconomic status
        Poorest 20%2276210061,544
        Wealthiest 20%5046410083,892
    • Abbreviation: IUD, intrauterine device.

    • ↵a Pooled data from 36 Demographic and Health Surveys.

    • View popup
    TABLE 3.

    Private Sector Sources of Contraception Averaged Across All Countries, by Region, by Methoda

    CategoryPrivate Clinics, %Pharmacies and Drug Shops, %NGOs and FBOs, %Shops and Markets, %Total, %No. of Private Sector Contraceptive Users
    GeographyAll 36 countries36411211100109,020
    Asia384561010080,744
    East and Southern Africa3626211710013,295
    West and Central Africa25548121006,686
    MethodCondom55643410023,492
    Pill127251110032,203
    Injectable621918110016,372
    Implant6223511002,661
    IUD88111<11007,678
    Sterilization76<124010026,209
    • Abbreviations: FBO, faith-based organization; IUD, intrauterine device; NGO, nongovernmental organization.

    • ↵a Pooled data from 36 Demographic and Health Surveys.

    • View popup
    TABLE 4.

    Unadjusted Odds and Adjusted Odds of Using a Private Sector Source Compared With a Public Sector Source Among All Women Using Modern Contraceptiona

    OR95% CIP ValueaOR95% CIP Value
    N=365,202
    Contraceptive method (ref: sterilization)
        Pills7.487.14, 7.83<.0017.647.17, 8.15<.001
        Condoms15.1914.20, 16.25<.00110.649.85, 11.50<.001
        Injectables2.952.80, 3.11<.0012.332.15, 2.53<.001
        Implants0.730.67, 0.79<.0010.610.55, 0.68<.001
        IUDs2.422.29, 2.56<.0011.581.47, 1.70<.001
        Other modern10.617.76, 14.49<.0018.736.23, 12.22<.001
    Age, years (ref: 40–49)
        15–193.303.04, 3.59<.0012.031.81, 2.26<.001
        20–242.222.12, 2.32<.0011.481.40, 1.56<.001
        25–291.721.65, 1.79<.0011.361.29, 1.43<.001
        30–341.511.45, 1.57<.0011.271.22, 1.34<.001
        35–391.351.30, 1.39<.0011.211.16, 1.26<.001
    Never married (ref: ever married)2.902.67, 3.15<.0011.551.37, 1.74<.001
    Wealth quintile (ref: poorest)
        Poorer1.241.18, 1.31<.0011.281.21, 1.35<.001
        Middle1.431.36, 1.51<.0011.531.45, 1.63<.001
        Richer2.021.91, 2.13<.0012.142.01, 2.27<.001
        Richest3.863.64, 4.08<.0014.093.84, 4.37<.001
        Urban residence (ref: rural)2.272.18, 2.36<.0011.421.36, 1.48<.001
    • Abbreviation: aOR, adjusted odds ratio; CI, confidence interval; IUD, intrauterine device, OR, odds ratio.

    • ↵a Pooled data from 36 Demographic and Health Surveys. Data are pooled across the most recent survey in all countries analyzed. The adjusted model includes survey fixed effects.

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Global Health: Science and Practice: 10 (3)
Global Health: Science and Practice
Vol. 10, No. 3
June 29, 2022
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Where Women Access Contraception in 36 Low- and Middle-Income Countries and Why It Matters
Sarah E. K. Bradley, Tess Shiras
Global Health: Science and Practice Jun 2022, 10 (3) e2100525; DOI: 10.9745/GHSP-D-21-00525

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Where Women Access Contraception in 36 Low- and Middle-Income Countries and Why It Matters
Sarah E. K. Bradley, Tess Shiras
Global Health: Science and Practice Jun 2022, 10 (3) e2100525; DOI: 10.9745/GHSP-D-21-00525
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