Contraception is one of the key components for family planning and vital means to reduce mortality and morbidity of both child and mother (1–3, 8, 28). In this study, using the recent 2015/2016 Angola Multiple Indicator and Health Survey, several personal and community level predictors for utilization of modern contraceptive methods among married women were analyzed. We found that women’s age, women’s and husband educational level, place of residence, women’s occupation, economic status, media exposure, number of alive children, desire to have more children, and subnational region were the main determinants for utilization of modern contraceptive methods.
In line with previous literature (19, 21, 24, 25, 28), our findings also revealed that women were less likely to use modern contraceptives with increasing age when controlling for other factors. Modern contraceptive use among women 45–49 years of age was lower than adolescent women (women within 15–19 years of age). Higher uptake of contraceptive use among young women may be due to the influence of communication among young women and their husbands/partners about family planning, as seen in a 2016 study in Angola (29).
We found women’s educational level influenced uptake of modern contraceptive use as supported by previous studies (30–32). It highlights, especial attention should be given for married women with less educational level or not have formal education at service provision area such as during counseling and need to taking account during awareness creation such as using audio-visual aid instead of leaflets distribution.
Modern contraceptive also varied based on their occupation types. Compared to married women who were not working, women with agriculturally self-employed were less likely to use. However, those worked in household and domestic were more utilize modern contraceptive methods.
In our study, we found that utilization of modern contraceptives varied based on husband educational level. In fact, married women whose husband attended primary school and higher level were more likely to use contraception as compared to women whose husband did not attend formal education. Similar findings in previous studies (26, 33), suggest husband’s educational level increased the uptake of contraceptive use for family planning because of increased communication between the couple, that lead to increased support of contraceptive use by the husband, which also influenced his actions through is adoption of condom use and/or sterilization (34, 35).
Having exposure for media significantly increased the uptake of modern contraceptive methods. In our study, married women who either read the newspaper, listened to radio or watched television for at least once a week were more likely to utilize modern contraceptive methods than women with no media exposure. Previous studies in Senegal and West Bengal (36, 37), showed similar findings. Mass media is a key strategy for increasing demand for use in health services (38). It is a process that helps communities to identify their own needs and to respond to and address these needs (38). Gaining the participation of community members can help providers raise awareness both of health issues at the community level and of social and cultural issues that may promote or inhibit use of information and services, as well as improve clients’ understanding of the methods or services being offered (39). Specific barriers to service access and use can be addressed and service utilization increased (39). Community mobilization encourages concern of the needs of specific populations and localities. In particular, underserved populations, such as youth and men, can be reached more effectively through community mobilization (39).
Consistent with previous studies (18, 40, 41), the number of living children had significant association with the use of modern contraceptive methods. Compared to married women with no child, the likelihood of utilization was higher among women with children. A possible explanation might be related to certain myths that prohibit women from seeking family planning, such as the belief that contraceptive use is associated with women who are “promiscuous” (42). Cultural and traditional beliefs hold strong in many rural areas in Africa, holding on to beliefs that influence lack of change (i.e. use of modern contraception) (43). Another justification for less use of modern contraceptive among women with no child especially if it is due to death of child, it could be due to higher desire to have more children as means of filling the gap brought on by the loss of that particular child (44).
The other main finding of the study was, the influence of women’s desire to have more children on the utilization of contraceptive methods. Women wanted to have children after two years were more utilized than women who desired to have children in a shorter period. Additionally, those women who undecided when to have children and those who had no more desire or sterilized (themselves/their husband) better utilized the modern contraceptive methods as compared to women who wanted to have more children in less than two years. Our finding is in line with previous study (45). Evidence suggested that desire for more children might be related to religion (43). A study with similar results found that in Kenya and Tanzania, Muslim women desire more children than Christians (43, 46). Additionally, It might be related to educational level of the women and overall perception towards family size (43). A study in Ethiopia showed, women with an educational attainment less than grade one were found to have a larger ideal number of children, compared to illiterate women as well as those who have attained grade one or higher (43). Another justification related to perception is, women who attach a “high-benefit” economic value to children have a larger reported ideal number of children (i.e., family size) than women who perceive children to be a high cost. Couples view their children as an investment and that these children are due for pay-up when their parents reach old-age (43). In African traditions, it is almost always predictable that once the child grows older, he/she will be indebted to financially pay back (i.e., support) the parent(s) for his/her (47)a high value to having children will aim for larger families who will later fit the role of being a provider and caregiver to the parents in old age (43).
Women living in urban setting were more likely to utilize modern contraception than their counterparts in rural regions as documented in previous studies (47, 48). This could be related to knowledge about contraceptive methods; which is highly related with its uptake (27, 49, 50) and rural residents had relatively lower level of knowledge than urban residents (47). Furthermore, uptake of contraception is strongly related with education (34), and formal education remains low among women and men in rural areas (47).
We found difference in utilization of modern contraceptive across regions as suggested in previous studies (25, 33, 51). The disparities might be due to existed social norm and culture (45, 52) and difference in accessibility of health facility and quality of the services given in the facilities across regions (33).
This study has its own strength and limitations. Using the recent and nationally representative data can help to understand the current nationwide predictors of modern contraceptive use, believed to be the main strength of the study. However, the study has the following limitations. Since the data is cross-sectional it does not measure causality between explanatory factors and the outcome variable-modern contraceptive use. The authors are only able to use the variables available in the secondary dataset for analysis and other variables such as cultural and perception factors as well as quality of care were not included.