Uptake and correlates of modern contraceptive use among women aged 15-49 years in Botswana; evidence from the Botswana demographic survey 2017.

Background: Botswana is one of the countries in SSA with the lowest total fertility rate. This study aimed to explore the uptake and correlates of modern contraceptive use among women of reproductive ages (15-49 years) in Botswana.

Methods: The study used secondary data from the 2017 Botswana Demographic Survey. The study used a weighted sample of 1,120,008 women aged 15-49 years, who successfully completed the Botswana Demographic Survey questionnaire. Logistic regression models were used to derive adjusted odd ratio as the measures of association between need, predisposing and enabling factors, and modern contraceptive use among women. All comparisons are considered statistically significant at p > 0.01.

Results: From the 1,120,008 women included in the analysis, contraceptive prevalence was estimated at 80.4%. The most used methods of contraception among the sampled women were condoms (64.2%), followed by injectables (17%) and pills (12.6%). After controlling for confounders, the odds of contraceptive use were significantly higher among women aged 15-24 years (AOR = 1.41; 95% CI: 1.36-1.46) and 25-34 years (AOR = 1.78; 95% CI: 1.73-1.83), compared to women aged 35-49 years. Other significant correlates of contraceptive use included residing in rural areas (AOR = 0.94; 95% CI: 0.91-0.96), having primary (AOR = 1.82; 95% CI: 1.59-2.08) or secondary education (AOR = 2.41; 95% CI: 2.21-2.62), and accessing contraceptives from health facilities (AOR = 1.28; 95% CI: 1.24-1.68), compared to their respective counterparts. Conversely, after adjusting for confounders, the odds of contraceptive use were significantly lower among women who identified as Christians (AOR = 0.91; 95% CI: 0.88-0.94), those of other non-Christian religions (AOR = 0.80; 95% CI: 0.75-0.86), married women (AOR = 0.85; 95% CI: 0.83-0.87), and women who reported experiencing complications (AOR = 0.27; 95% CI: 0.26-0.28), compared to their respective counterparts.

Conclusion: The study reveals a high contraceptive prevalence (80.4%) among women, with condoms being the most used method. Younger women (aged 15-34), those with formal education, and those accessing services from health facilities were more likely to use contraceptives. However, contraceptive use was significantly lower among women in rural areas, those identifying with religious affiliations (both Christian and non-Christian), married women, and those who had experienced complications. These findings highlight the need for targeted interventions that address religious beliefs, marital dynamics, healthcare access in rural areas, and management of contraceptive-related complications.