**3. Results**

inclusion in this category included being not having desire for additional child, not currently pregnant, not postpartum amenorrheic, not considered fecund, but not using a method of contraception. Women who are currently pregnant with an unwanted pregnancy and postpartum amenorrheic women whose last births in the last 2 years were unwanted are also included in the category); no unmet need (criteria for inclusion in this category included being infecund or being fecund but desire to have a child in the next 2 years); and unmet need for spacing (criteria for inclusion in this category included being not pregnant, not postpartum amenorrheic, not considered fecund, desire to delay the next birth by two or more years but not using any contraception. Women who currently had a mistimed pregnancy or postpartum women whose last birth in the last 2 years were mistimed are also included in this category). However, at the multivariable analysis level, both unmet need for spacing and unmet need for limiting are grouped as unmet need, which is the category of interest in the chapter.

Two sets of explanatory variables are analysed in the study. The first sets are individual characteristics, namely, healthcare decision, gender norms that justify men's control over women, partner education, marital status, fertility desire, child death and age at first marriage. A number of previous studies have linked some of these variables to unmet need for family planning [30–32, 36, 65, 66]. Healthcare decision was based on who had final say on women's health care decision. Gender norm that justify men's control over women was based on women's response to whether wife battery was justify given some circumstances such as when wife goes out without husband permission, argues with husband, refuses to have sex with husband, burns food, and neglects children. Women who accepted at least one of the norms were grouped as 'norm accepted', while women who rejected all the norms were grouped as 'norm not accepted'. The second sets of variables are community characteristics, namely, community wealth level (proportion of women in the richer or richest wealth quintile in the community), community literacy level (proportion of women who can read and write complete sentence), proportion of women who have ever used contraceptive method in the community and community childcare burden (proportion of high parous women in the community). The community characteristics were derived from individual characteristics aggregated at the cluster level, and divided into low, medium and high categories. Three variables, namely, pregnancy termination, visitation by family planning worker and exposure to family planning mass media messages are selected for statistical control. These variables may impact need for either spacing or limiting pregnancies. While visitation by family planning worker and exposure to family planning media messages may enhance contraceptive use by providing reliable information about contraceptive choice, pregnancy termination experience may give insight into levels of exposures to unhealthy reproductive practices due to either non-use

Statistical analyses were performed at three levels. One, frequency distribution, percentages and charts were used to described sample characteristics or prevalence of unmet need for family planning. Two, cross tabulations and unadjusted binary logistic regression coefficients were used to

**2.3. Explanatory and control variables**

98 Family Planning

of contraceptive or contraceptive failure.

**2.4. Data analyses**

#### **3.1. Sample characteristics and prevalence of unmet need for family planning**

**Figure 1** presents the prevalence of unmet need for family planning among the respondents. Unmet need for spacing was higher in the Gambia compared with Guinea and Nigeria, while unmet need for limiting was higher in Guinea compared with Nigeria and the Gambia. Overall, the prevalence of unmet need for family planning among urban women of advanced reproductive age was slightly more than one-fifth in Guinea (22.2%) and the Gambia (22.9%), but slightly more than one-tenth in Nigeria (12.6%). **Table 1** presents respondents' sociodemographic profile. In Guinea, women's healthcare decision was not only mostly taken by husband/others (68.4%), but also the proportion of joint decision with male partners was slightly less than one-fifth among respondents (19.8%). But in Nigeria and the Gambia, more than one-third of women's healthcare decisions were taken jointly with the male partner. However, decision by husband/others was dominant in Nigeria (48.9%), while joint decision was dominant in the Gambia (39.8%). Nearly all respondents in Nigeria and the Gambia did not accept gender norms that justify men's control over women. But in Guinea, one-third of the women (33.0%) accepted the norms. The majority of respondents' partners in Guinea and the Gambia had no formal education. But across the countries, while secondary education was the dominant educational level attained by respondents' partners, higher education was

**Figure 1.** Unmet need for family planning in selected urban Western Africa.

the least attained among the respondent husbands. In Guinea, the majority of respondents' partners desired more children than the women, but in Nigeria, the majority of respondents had the same desired fertility with their husbands, though a substantial proportion of respondents' partners want more children than the respondents. On the contrary, the majority of respondents in the Gambia were unsure about their fertility desire. The majority of respondents in the studied countries were currently married.

More than one-third of respondents in Guinea and Nigeria had experienced child death, but in the Gambia, the proportion was slightly higher than a quarter (27.4%). In the studied countries, high proportion of respondents had no exposure to mass media family planning messages in the last 12 months preceding the surveys. In all the countries, the majority of respondents were not visited by a family planning worker within the last 12 months preceding the surveys. In Guinea, more than half of respondents were 17 years or less at the time of their first marriage (52.7%). In the Gambia, nearly half of respondents were married before the age of 18 years (48.9%). However, across the countries, more than one-third became married within the range of 18–24 years. The proportion of respondents who had ever had a pregnancy termination was similar in the three countries, though with slightly higher proportion in the Gambia. In Guinea and Nigeria, the majority of women lived in communities with high wealth level, but in the Gambia, the majority lived in communities with average wealth level. Likewise, in Guinea and Nigeria, the majority of respondents lived in communities with low literacy level; while in the Gambia, the majority lived in communities with moderate literacy level. In Nigeria, slightly more than one-third of respondents (36.5%) lived in communities with high proportion of women who had ever used a contraceptive method, but this was not observed in Guinea and the Gambia. In Guinea, nearly half of the women (49.5%) lived in communities with low childcare burden, but in Nigeria and the Gambia, more than one-third of respondents lived in communities with high childcare burden.

