Assessing Wealth-Related Inequalities in Demand for Family Planning Satisfied in 43 African Countries
Background: Around 80% of the African population lives in urban areas, and a rapid urbanization is observed in almost all countries. Urban poverty has been linked to several sexual and reproductive health risks, including high levels of unintended pregnancies. We aim to investigate wealth inequaliti...
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| Format: | Article |
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Frontiers Media S.A.
2021-07-01
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| Series: | Frontiers in Global Women's Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fgwh.2021.674227/full |
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| author | Franciele Hellwig Franciele Hellwig Carolina V. N. Coll Cauane Blumenberg Fernanda Ewerling Caroline W. Kabiru Aluisio J. D. Barros Aluisio J. D. Barros |
| author_facet | Franciele Hellwig Franciele Hellwig Carolina V. N. Coll Cauane Blumenberg Fernanda Ewerling Caroline W. Kabiru Aluisio J. D. Barros Aluisio J. D. Barros |
| author_sort | Franciele Hellwig |
| collection | DOAJ |
| description | Background: Around 80% of the African population lives in urban areas, and a rapid urbanization is observed in almost all countries. Urban poverty has been linked to several sexual and reproductive health risks, including high levels of unintended pregnancies. We aim to investigate wealth inequalities in demand for family planning satisfied with modern methods (mDFPS) among women living in urban areas from African countries.Methods: We used data from 43 national health surveys carried out since 2010 to assess wealth inequalities in mDFPS. mDFPS and the share of modern contraceptive use were stratified by groups of household wealth. We also assessed the ecological relationship between the proportion of urban population living in informal settlements and both mDFPS and inequalities in coverage.Results: mDFPS among urban women ranged from 27% (95% CI: 23–31%) in Chad to 87% (95% CI: 84–89%) in Eswatini. We found significant inequalities in mDFPS with lower coverage among the poorest women in most countries. In North Africa, inequalities in mDFPS were identified only in Sudan, where coverage ranged between 7% (95% CI: 3–15%) among the poorest and 52% (95% CI: 49–56%) among the wealthiest. The largest gap in the Eastern and Southern African was found in Angola; 6% (95% CI: 3–11%) among the poorest and 46% (95% CI: 41–51%) among the wealthiest. In West and Central Africa, large gaps were found for almost all countries, especially in Central African Republic, where mDFPS was 11% (95% CI: 7–18%) among the poorest and 47% (95% CI: 41–53%) among the wealthiest. Inequalities by type of method were also observed for urban poor, with an overall pattern of lower use of long-acting and permanent methods. Our ecological analyses showed that the higher the proportion of the population living in informal settlements, the lower the mDFPS and the higher the inequalities.Conclusion: Our results rise the need for more focus on the urban-poorer women by public policies and programs. Future interventions developed by national governments and international organizations should consider the interconnection between urbanization, poverty, and reproductive health. |
| first_indexed | 2024-12-21T21:33:07Z |
| format | Article |
| id | doaj.art-82ff840c0f2e4802a9f1d47921ce5a4a |
| institution | Directory Open Access Journal |
| issn | 2673-5059 |
| language | English |
| last_indexed | 2024-12-21T21:33:07Z |
| publishDate | 2021-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Global Women's Health |
| spelling | doaj.art-82ff840c0f2e4802a9f1d47921ce5a4a2022-12-21T18:49:34ZengFrontiers Media S.A.Frontiers in Global Women's Health2673-50592021-07-01210.3389/fgwh.2021.674227674227Assessing Wealth-Related Inequalities in Demand for Family Planning Satisfied in 43 African CountriesFranciele Hellwig0Franciele Hellwig1Carolina V. N. Coll2Cauane Blumenberg3Fernanda Ewerling4Caroline W. Kabiru5Aluisio J. D. Barros6Aluisio J. D. Barros7International Center for Equity in Health, Federal University of Pelotas, Pelotas, BrazilPostgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, BrazilInternational Center for Equity in Health, Federal University of Pelotas, Pelotas, BrazilInternational Center for Equity in Health, Federal University of Pelotas, Pelotas, BrazilInternational Center for Equity in Health, Federal University of Pelotas, Pelotas, BrazilPopulation Dynamics and Reproductive Health Unit, African Population and Health Research Center, Nairobi, KenyaInternational Center for Equity in Health, Federal University of Pelotas, Pelotas, BrazilPostgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, BrazilBackground: Around 80% of the African population lives in urban areas, and a rapid urbanization is observed in almost all countries. Urban poverty has been linked to several sexual and reproductive health risks, including high levels of unintended pregnancies. We aim to investigate wealth inequalities in demand for family planning satisfied with modern methods (mDFPS) among women living in urban areas from African countries.Methods: We used data from 43 national health surveys carried out since 2010 to assess wealth inequalities in mDFPS. mDFPS and the share of modern contraceptive use were stratified by groups of household wealth. We also assessed the ecological relationship between the proportion of urban population living in informal settlements and both mDFPS and inequalities in coverage.Results: mDFPS among urban women ranged from 27% (95% CI: 23–31%) in Chad to 87% (95% CI: 84–89%) in Eswatini. We found significant inequalities in mDFPS with lower coverage among the poorest women in most countries. In North Africa, inequalities in mDFPS were identified only in Sudan, where coverage ranged between 7% (95% CI: 3–15%) among the poorest and 52% (95% CI: 49–56%) among the wealthiest. The largest gap in the Eastern and Southern African was found in Angola; 6% (95% CI: 3–11%) among the poorest and 46% (95% CI: 41–51%) among the wealthiest. In West and Central Africa, large gaps were found for almost all countries, especially in Central African Republic, where mDFPS was 11% (95% CI: 7–18%) among the poorest and 47% (95% CI: 41–53%) among the wealthiest. Inequalities by type of method were also observed for urban poor, with an overall pattern of lower use of long-acting and permanent methods. Our ecological analyses showed that the higher the proportion of the population living in informal settlements, the lower the mDFPS and the higher the inequalities.Conclusion: Our results rise the need for more focus on the urban-poorer women by public policies and programs. Future interventions developed by national governments and international organizations should consider the interconnection between urbanization, poverty, and reproductive health.https://www.frontiersin.org/articles/10.3389/fgwh.2021.674227/fullurban healthurban poorinformal settlementcontraceptionfamily planningAfrica |
| spellingShingle | Franciele Hellwig Franciele Hellwig Carolina V. N. Coll Cauane Blumenberg Fernanda Ewerling Caroline W. Kabiru Aluisio J. D. Barros Aluisio J. D. Barros Assessing Wealth-Related Inequalities in Demand for Family Planning Satisfied in 43 African Countries Frontiers in Global Women's Health urban health urban poor informal settlement contraception family planning Africa |
| title | Assessing Wealth-Related Inequalities in Demand for Family Planning Satisfied in 43 African Countries |
| title_full | Assessing Wealth-Related Inequalities in Demand for Family Planning Satisfied in 43 African Countries |
| title_fullStr | Assessing Wealth-Related Inequalities in Demand for Family Planning Satisfied in 43 African Countries |
| title_full_unstemmed | Assessing Wealth-Related Inequalities in Demand for Family Planning Satisfied in 43 African Countries |
| title_short | Assessing Wealth-Related Inequalities in Demand for Family Planning Satisfied in 43 African Countries |
| title_sort | assessing wealth related inequalities in demand for family planning satisfied in 43 african countries |
| topic | urban health urban poor informal settlement contraception family planning Africa |
| url | https://www.frontiersin.org/articles/10.3389/fgwh.2021.674227/full |
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