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      Unmet need for family planning among married women in sub-Saharan Africa: a meta-analysis of DHS data (1995 – 2020)

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          Abstract

          Background

          Closing the gap of unmet needs for family planning (FP) in sub-Saharan Africa remains critical in improving maternal and child health outcomes. Determining the prevalence of unmet needs for family planning among married women in the reproductive age is vital for designing effective sexual reproductive health interventions and programmes. Here, we use nationally representative data drawn from sub-Saharan countries to estimate and examine heterogeneity of unmet needs for family planning among currently married women of reproductive age.

          Methods

          This study used secondary data from Demographic and Health Surveys (DHS) conducted between January 1, 1995 to December 31, 2020 from 37 countries in sub-Saharan African. An Inverse Heterogeneity model (IVhet) in MetaXL application was used to estimate country and sub-regional level pooled estimates and confidence intervals of unmet needs for FP in SSA.

          Results

          The overall prevalence of unmet need for family planning among married women of reproductive age in the sub-region for the period under study was 22.9% (95% CI: 20.9–25.0). The prevalence varied across countries from 10% (95% CI: 10–11%) in Zimbabwe to 38% (95% CI: 35–40) and 38 (95% CI: 37–39) (I2 = 99.8% and p-value < 0.0001) in Sao Tome and Principe and Angola, respectively. Unmet needs due to limiting ranged from 6%; (95% CI: 3–9) in Central Africa to 9%; (95% CI: 8–11) in East Africa. On the other hand, the prevalence of unmet needs due to spacing was highest in Central Africa (Prev: 18; 95% CI: 16–21) and lowest in Southern Africa (Prev: 12%; 95% CI: 8–16). Our study indicates that there was no publication bias because the Luis Furuya-Kanamori index (0.79) was within the symmetry range of -1 and + 1.

          Conclusion

          The prevalence of unmet need for FP remains high in sub-Saharan Africa suggesting the need for health policymakers to consider re-evaluating the current SRH policies and programmes with the view of redesigning the present successful strategies to address the problem.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s40834-022-00198-5.

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          Most cited references35

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          Introduction, comparison, and validation of Meta‐Essentials : A free and simple tool for meta‐analysis

          We present a new tool for meta‐analysis, Meta‐Essentials, which is free of charge and easy to use. In this paper, we introduce the tool and compare its features to other tools for meta‐analysis. We also provide detailed information on the validation of the tool. Although free of charge and simple, Meta‐Essentials automatically calculates effect sizes from a wide range of statistics and can be used for a wide range of meta‐analysis applications, including subgroup analysis, moderator analysis, and publication bias analyses. The confidence interval of the overall effect is automatically based on the Knapp‐Hartung adjustment of the DerSimonian‐Laird estimator. However, more advanced meta‐analysis methods such as meta‐analytical structural equation modelling and meta‐regression with multiple covariates are not available. In summary, Meta‐Essentials may prove a valuable resource for meta‐analysts, including researchers, teachers, and students.
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            Maternal deaths averted by contraceptive use: an analysis of 172 countries.

            Family planning is one of the four pillars of the Safe Motherhood Initiative to reduce maternal death in developing countries. We aimed to estimate the effect of contraceptive use on maternal mortality and the expected reduction in maternal mortality if the unmet need for contraception were met, at country, regional, and world levels. We extracted relevant data from the Maternal Mortality Estimation Inter-Agency Group (MMEIG) database, the UN World Contraceptive Use 2010 database, and the UN World Population Prospects 2010 database, and applied a counterfactual modelling approach (model I), replicating the MMEIG (WHO) maternal mortality estimation method, to estimate maternal deaths averted by contraceptive use in 172 countries. We used a second model (model II) to make the same estimate for 167 countries and to estimate the effect of satisfying unmet need for contraception. We did sensitivity analyses and compared agreement between the models. We estimate, using model I, that 342,203 women died of maternal causes in 2008, but that contraceptive use averted 272,040 (uncertainty interval 127,937-407,134) maternal deaths (44% reduction), so without contraceptive use, the number of maternal deaths would have been 1·8 times higher than the 2008 total. Satisfying unmet need for contraception could prevent another 104,000 maternal deaths per year (29% reduction). Numbers of unwanted pregnancies and unmet contraceptive need are still high in many developing countries. We provide evidence that use of contraception is a substantial and effective primary prevention strategy to reduce maternal mortality in developing countries. Bill and Melinda Gates Foundation. Copyright © 2012 Elsevier Ltd. All rights reserved.
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              Contraception and health.

              Increasing contraceptive use in developing countries has cut the number of maternal deaths by 40% over the past 20 years, merely by reducing the number of unintended pregnancies. By preventing high-risk pregnancies, especially in women of high parities, and those that would have ended in unsafe abortion, increased contraceptive use has reduced the maternal mortality ratio--the risk of maternal death per 100,000 livebirths--by about 26% in little more than a decade. A further 30% of maternal deaths could be avoided by fulfilment of unmet need for contraception. The benefits of modern contraceptives to women's health, including non-contraceptive benefits of specific methods, outweigh the risks. Contraception can also improve perinatal outcomes and child survival, mainly by lengthening interpregnancy intervals. In developing countries, the risk of prematurity and low birthweight doubles when conception occurs within 6 months of a previous birth, and children born within 2 years of an elder sibling are 60% more likely to die in infancy than are those born more than 2 years after their sibling. Copyright © 2012 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                millsphiri@gmail.com
                Journal
                Contracept Reprod Med
                Contracept Reprod Med
                Contraception and Reproductive Medicine
                BioMed Central (London )
                2055-7426
                11 January 2023
                11 January 2023
                2023
                : 8
                : 3
                Affiliations
                [1 ]GRID grid.11951.3d, ISNI 0000 0004 1937 1135, Demography and Population Studies Programme, Schools of Public Health and Social Sciences, , University of the Witwatersrand, ; Johannesburg, South Africa
                [2 ]GRID grid.12984.36, ISNI 0000 0000 8914 5257, Department of Population Studies, School of Humanities and Social Sciences, , University of Zambia, ; Lusaka, Zambia
                [3 ]GRID grid.507436.3, ISNI 0000 0004 8340 5635, University of Global Health Equity, Bill and Joyce Cummings Institute of Global Health, ; KG 7 Ave., Kigali Heights, 5Th Floor, PO Box 6955, Kigali, Rwanda
                [4 ]GRID grid.16463.36, ISNI 0000 0001 0723 4123, School of Nursing and Public Health, Department of Public Health, , University of KwaZulu-Natal, Howard College Campus, ; George Campbell Building, Durban, 4001 South Africa
                Article
                198
                10.1186/s40834-022-00198-5
                9832678
                36627720
                0f9ff294-f92e-4ea4-bab1-090ba95bce3c
                © The Author(s) 2023

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 8 December 2021
                : 26 October 2022
                Categories
                Research
                Custom metadata
                © The Author(s) 2023

                prevalence,unmet need,family planning,meta-analysis,sub-saharan africa

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