Unravelling Factors Influencing Demand for Modern Contraception and Evaluating Coverage Progress since 2015 in Ethiopia, Kenya, and Nigeria: Insights from Multilevel and Geostatistical Modelling

Abstract

Abstract Introduction The United Nations established the Sustainable Development Goals (SDGs) in 2015 to enhance global development. In this study, we examine an SDG indicator: the percentage of women aged 15–49 whose family planning needs are met by modern contraception (mDFPS). We evaluate both the factors influencing its coverage and its progress since 2015. Methods We used nationally representative survey data (Demographic and Health Surveys (DHS) and Performance Monitoring for Action (PMA)) from Ethiopia, Kenya, and Nigeria. We assessed individual and community-level predictors of mDFPS. We also computed mDFPS coverage across countries and subnational areas, assessing coverage changes from the SDGs onset to the most recent period with data using a Bayesian model-based geostatistical approach. Additionally, we assessed whether the subnational areas exceeded the minimum recommended WHO mDFPS coverage of 75%. Coverage assessment and mapping were done at pixel (5 x 5 km) and sub-national levels. Results: Varied individual and community-level determinants emerged, highlighting the countries' uniqueness. The results indicate mDFPS stagnation in most administrative areas across the three countries. Geographic disparities persisted over time, favouring affluent regions. Ethiopia and Nigeria showed minimal mDFPS improvement, while Kenya exhibited increased coverage. Mean posterior change, 95% credible intervals (CI) and exceedance probabilities (EP) were: Ethiopia 5.68% (95% CI: [-38.07, 49.44], EP = 0.61), Kenya 10.19% (95% CI: [-17.72, 39.33], EP = 0.80), and Nigeria 1.98% (95% CI: [-17.72, 39.33], EP = 0.58). None of the sub-national areas in Ethiopia and Nigeria exceeded the WHO-recommended coverage in their latest survey. While 9 out of 47 counties in Kenya in 2022 exceeded the WHO mDFPS coverage recommendation. Conclusion: The study unveils demographic, geographic, and socioeconomic mDFPS disparities, signalling progress and stagnation across administrative areas. The findings offer policymakers and governments insights into targeting interventions for enhanced mDFPS coverage. Context-specific strategies can address local needs, aiding SDG attainment.