**Characteristics**

**Country**

**Guinea** **Frequency (%)**

**Healthcare decision**

Woman alone

Jointly Husband/others

547 (68.4) **Gender norms justifying men's control over women**

Norm accepted

Norm not accepted

**Partner education**

None Primary Secondary

Higher **Fertility desire**

Both want same

Husband want more

Husband want fewer

Don't know **Marital status**

Not currently married

Currently married

685 (85.6)

4230 (85.8)

1073 (85.6)

Low

115 (14.4)

698 (14.2)

180 (14.4)

160 (20.0) 187 (23.4)

732 (14.9)

436 (34.8)

Medium

High

1020 (20.7)

225 (18.0)

Low

281 (35.2) 247 (30.8) 272 (34.0) **Proportion ever used contraceptive in community\*\*\***

301 (37.6)

1810 (36.7)

474 (37.8)

101

1564 (31.7)

248 (19.8)

http://dx.doi.org/10.5772/intechopen.72896

1643 (33.5)

558 (44.5)

1721 (34.9)

447 (35.7)

304 (38.0)

1490 (30.2)

382 (30.4)

**Community literacy level\*\***

149 (18.6)

1686 (34.2)

210 (16.8)

High

418 (52.3)

78 (9.7) 169 (21.2) 135 (16.8)

1084 (22.0)

160 (12.8)

Low Medium

187 (23.4) 265 (33.2) 348 (43.4)

1773 (36.0)

235 (18.0)

1614 (22.7)

585 (46.7)

Drivers of Unmet Need for Family Planning among Women of Advanced Reproductive Age…

1541 (31.3)

433 (34.5)

1518 (30.8)

291 (23.2)

1142 (23.2)

55 (4.4)

1184 (24.0)

747 (59.6)

Never experienced

Ever experienced

**Community wealth level\***

148 (18.5)

924 (18.7)

270 (21.5)

652 (81.5)

4004 (81.3)

983 (78.5)

536 (67.0)

4691 (95.2)

1233 (98.4)

25 or older **Pregnancy termination**

264 (33.0)

237 (4.8)

20 (1.6)

18-24

2411 (48.9)

389 (31.0)

**Age at first marriage (years)**

17 or less

422 (52.7) 294 (36.8)

84 (10.5)

993 (20.1)

146 (11.7)

1975 (40.1)

494 (39.4)

1960 (39.8)

613 (48.9)

95 (11.8) 158 (19.8)

1957 (39.7)

498 (39.8)

Visited

560 (11.4)

366 (29.2)

Not visited

768 (96.0)

32 (4.0)

702 (14.3)

48 (3.8)

4226 (85.7)

1205 (96.2)

**Frequency (%)**

**Frequency (%)**

**Nigeria**

**The Gambia**

**Characteristics**

**Country**

**Guinea** **Frequency (%)**

**Visitation by family planning worker**

**Frequency (%)**

**Frequency (%)**

**Nigeria**

**The Gambia**


the least attained among the respondent husbands. In Guinea, the majority of respondents' partners desired more children than the women, but in Nigeria, the majority of respondents had the same desired fertility with their husbands, though a substantial proportion of respondents' partners want more children than the respondents. On the contrary, the majority of respondents in the Gambia were unsure about their fertility desire. The majority of respon-

More than one-third of respondents in Guinea and Nigeria had experienced child death, but in the Gambia, the proportion was slightly higher than a quarter (27.4%). In the studied countries, high proportion of respondents had no exposure to mass media family planning messages in the last 12 months preceding the surveys. In all the countries, the majority of respondents were not visited by a family planning worker within the last 12 months preceding the surveys. In Guinea, more than half of respondents were 17 years or less at the time of their first marriage (52.7%). In the Gambia, nearly half of respondents were married before the age of 18 years (48.9%). However, across the countries, more than one-third became married within the range of 18–24 years. The proportion of respondents who had ever had a pregnancy termination was similar in the three countries, though with slightly higher proportion in the Gambia. In Guinea and Nigeria, the majority of women lived in communities with high wealth level, but in the Gambia, the majority lived in communities with average wealth level. Likewise, in Guinea and Nigeria, the majority of respondents lived in communities with low literacy level; while in the Gambia, the majority lived in communities with moderate literacy level. In Nigeria, slightly more than one-third of respondents (36.5%) lived in communities with high proportion of women who had ever used a contraceptive method, but this was not observed in Guinea and the Gambia. In Guinea, nearly half of the women (49.5%) lived in communities with low childcare burden, but in Nigeria and the Gambia, more than one-third

dents in the studied countries were currently married.

