Inequalities in contraceptive prevalence among married women of reproductive age in Sierra Leone, 2008-2019.

Background: Family planning, through access to safe and effective contraception, empowers women to make informed choices about their reproductive health. It is crucial in reducing unintended pregnancies, maternal mortality, and improving overall well-being. However, achieving equitable access to contraception remains a challenge in many low- and middle-income countries, including Sierra Leone. This study investigated the inequalities in contraceptive prevalence among married women of reproductive age (15-49 years) in Sierra Leone in 2008, 2013 and 2019.

Methods: This study employed time-trend study design utilizing data from three rounds of the Sierra Leone Demographic Health Survey conducted in 2008, 2013, and 2019. The health equity assessment toolkit software, developed by the World Health Organisation, was utilised to calculate various inequality measures. These include simple measures such as difference and ratio, as well as complex measures such as population attributable risk and fraction.

Results: The prevalence of contraceptive use among reproductive-aged married women in Sierra Leone increased from 8.2% in 2008 to 21.2% in 2019. The inequality in married women's age in contraceptive prevalence between older and younger women decreased slightly from 7.5 percentage points in 2008 to 7.2 percentage points in 2019. The ratio also decreased, indicating a narrowing gap in contraceptive prevalence between the age groups over time. Inequality in economic status in contraceptive prevalence between married women in the richest and poorest wealth index decreased from 15.7 percentage points in 2008 to 9.9 percentage points in 2019. The population attributable fraction and population attributable risk decreased notably, suggesting that economic status became less of a determinant factor in contraceptive prevalence over time. The educational inequality in contraceptive prevalence between married women with secondary or higher education and those with no education experienced a decline from 16.5 percentage points in 2008 to 12.6 percentage points in 2019. Place of residence inequality in contraceptive prevalence between married women in urban and rural areas decreased from 11.2 percentage points in 2008 to 7.4 percentage points in 2019. Provincial inequality in contraceptive prevalence between married women in the Western area and Northwestern province decreased from 16.7 percentage points in 2008 to 8.6 percentage points in 2019.

Conclusion: The prevalence of contraceptive use among reproductive-aged married women in Sierra Leone has notably increased over the past decade, accompanied by notable reductions in inequalities across age, economic status, education, place of residence, and geographic provinces. While inequalities persist, the narrowing gaps underscore progress in improving equitable access to contraceptive services. These findings underscore the importance of sustained efforts to address remaining inequalities and further enhance access to family planning resources for all women, particularly those in underserved populations.