What factors are associated with contraceptive method choice during social marketing campaigns in Kinshasa, Democratic Republic of the Congo? A mixed-methods cross-sectional study.

Abstract

Introduction: The Democratic Republic of the Congo (DRC) has one of the highest maternal mortality ratios worldwide (746 per 100 000 live births), alongside limited access to contraception. Modern contraceptive prevalence remains low, estimated at 11% among women in union. This situation is compounded by insufficient funding and limited government commitment. In this context, social marketing has been considered a strategic response to these challenges.This study aimed to identify factors associated with contraceptive method choice during social marketing family planning campaigns and to explore the perceptions and attitudes of healthcare providers and women users towards these campaigns. The quantitative component included only women who adopted a contraceptive method during campaigns, which limits inference on overall uptake.

Methods: Sequential explanatory mixed-methods study combining an analytical cross-sectional survey with an exploratory qualitative component, conducted in health facilities implementing social marketing campaigns between January 2022 and December 2023 in Kinshasa, DRC.Participants were healthcare providers and 339 women who adopted a contraceptive method during the campaigns.Study variables included sociodemographic characteristics, contraceptive method choice and providers' and users' perceptions.

Results: Most women (81.7%) opted for implants. Contraceptive method choice was significantly associated with educational level, marital status and exposure to media as a source of campaign information. Implant adoption followed a curvilinear pattern across educational levels, peaking among women with secondary education, and was markedly higher among married women. Rumours and cost were identified as barriers to contraceptive use and access.

Conclusions: These findings support the continued use of social marketing as a viable strategy to expand contraceptive access. Although social marketing campaigns facilitated access to contraception, substantial challenges persist in the context of the Democratic Republic of Congo, underscoring the need for sustained family planning efforts.