Long-acting reversible methods of contraception: trends, levels, and predictors among married women of reproductive age in Nigeria.

Abstract

Background: Copper Intrauterine contraceptive devices (IUDs) and hormonal implants are the two most known safe, convenient, highly effective and long-acting reversible contraceptive methods worldwide that prevent pregnancy for all ages without demanding user action. Regardless of these advantages, its utilisation are low among sexually active women in Nigeria. Thus, this study examines trends, levels and predictors of long-acting reversible contraceptives (LARC) among married women of reproductive age in Nigeria.

Methods: The study used pooled four (4) round of the individual women recode (IR) datasets of the Nigeria Demographic and Health Surveys (NDHS) across four-time points (2003-2018). A weighted sample size of 17,483 sexually active married women of reproductive age (15-49 years) comprising 962, 4839, 5963, and 5719 respondents for 2003, 2008, 2013, and 2018 respectively. Data were analysed using frequency tables, charts, chi-square test of independence and binary logistic regression at 95% confidence intervals (CI) and p < 0.05 to determine predictors of LARC use among respondents in Nigeria.

Results: There was a monotonic upward trend using LARC from 4.7 to 21.7% across the survey years (2003-2018). Generally, LARC use within the reference period (2003-2018) increased by 51.1%. Remarkably, in the same period, the use of IUDs decreased by 12.8% while the use of Implant/Norplant increased by 17,500%. Sexually active married women (15-49) who were working (aOR = 1.4, [95% CI = 1.1, 1.7]; p < 0.01), and those who were exposed to mass media (aOR = 1.2, [95% CI = 1.1, 1.4]; p < 0.05) want more children (aOR = 2.2, [95% CI = 1.8, 2.6]; p < 0.001), visit to health care centres in the last 12 months (aOR = 1.2, [95% CI = 1.0, 1.4]; p < 0.01), within the middle wealth quintiles (aOR = 1.4, [95% CI = 1.0, 1.9]; p < 0.05), and from the North West (aOR = 1.9, [95% CI = 1.5, 2.5]; p < 0.001) had statistically significant higher odds of LARC use compared with those who were not working, exposed to mass media, want no more children, visit health care services, poorest wealth quintiles, and from the North Central respectively.

Conclusion: Even though there is evidence of improvement in the use of LARC, policies and programmes should be directed towards the identified groups to increase the availability, accessibility, and uptake of LARC in Nigeria. Uptake of IUDs and the use of Implant/Norplant should be encouraged through the support and training of private healthcare providers by governmental and non-profit governmental organizations.