**Figure 1.** Unmet need for family planning in selected urban Western Africa.

100 Family Planning

of respondents lived in communities with high childcare burden.


\*\*Proportion of women who can read or write complete sentence in community. \*\*\*Proportion of women who had ever used a contraceptive method in community.

\*\*\*\*Proportion of high parous women in community.

**Table 1.** Socio-demographic characteristics of respondents, Guinea, Nigeria and the Gambia. **3.2. Bivariable results**

**Table 2** presents the bivariate relationships between the research variables. Healthcare deci

sion and unmet need for family planning were negatively associated in Guinea and Nigeria, but in the Gambia, a mixed association was observed. However, in the studied countries, women who did not participate in the decision had the lowest proportion of unmet need for family planning, while in Guinea and Nigeria, women who had sole participation in the decision had higher prevalence of unmet need for family planning. On the contrary, in the Gambia, women who jointly participated in the decision with their husbands had higher level of unmet need for family planning. In all the three countries, gender norms that justify men's control over women were negatively associated with unmet need for family planning. For instance, in the Gambia, the prevalence of unmet need for family planning was 22.5% among women who did not accept the norms compared with 45.6% prevalence among women who accepted the gender norms. The association between partners' education and unmet need for family planning were mixed in Guinea and Nigeria, but positive in the Gambia. In Guinea and Nigeria, the prevalence of unmet need for family planning decline as education improved from none to primary, and thereafter increased when education improved to secondary. However, at higher education, the prevalence reduced compared to the prevalence at second

Drivers of Unmet Need for Family Planning among Women of Advanced Reproductive Age…

http://dx.doi.org/10.5772/intechopen.72896

ary education. In the Gambia, the observed prevalence by variation in the educational level was inconsistent. Across the countries, marital status relates positively with unmet need for family planning, though the proportion of women who are not currently married was rather negligible in the sample which may have occasioned the observed association. Though, fertil

ity desire had mixed relationship with unmet need for family planning across the countries, but in all the countries, while it was positively related with unmet need for family planning among women whose husbands wanted more children, it showed negative association with unmet need for family planning among women whose husbands wanted fewer children.

Child death and unmet need for family planning are negatively associated in the studied countries. In all the selected countries, women who had ever experienced death of a child had lower prevalence of unmet need for family planning. For instance, in Guinea, the preva

lence of unmet need for family planning among women who had experienced child death was 21.0% compared with 24.3% among women who had ever experienced death of a child. Likewise, in the Gambia, while women who had ever experienced child death had a preva

lence of 26.2% unmet need for family planning, women who had never experienced child death had a prevalence of 21.7% unmet need for family planning. In all the countries, age at first marriage and unmet need for family planning had mixed relationships. But while women whose first marriage occurred at 25 years or older years had lowest prevalence of unmet need in Guinea and Nigeria, there were no difference in the prevalence among women whose first marriage occurred at 18–24 years or older groups in the Gambia. Except in Nigeria, com

munity wealth level and unmet need for family planning are negatively associated, but in all the countries, unmet need was lower in communities with high wealth level compared with women in communities with low wealth level. Except in the Gambia, community literacy level and unmet need for family planning are negatively associated with lower unmet need in communities with high literacy level compared with communities with low literacy level. Except in Nigeria, community childcare burden was negatively associated with unmet need


103






#### **3.2. Bivariable results**

**Characteristics**

**Country**

**Guinea** **Frequency (%)**

**Child death** Ever experienced

Never experienced

**Exposure to mass media family planning messages**

No exposure

Radio Television Newspaper **Total (Sample Size)**

**800 (100.0)** Survey 2013.\*Proportion of women in richer or richest wealth groups in community.

\*\*Proportion of women who can read or write complete sentence in community.

\*\*\*Proportion of women who had ever used a contraceptive method in community.

\*\*\*\*Proportion of high parous women in community.

**Table 1.**

Socio-demographic characteristics of respondents, Guinea, Nigeria and the Gambia.

**4928 (100.0)**

**1253 (100.0)**

**Total (Sample Size)**

Source: Author analysis based on Guinea Demographic and Health Survey 2012, Nigeria Demographic and Health Survey 2013 and the Gambia Demographic and Health

**800 (100.0)**

**4928 (100.0)**

**1253 (100.0)**

456 (57.0) 125 (15.6) 185 (23.2)

34 (4.2)

644 (13.1)

60 (4.8)

1231 (25.0)

400 (31.9)

948 (19.2)

174 (13.9)

High

510 (63.8)

3126 (63.4)

2105 (42.7)

619 (49.4)

Medium

910 (72.6)

**Community childcare burden\*\*\*\***

Low

396 (49.5) 191 (23.9) 213 (26.6)

1692 (34.3)

450 (35.9)

1378 (28.0)

413 (32.9)

1858 (37.7)

390 (31.2)

290 (36.2)

