**4. Discussion**

**Parameter**

**Guinea** **Empty** 

**Model 1**

**Model 2**

**Model 3**

**Empty** 

**Model 1**

**Model 2**

**Model 3**

**Empty** 

**Model 1**

**Model 2**

**Model 3**

110 Family Planning

**model**

**model**

**model**

Community-level

2.661

2.225

2.008

1.943

3.611

1.862

1.705

1.592

2.066

1.885

1.664

1.522 (0.209)

(0.312)

(0.307)

(0.276)

(0.250)

(0.501)

(0.243)

(0.239)

(0.206)

(0.343)

(0.299)

(0.244)

variance (Standard

Error)

Log-likelihood

LR test (χ2

ICC **Note**: \*p < 0.001.

**Table 4.**

Multilevel logistic regression showing random effects on unmet need for family planning.

)

932.1\* 0.447

0.403

0.379

0.371

0.523

0.361

0.341

0.326

0.386

0.364

0.336

0.316 (31.6%)

(44.7%)

(44.3%)

(37.9%)

(37.1%)

(52.3%)

(36.1%)

(34.1%)

(32.6%)

(38.6%)

(36.4%)

(33.6%)

530.7\*

441.3\*

372.5\*

1624.2\*

798.8\*

570.8\*

318.7\*

432.1\*

347.6\*

319.6\*

216.3\*

−3028

−2963

−2932

−2908

−4231

−4118

−3794

−3658

−2543

−2117

−2008

−1938.7

**Nigeria**

**The Gambia**

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 maternal and child health outcome if they become pregnant [51–54], but also higher risk of unintended pregnancies and its associated consequences [17, 18], this chapter by further revealing 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 reproductive 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 [36–43]. The high quality of data analysed in the chapter is not in doubt and provides reliable international 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 operating 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 study [21]. A number of the findings may impact policy and programmes.

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 prevalence 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 need for family planning in the studied countries particularly Guinea and the Gambia may require more urgent attention to accelerate pace of reduction in the countries. Bearing in mind that most women of advanced reproductive age in West Africa are high parous women [48, 50], it is important to devise specific programmes to target women in advanced age group by providing expanded counselling and services that addresses their peculiar contraceptive concerns. Such programmes should extensively use the mass media, particularly newspapers, to provide needed information. Two, the study found that gender norms affected the level of unmet need for family planning in all the countries. In virtually all West African countries, men still play dominant roles in women's reproductive health despite increasing attention on gender equity and the implementation of several women-focused social programmes across the region. The key challenge, however, has remained how to effectively alter the balance of power between men and women within households and communities. In this regard, behaviour change communication (BCC) programmes have been developed in all the studied countries [59]. While it is important to sustain the BCC programmes, it is also necessary to scale up the promotion of men's method in West Africa since research has provided sufficient evidence that many men will use modern methods of contraception if they have appropriate information and counselling [65, 66]. This may likely reduce the extent of unmet contraceptive need by reducing the risk of unintended pregnancy and fertility among women.

**5. Conclusion**

**Acknowledgements**

analyse the data sets.

**Conflict of interest**

**Author details**

Nigeria

**References**

Bola Lukman Solanke

The author declares no conflict of interest.

Address all correspondence to: modebolasolanke@gmail.com

Edition. Washington, DC: Population Reference Bureau; 1998

This chapter examined drivers of unmet need for family planning among urban women of advanced reproductive age. Though, the chapter analysed a cross-sectional data which usually limits a cause-effect relationship between variables, nonetheless, the analyses provided sufficient empirical associations between the research variables. Individual and community factors are important for explaining variations in unmet contraceptive need among urban women of advanced reproductive age. The key drivers are gender norms that justify men's control over women, partner education, fertility desire, child mortality, age at first marriage, community literacy level, community wealth level, community childcare burden and exposure to mass media family planning messages. The development of interventions to specifi-

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

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

113

cally target women of advanced reproductive age is imperative in urban West Africa.

The author expresses appreciation to MEASURE DHS for granting request to download and

Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife,

[1] Haupt A, Kane TT.Population Reference Bureau's Population Handbook. 4th International

[2] Ahmed S, Li Q, Liu L, Tsui AO. Maternal deaths averted by contraceptive use: An analysis of 172 countries. Lancet. 2012;**380**:111-125. DOI: 10.1016/S0140-6736(12)60478-4

[3] Canning D, Schultz TP. The economic consequences of reproductive health and family

planning. Lancet. 2012;**380**:165-171. DOI: 10.1016/S0140-6736(12)60827-7

Three, men's desire for fewer children reduces likelihood of unmet contraceptive need in urban West Africa. In many parts of the world, surveys have shown that men often desire more children than women [65, 66]. This further buttress continued need for male involvement in women's reproductive health particularly in the use of contraceptive. It is not likely that unmet contraceptive need among women in West Africa will substantially reduce without change in men's desire for more children. Governments and family planning providers in West Africa have onerous responsibility of helping more men not only to support or approve partners use of modern contraceptives, but also for men to take the lead in use of modern contraceptives. This may be achieved by developing family planning programmes that presents use of contraceptives as one of men's key responsibility to their partners. In addition, such programmes could provide information detailing how traditional gender roles can adversely affect women's sexual and reproductive health. Four, child death experience impact unmet contraceptive need among urban women of advanced reproductive age in West Africa. In virtually every part of West Africa, children have strong cultural relevance. Births are highly celebrated, and childlessness is not accepted in most communities. Hence, the event of death of a child is viewed as a serious tragedy for individuals, couples and communities. In the event of a child death, women are mostly encouraged to have replacement except such women have been declared infecund. Such practice often elevates the risk of many women of advanced reproductive age. However, this practice and its associated risk could be addressed by taken more actions to ensure child survival in West Africa. Five, community contexts have effects on the extent of unmet contraceptive need among urban women of advanced reproductive age. In several communities, women usually have similar perception and attitude towards issues of childbearing. In many instances, women tend to compare experiences and reacts in like manners. This provides basis for more community-based family planning programmes across West Africa. However, it is important to consider developing specific community-based programmes for urban women of advanced reproductive age.
