Exploring the socioeconomic and education-based inequalities in modern and traditional contraceptive use among women in Africa.

Abstract

BACKGROUND: Contraceptive use is integral to improving reproductive health outcomes, but disparities in access and use persist across Africa, influenced by socio-economic, educational, and age-related factors. This study explores socioeconomic and education-based inequalities in modern and traditional contraceptive use among women in 41 African countries. METHODS: Secondary data from the World Health Organisation’s Health Equity Assessment Toolkits and national demographic surveys (2010–2022) were analysed. The study focused on women aged 15–49, categorised by socio-economic status, education level, and age. Descriptive and inferential statistical methods were used, employing inequality measures such as D (Estimate), R (Estimate), PAF (Estimate), and PAR (Estimate) to assess disparities in contraceptive use. RESULTS: The study found significant variation in contraceptive prevalence, ranging from high-prevalence nations such as Zimbabwe (66.8%), Malawi (65.6%), and Lesotho (64.9%). South Sudan (4%) and Chad (8.2%) had very low prevalence rates. Age-related disparities were also significant, with contraceptive use generally higher in the 20–49 years age group compared to the 15–19 years age group. Again, Ghana exhibited 17% use among 15–19-year-olds compared to 53% in the 20–49-year-old group. The D revealed substantial inequalities in contraceptive use, particularly in countries like Kenya (22.5) and Malawi (20.6). The R highlighted greater disparities in countries such as Nigeria (4.0), indicating a significant socio-economic divide. The PAF demonstrated that socio-economic inequalities contributed to disparities, with Mozambique (5.8) and Niger (8.1) showing higher contributions. PAR further revealed that countries like Malawi (1.6) and Gambia (1.0) had a higher burden of inequality in contraceptive use. CONCLUSION: This study demonstrates persistent and intersecting age-, wealth-, and education-related inequalities in contraceptive use across Africa. By applying standardised inequality metrics in a cross-country comparative framework, the findings extend beyond prevalence-based analyses and provide actionable evidence to inform equity-oriented family planning policies and programmes. CLINICAL TRIAL NUMBER: Not applicable.