1802 (36.6)

343 (27.4)

High

**Frequency (%)**

**Frequency (%)**

Medium

**Nigeria**

**The Gambia**

**Characteristics**

**Country**

**Guinea** **Frequency (%)**

282 (35.2) 217 (27.2)

1799 (36.5)

265 (21.0)

1319 (26.8)

514 (41.0)

**Frequency (%)**

**Frequency (%)**

**Nigeria**

**The Gambia**

102 Family Planning

**Table 2** presents the bivariate relationships between the research variables. Healthcare decision and unmet need for family planning were negatively associated in Guinea and Nigeria, but in the Gambia, a mixed association was observed. However, in the studied countries, women who did not participate in the decision had the lowest proportion of unmet need for family planning, while in Guinea and Nigeria, women who had sole participation in the decision had higher prevalence of unmet need for family planning. On the contrary, in the Gambia, women who jointly participated in the decision with their husbands had higher level of unmet need for family planning. In all the three countries, gender norms that justify men's control over women were negatively associated with unmet need for family planning. For instance, in the Gambia, the prevalence of unmet need for family planning was 22.5% among women who did not accept the norms compared with 45.6% prevalence among women who accepted the gender norms. The association between partners' education and unmet need for family planning were mixed in Guinea and Nigeria, but positive in the Gambia. In Guinea and Nigeria, the prevalence of unmet need for family planning decline as education improved from none to primary, and thereafter increased when education improved to secondary. However, at higher education, the prevalence reduced compared to the prevalence at secondary education. In the Gambia, the observed prevalence by variation in the educational level was inconsistent. Across the countries, marital status relates positively with unmet need for family planning, though the proportion of women who are not currently married was rather negligible in the sample which may have occasioned the observed association. Though, fertility desire had mixed relationship with unmet need for family planning across the countries, but in all the countries, while it was positively related with unmet need for family planning among women whose husbands wanted more children, it showed negative association with unmet need for family planning among women whose husbands wanted fewer children.

Child death and unmet need for family planning are negatively associated in the studied countries. In all the selected countries, women who had ever experienced death of a child had lower prevalence of unmet need for family planning. For instance, in Guinea, the prevalence of unmet need for family planning among women who had experienced child death was 21.0% compared with 24.3% among women who had ever experienced death of a child. Likewise, in the Gambia, while women who had ever experienced child death had a prevalence of 26.2% unmet need for family planning, women who had never experienced child death had a prevalence of 21.7% unmet need for family planning. In all the countries, age at first marriage and unmet need for family planning had mixed relationships. But while women whose first marriage occurred at 25 years or older years had lowest prevalence of unmet need in Guinea and Nigeria, there were no difference in the prevalence among women whose first marriage occurred at 18–24 years or older groups in the Gambia. Except in Nigeria, community wealth level and unmet need for family planning are negatively associated, but in all the countries, unmet need was lower in communities with high wealth level compared with women in communities with low wealth level. Except in the Gambia, community literacy level and unmet need for family planning are negatively associated with lower unmet need in communities with high literacy level compared with communities with low literacy level. Except in Nigeria, community childcare burden was negatively associated with unmet need


for family planning. Across the countries, communities with low childcare burden had the lowest levels of unmet need compared with the prevalence in other communities. In Guinea and Nigeria, communities with low proportion of ever users of contraceptive method had higher prevalence of unmet need for family planning, while in the Gambia communities with

**Table 2.** Association between individual/community characteristics and unmet need for family planning among urban

**Table 3** presents the fixed effects of the multilevel logistic regression. In Model 1 which included only the individual characteristics, all the explanatory variables had varying significant effects on the likelihood of unmet need for family planning in Nigeria and the Gambia, but in Guinea, age at first marriage had no significant influence on unmet need for family planning. The inclusion of the community characteristics in Model 2 reduced the effect of some of the individual characteristics. In all the countries studied, health care decision and age at first marriage did not reveal significant effect on unmet need for family planning, while gender norms, education, marital status, fertility desire and child death were significant individual characteristics. However, in the Gambia, partner education did not significantly impact unmet need for family planning. All the four community characteristics

high proportion of ever users had higher level of unmet contraceptive need.

**Characteristics Guinea Nigeria The Gambia**

Low ref 25.5 — 15.3 — 22.8 — Medium 24.5 −0.055 13.4 −0.161 21.7 −0.065 High 16.7 −0.539\*\* 8.9 −0.624\* 25.7 0.158

Low ref 23.9 — 14.4 — 22.4 — Medium 19.3 −0.276 13.2 −0.161 20.8 −0.097 High 23.5 −0.027 10.5 −0.624\* 27.9 0.288

Low ref 19.5 — 9.3 — 17.1 — Medium 23.2 0.221 13.4 −0.099 25.6 0.513\*\* High 26.2 0.379 15.6 −0.364\*\* 25.4 0.503\*\*

**Coefficient % of** 

**unmet need**

Drivers of Unmet Need for Family Planning among Women of Advanced Reproductive Age…

**Coefficient % of** 

**unmet need**

http://dx.doi.org/10.5772/intechopen.72896

**Coefficient**

105

**% of unmet need**

**3.3. Multivariable results**

**Community literacy level**

**Community childcare burden**

**Notes:** ref. (reference category)

women of advanced reproductive age.

