Individual and community level factors influencing modern contraceptive use among women of reproductive age in South Africa: a multilevel analysis.

Background: Contraceptive use is a major global public health priority, contributing to improved maternal and child health, gender equality, and sustainable development. Despite advancements, women with sensory disabilities in low- and middle-income countries continue to face challenges in accessing modern contraceptives, leading to low utilisation. Despite this, no research has examined the influence of sensory disability status on modern contraceptive use among women of reproductive age in South Africa. Thus, this study explored the association between sensory disability status and other individual and community-level factors and modern contraceptive utilisation in South Africa.

Methods: Data were drawn from the 2016 South Africa Demographic and Health Survey (SADHS). A sample of 7,040 sexually active women aged 15-49 years was used in the analysis. A two-level multilevel binary logistic regression model was used to examine the association between sensory disability status and other individual and community-level factors and modern contraceptive use.

Results: The prevalence of modern contraception among sexually active women in South Africa was 57.32% [95% CI = 55.59-59.03]. Women with sensory disabilities [aOR = 0.81, CI = 0.67-0.98] were less likely to use contraceptives. Other factors negatively associated with use included desiring five or more children [aOR = 0.67, 95% CI = 0.47-0.97] and living in communities with a high ideal number of children [aOR = 0.75, 95% CI = 0.63-0.90]. Factors positively associated with contraceptive use included mobile phone ownership [aOR = 1.45, 95% CI = 1.15-1.82] and living in communities with high employment [aOR = 1.32, 95% CI = 1.06-1.64].

Conclusion: Sensory disability status influenced women's contraceptive behaviour in South Africa. Current family planning interventions should target women with sensory disabilities by prioritising accessible communication methods (e.g., braille, sign language), disability awareness training for healthcare workers, and integration of reproductive health services into disability support programmes.