\*p < 0.01 \*\*p < 0.05.

**Proportion ever used contraceptive in community**


**Table 2.** Association between individual/community characteristics and unmet need for family planning among urban women of advanced reproductive age.

for family planning. Across the countries, communities with low childcare burden had the lowest levels of unmet need compared with the prevalence in other communities. In Guinea and Nigeria, communities with low proportion of ever users of contraceptive method had higher prevalence of unmet need for family planning, while in the Gambia communities with high proportion of ever users had higher level of unmet contraceptive need.

#### **3.3. Multivariable results**

**Characteristics Guinea Nigeria The Gambia**

Woman alone ref 40.3 — 16.5 — 24.5 — Jointly 22.2 −0.865\*\* 12.9 −0.288 29.0 0.232 Husband/others 19.0 −1.065\*\* 11.5 −0.0425\*\* 13.7 −0.716\*\*

Norm accepted ref 22.4 — 18.4 — 45.6 — Norm not accepted 22.0 −0.021 12.3 −0.474\*\* 22.5 −1.057

None ref 22.4 — 12.8 — 22.6 — Primary 21.8 −0.032 12.4 −0.039 23.2 0.035 Secondary 29.2 0.360 13.4 0.053 23.9 0.075 Higher 12.9 −0.660\*\* 11.5 −0.118 22.7 0.007

Not currently married ref 1.2 — 1.2 — 1.0 — Currently married 25.7 3.319\* 14.5 2.680\* 26.6 3.567\*

Both want same 17.5 — 13.5 — 20.2 — Husband want more 26.4 0.524 14.2 0.062 24.4 0.240 Husband want fewer 9.2 −0.740 3.6 −1.413\* 3.0 −2.110\* Do not know 30.1 0.706\*\* 20.1 0.478\*\* 33.2 0.675\*\*

Ever experienced ref 24.3 — 15.2 — 26.2 — Never experienced 21.0 −0.191 11.1 −0.358\* 21.7 −0.250

17 or less ref 22.1 — 13.2 — 23.4 — 18-24 24.3 0.119 14.2 0.084 21.7 −0.096 25 or older 15.1 −0.469 8.3 −0.526\* 24.7 0.072

Low ref 24.9 — 13.8 — 26.2 — Medium 20.4 −0.255 15.3 0.116 20.6 −0.311 High 22.0 −0.162 9.2 −0.466\*\* 22.6 −0.197

**Coefficient % of** 

**unmet need**

**Coefficient % of** 

**unmet need**

**Coefficient**

**% of unmet need**

**Gender norms justifying men's control over women**

**Healthcare decision**

104 Family Planning

**Partner education**

**Marital status**

**Fertility desire**

**Child death**

**Age at first marriage (years)**

**Community wealth level**

**Table 3** presents the fixed effects of the multilevel logistic regression. In Model 1 which included only the individual characteristics, all the explanatory variables had varying significant effects on the likelihood of unmet need for family planning in Nigeria and the Gambia, but in Guinea, age at first marriage had no significant influence on unmet need for family planning. The inclusion of the community characteristics in Model 2 reduced the effect of some of the individual characteristics. In all the countries studied, health care decision and age at first marriage did not reveal significant effect on unmet need for family planning, while gender norms, education, marital status, fertility desire and child death were significant individual characteristics. However, in the Gambia, partner education did not significantly impact unmet need for family planning. All the four community characteristics


**Characteristic predicting unmet need for family** 

**Model 1**

**Guinea**

**Odds** 

**Odds** 

**Odds ratio**

**Odds** 

**Odds** 

**Odds ratio**

**Odds** 

**Odds** 

**Odds ratio**

**ratio**

**ratio**

**ratio**

**ratio**

**ratio**

**Child death**

Ever experienced ref

Never experienced

**Age at first marriage (years)**

17 or less ref

18-24 25 or older **Community wealth level**

Low ref Medium

High **Community literacy level**

Low ref Medium

High **Proportion ever used contraceptive in community**

Low ref Medium

High **Community childcare burden**

Low ref

—

0.968\*\*

—

1.089 0.578

0.543\*

0.752\*\*

0.566

—

1.278 0.638\*

—

1.067 0.611\*\*

—

0.923 1.248\*\*

—

—

—

—

—

—

107

0.809\*

1.156\*\*

1.300

0.791

1.213

1.041

1.058

0.988

1.023

1.092

—

—

—

—

—

http://dx.doi.org/10.5772/intechopen.72896

0.892\*

0.976\*

0.681\*\*

0.870\*

0.922\*\*

1.116

0.898

1.319\*\*

1.091

1.056

—

—

—

—

—

0.956\*

0.976\*

0.348\*\*

0.952\*

0.609\*

Drivers of Unmet Need for Family Planning among Women of Advanced Reproductive Age…

1.242

1.070

1.063

1.249

1.131

—

—

—

—

—

0.615

0.677

1.239\*\*

0.605\*\*

0.568\*\*

1.008

0.938

1.091

1.072

0.931

1.062

1.063

0.905

—

—

—

—

—

—

—

—

0.803\*\*

0.707\*\*

0.687\*

0.844\*

0.756\*

0.861\*\*

0.842\*\*

0.732\*\*

—

—

—

—

—

—

—

—

**ratio**

**Nigeria**

**The** 

**Guinea**

**Nigeria**

**The** 

**Guinea**

**Nigeria**

**The Gambia**

**Gambia**

**Gambia**

**Model 2**

**Model 3**

**planning**


**Characteristic predicting unmet need for family** 

**Model 1**

**Guinea**

**Odds** 

**Odds** 

**Odds ratio**

**Odds** 

**Odds** 

**Odds ratio**

**Odds** 

**Odds** 

**Odds ratio**

**ratio**

**ratio**

**ratio**

**ratio**

**ratio**

—

0.620\*\*

0.345\*

0.323\*

0.910\*\*

0.608

1.016

0.900

0.599

0.811

0.899

0.535\*\*

1.098

0.707

0.971

1.078

0.714

0.962

1.027

—

—

—

—

—

—

—

—

**Healthcare decision**

Woman alone ref

Jointly Husband/others

**Gender norms justifying men's control over women**

Norm accepted ref

Norm not accepted

**Partner education**

None ref

Primary Secondary

Higher **Marital status**

Not currently married ref

Currently married

**Fertility desire**

Both want same

Husband want more

Husband want fewer

Do not know

—

1.412\* 0.759\* 1.804\*

1.548\*\*

2.304\*\*

1.942\*\*

1.543\*\*

2.481\*

1.792\*\*

1.560\*\*

2.542\*\*

0.596\*\*

0.744\*\*

0.888

0.619\*\*

0.773\*

0.467\*

0.625\*\*

0.755\*\*

1.073

1.483

1.537

1.011

1.538\*

1.836\*

1.023

1.503

—

—

—

—

—

—

—

—

—

3.066\*

2.260\*\*

2.416\*\*

3.221\*

2.149\*\*

2.188\*

3.041\*\*

2.092\*

2.308\*

—

—

—

—

—

—

—

—

—

0.479\*\*

—

0.626 1.036 0.486\*\*

0.496\*\*

0.831\*\*

0.461\*\*

1.185

1.272

0.421\*\*

0.539\*

0.590\*\*

0.543\*\*

1.262

1.052

1.219

1.259

1.007

1.193

1.280

0.687

1.091

0.568

0.874

1.245

0.597

0.868

1.247

—

—

—

—

—

—

—

—

0.616\*\*

0.582\*\*

0.942\*

0.452\*\*

0.569\*

0.862\*\*

0.698\*

0.542\*\*

—

—

—

—

—

—

—

—

**ratio**

**Nigeria**

**The** 

**Guinea**

**Nigeria**

**The** 

**Guinea**

**Nigeria**

**The Gambia**

106 Family Planning

**Gambia**

**Gambia**

**Model 2**

**Model 3**

**planning**

#### Drivers of Unmet Need for Family Planning among Women of Advanced Reproductive Age… http://dx.doi.org/10.5772/intechopen.72896

107


**Table 3.**Odds ratios showing fixed effects of multilevel logistic regression. analysed showed significant effects on the likelihood of unmet need for family planning across the studied countries. For instance, in all the countries, the likelihood of unmet need for family planning reduced significantly in communities with high wealth level compared with communities with low wealth level. Likewise, the likelihood of unmet need for fam

Drivers of Unmet Need for Family Planning among Women of Advanced Reproductive Age…

ily planning reduced significantly in communities with high literacy level compared with communities with low literacy level. Also, the likelihood of unmet need for family planning increased significantly in communities with high childcare burden compared with commu

nities with low childcare burden. In the full model (Model 3), healthcare decision was the only individual characteristic with no significant effect on the odds of unmet need for family planning. Across the countries, women who did not accept gender norms that justified men's control over women, were 13.8, 30.2 and 45.8% less likely to have unmet contraceptive need, respectively, in Guinea, Nigeria and the Gambia. Partner education revealed a significant effect only when educational level reaches higher education. For instance, in Guinea, women whose partner attained higher education were 57.9% less likely to have unmet contracep

all the countries, currently married women were more likely to have unmet contraceptive need, though this may relate more with the dominance of currently married women in all

Though, with a slight variation in Guinea, fertility desire significantly affected the likelihood of unmet need for family planning. But in all the selected countries, the likelihood of unmet need for family planning reduces among women whose husbands wanted fewer children compared with other women. For instance, in Nigeria, women whose husbands wanted fewer children were 37.5% less likely to have unmet contraceptive need compared with women in

enced child death were less likely to have unmet contraceptive need. Age at first marriage had mixed effects across the countries. In Guinea, women who were 25 years or older at their first

in Nigeria and the Gambia, this group of women were less likely to have unmet contraceptive need. Three of the community characteristics had significant effect on the likelihood of unmet need for family planning. In the three countries, women in communities with high wealth level had less likelihood of unmet need for family planning. For instance, in Guinea, women in communities with high wealth level were 65.2% less likely to have unmet contraceptive

in communities with high literacy level were also less likely to have unmet contraceptive need in all the countries studied. For instance, in Nigeria, women in communities with high literacy level were 13.0% less likely to have unmet contraceptive need compared with women

in communities with high childcare burden had higher likelihood of unmet contraceptive

women in communities with high childcare burden were nearly twice more likely to have unmet need for family planning compared with women in communities with low childcare

= 1.870; p

= 0.870; p

< 0.05). Likewise, in the Gambia, women in communities with high wealth

< 0.05) and the Gambia (OR

education were 41.0% less likely to have unmet contraceptive need (OR

= 0.625; p

marriage were 23.9% more likely to have unmet contraceptive need (OR

level were 39.1% less likely to have unmet contraceptive need (OR

< 0.05). Also in the Gambia, women whose partner attained higher

< 0.05). In all the countries, women who had never experi

tive need (OR

the studied countries.

the reference category (OR

= 0.348; p

in communities with low literacy level (OR

need. For instance, in Guinea (OR

need (OR

= 0.421; p


109




< 0.05), but

< 0.01). Women

< 0.05),

< 0.05). In

= 0.590; p

http://dx.doi.org/10.5772/intechopen.72896

= 1.239; p

= 0.609; p

< 0.01). Across the countries, women

= 1.843; p

analysed showed significant effects on the likelihood of unmet need for family planning across the studied countries. For instance, in all the countries, the likelihood of unmet need for family planning reduced significantly in communities with high wealth level compared with communities with low wealth level. Likewise, the likelihood of unmet need for family planning reduced significantly in communities with high literacy level compared with communities with low literacy level. Also, the likelihood of unmet need for family planning increased significantly in communities with high childcare burden compared with communities with low childcare burden. In the full model (Model 3), healthcare decision was the only individual characteristic with no significant effect on the odds of unmet need for family planning. Across the countries, women who did not accept gender norms that justified men's control over women, were 13.8, 30.2 and 45.8% less likely to have unmet contraceptive need, respectively, in Guinea, Nigeria and the Gambia. Partner education revealed a significant effect only when educational level reaches higher education. For instance, in Guinea, women whose partner attained higher education were 57.9% less likely to have unmet contraceptive need (OR = 0.421; p < 0.05). Also in the Gambia, women whose partner attained higher education were 41.0% less likely to have unmet contraceptive need (OR = 0.590; p < 0.05). In all the countries, currently married women were more likely to have unmet contraceptive need, though this may relate more with the dominance of currently married women in all the studied countries.

Though, with a slight variation in Guinea, fertility desire significantly affected the likelihood of unmet need for family planning. But in all the selected countries, the likelihood of unmet need for family planning reduces among women whose husbands wanted fewer children compared with other women. For instance, in Nigeria, women whose husbands wanted fewer children were 37.5% less likely to have unmet contraceptive need compared with women in the reference category (OR = 0.625; p < 0.05). In all the countries, women who had never experienced child death were less likely to have unmet contraceptive need. Age at first marriage had mixed effects across the countries. In Guinea, women who were 25 years or older at their first marriage were 23.9% more likely to have unmet contraceptive need (OR = 1.239; p < 0.05), but in Nigeria and the Gambia, this group of women were less likely to have unmet contraceptive need. Three of the community characteristics had significant effect on the likelihood of unmet need for family planning. In the three countries, women in communities with high wealth level had less likelihood of unmet need for family planning. For instance, in Guinea, women in communities with high wealth level were 65.2% less likely to have unmet contraceptive need (OR = 0.348; p < 0.05). Likewise, in the Gambia, women in communities with high wealth level were 39.1% less likely to have unmet contraceptive need (OR = 0.609; p < 0.01). Women in communities with high literacy level were also less likely to have unmet contraceptive need in all the countries studied. For instance, in Nigeria, women in communities with high literacy level were 13.0% less likely to have unmet contraceptive need compared with women in communities with low literacy level (OR = 0.870; p < 0.01). Across the countries, women in communities with high childcare burden had higher likelihood of unmet contraceptive need. For instance, in Guinea (OR = 1.870; p < 0.05) and the Gambia (OR = 1.843; p < 0.05), women in communities with high childcare burden were nearly twice more likely to have unmet need for family planning compared with women in communities with low childcare

**Characteristic predicting unmet need for family** 

**Model 1**

**Guinea**

**Odds** 

**Odds** 

**Odds ratio**

**Odds** 

**Odds** 

**Odds ratio**

**Odds** 

**Odds** 

**Odds ratio**

**ratio**

**ratio**

**ratio**

1.144 1.854\*

1.463\*\*

1.881\*\*

1.870\*\*

—

0.583

—

2.044

—

1.365 1.079 0.840\*\*

0.989\*

0.755\*\*

1.604

1.351

1.039

1.546

—

—

1.065

0.908

—

—

1.034

0.904

—

—

1.472\*\*

1.843\*\*

1.081

2.079\*\*

1.181

1.088

2.086\*\*

**ratio**

**ratio**

Medium

High **Pregnancy termination**

Never experienced ref

Ever experienced

**Visitation by family planning worker**

Not visited ref

Visited **Exposure to mass media family planning messages**

No exposure

Radio Television Newspaper **Notes:** ref. (reference category)

\*p < 0.01

\*\*p < 0.05.

**Table 3.**

Odds ratios showing fixed effects of multilevel logistic regression.

**ratio**

**Nigeria**

**The** 

**Guinea**

**Nigeria**

**The** 

**Guinea**

**Nigeria**

**The Gambia**

108 Family Planning

**Gambia**

**Gambia**

**Model 2**

**Model 3**

**planning**


**Table 4.** Multilevel logistic regression showing random effects on unmet need for family planning. burden. Exposure to family planning messages was the only control variable that significantly influences unmet need for family planning with results showing that only exposure through newspaper reduces the likelihood of unmet contraceptive need in the studied countries.

Drivers of Unmet Need for Family Planning among Women of Advanced Reproductive Age…

The results of the random effects on unmet contraceptive need are presented in **Table 4**. The goodness-of-fit of the multilevel models were examined by the LR test which showed statistical significance across the countries. The consistent reduction in the values of the log likelihood across the countries also indicated that the fitted models are adequate. The ICC values suggest that the analysed community characteristics had significant effect on the likelihood of unmet need for family planning in the studied countries. When no individual and community charac

teristics were included in the empty model, the greatest variation in unmet need for family plan

in Model 1, the highest variation in unmet need for family planning attributable to community

est variation in unmet need for family planning attributable to the community characteristics

reproductive age in the urban communities examined have similar unmet contraceptive need.

This chapter examined the drivers of unmet need for family planning among urban women of advanced reproductive age in selected West African countries. With sufficient empirical evidence that women of advanced reproductive age not only have elevated risks of adverse

unintended pregnancies and its associated consequences [17, 18], this chapter by further reveal

ing levels of unmet contraceptive need among the women provided additional information on the need to focus attention on the reproductive behaviour of women of advanced reproduc

tive age. The chapter by examining unmet need for family planning in a multi-country setting improves upon previous studies that have focused urban women in specific countries [36

The high quality of data analysed in the chapter is not in doubt and provides reliable interna

tional comparability of the levels and correlates of unmet need for family planning within the West African region. Findings in the chapter provided more support for the socio-ecological theory [60] by revealing that unmet need for family planning was influenced by factors operat

ing at both the individual and community levels of urban societies. This finding also provided support for the hierarchy of influence on unmet need for family planning identified in a recent

One, unmet need for family planning was relatively higher in urban Guinea and the Gambia compared with urban Nigeria. Levels of unmet need for family planning as found in Guinea (22.2%) and the Gambia (22.9%) though lower than the 41.5% found in one study [28] but were far higher than the recent global estimate of 12.3% [19], and much higher than prev

alence reported in some previous studies [18, 27, 30, 33]. Though this study focused only women of advanced reproductive age and not all women of childbearing as analysed in most of the existing studies, the observed level nonetheless suggests that the prevalence of unmet

study [21]. A number of the findings may impact policy and programmes.

maternal and child health outcome if they become pregnant [51

= 0.523). With the inclusion of the individual characteristics

= 0.371). Overall, the ICC indicated that most women of advanced

= 0.403). Also, the full model showed that the high

http://dx.doi.org/10.5772/intechopen.72896

–54], but also higher risk of

ning was observed in Nigeria (ICC

were observed in Guinea (ICC

**4. Discussion**

characteristics was observed in Guinea (ICC


111








–43].

burden. Exposure to family planning messages was the only control variable that significantly influences unmet need for family planning with results showing that only exposure through newspaper reduces the likelihood of unmet contraceptive need in the studied countries.

The results of the random effects on unmet contraceptive need are presented in **Table 4**. The goodness-of-fit of the multilevel models were examined by the LR test which showed statistical significance across the countries. The consistent reduction in the values of the log likelihood across the countries also indicated that the fitted models are adequate. The ICC values suggest that the analysed community characteristics had significant effect on the likelihood of unmet need for family planning in the studied countries. When no individual and community characteristics were included in the empty model, the greatest variation in unmet need for family planning was observed in Nigeria (ICC = 0.523). With the inclusion of the individual characteristics in Model 1, the highest variation in unmet need for family planning attributable to community characteristics was observed in Guinea (ICC = 0.403). Also, the full model showed that the highest variation in unmet need for family planning attributable to the community characteristics were observed in Guinea (ICC = 0.371). Overall, the ICC indicated that most women of advanced reproductive age in the urban communities examined have similar unmet contraceptive need.
