3.1 Sample description of married women in 2018 DHS
Table 1 shows the percentage distribution of married women aged 15-49 years according to selected background characteristics. The study included 7, 597 married women aged 15-49 years. The mean age for the married women was 28 years. There were more married women in the 25 to 34 age group (38.5%) than in the other age groups. Slightly over half (50.7%) of the married women had attended only primary education. About 34.9% of the married women had at least five live births. Knowledge of modern family planning method is universal.
Table 1
Percent Distribution of Married women (15-49 years) by Selected Background Characteristics, DHS 2018, Zambia
Background Characteristics
|
Frequency
|
Percent
|
Age
|
15-24
|
1,875
|
24.5
|
25-34
|
2,941
|
38.5
|
35-49
|
2,832
|
37.0
|
Residence
|
Rural
|
3,080
|
40.3
|
Urban
|
4,568
|
59.7
|
Education Level
|
No education
|
743
|
9.7
|
Primary
|
3,881
|
50.7
|
Secondary
|
2,635
|
34.5
|
Tertiary
|
389
|
5.1
|
Children Ever Born
|
|
0-1
|
273
|
3.6
|
2-3
|
2,486
|
32.5
|
4-5
|
2,224
|
29.1
|
6+
|
2,666
|
34.9
|
Household Wealth
|
|
Poor
|
3,061
|
40.0
|
Medium
|
1,468
|
19.2
|
Rich
|
3,118
|
40.8
|
Knowledge of Family Planning method
|
|
Knows no method or only traditional method
|
24
|
0.3
|
Knows any modern method
|
7,624
|
99.7
|
Visited Health Facility 12 months prior to survey
|
|
Yes
|
2,286
|
29.9
|
No
|
5.362
|
70.1
|
Current Employment Status
|
|
Employed
|
4,173
|
45.4
|
Not employed
|
3,463
|
54.7
|
Total
|
7,597
|
100
|
Table 2 describes the prevalence of contraceptive use among married women in Zambia as captured by DHS 2018. The table also presents findings on prevalence of unmet need for family planning among currently married women by background characteristics. Bivariate analysis and statistical significance of relationships between contraceptive use and unmet need with the independent variables are presented to ascertain the influence of socio-demographic variables on outcomes of interest.
3.2 Contraceptive use
The overall fertility rate in Zambia is 4.7, with women in rural areas having 2 more children than women in urban areas. Findings shows that overall, contraceptive use among married women in Zambia is still low. Half (50%) of the married women in Zambia reported using any method of contraction in 2018 DHS. Differences by region show that married women who live in urban areas are more likely to use contraception than women who reside in rural areas (54% versus 47%). The findings suggest that education is a major factor in contraceptive use. This is evidenced by the observed increase in contractive use with the increase in level of education among married women. It is also observed that married women who reported higher numbers of children ever born were more likely to use a contraception method. Another interesting result of this study is married women who visited the health facility in the 12 months prior to the survey were more likely to use contraception than women who did not visit the health facility. The study findings also reveal that women who had exposure to media messages on family planning reported higher contraceptive use.
3.3 Prevalence of unmet need for family planning
The prevalence of unmet need for family planning among married women in Zambia was 20% during the 2018 DHS. This means that 1 in every 5 married women in Zambia have unmet need for family planning. Similar to contraceptive prevalence rate, the proportion of women with unmet need for family planning differs significantly between urban and rural areas with rural areas having higher unmet need for family planning. There is an inverse relationship between educational attainment and unmet need for family planning, as married women with a lower educational attainment have a higher proportion of unmet need than women with secondary and tertiary level of education. Married women who reported having 5 or more children ever born had a higher prevalence of unmet need compared to women without children (25% versus 14%). Exposure to family planning messages among married women contributes to improvement in meeting women’s needs for family planning services.
![](https://myfiles.space/user_files/58895_8739fc6c57c1c19a/58895_custom_files/img1629691879.png)
3.4 Determinants of Unmet Need
Multivariate logistic regression was used to examine the influence of predictors on the use of contraceptive and unmet for family planning in married women. Age, children ever born (parity), household wealth, province (region) of residence and exposure to media messages on family planning were significantly associated with unmet need for family planning in married women.
Our study suggests that increasing age is associated with a progressive reduction in unmet need. Women in the age groups 25-34 and 35-49 were less likely to have unmet need for family planning compared to women age 15-24 years {(AOR=0.61; 95% CI:0.47, 0.78; p<0.001) and (AOR=0.63; 95% CI:0.45, 0.86; p=0.004), respectively}.
Women with 4-5 births were about two times as likely to have an unmet need for family planning as women who with 0-1 births (AOR=1.90; 95% CI: 1.45, 2.50; p<0.001). Women who had six births or more had highest odds of unmet need for family planning when compared with women who had 0-1 births (AOR=2.47; 95% CI: 1.80, 3.37; p<0.001).
Our study also found that women who are exposed to family planning messages on television, radio or newspapers were 17% less likely to have unmet need for FP relative to women who were not exposed (AOR=0.83; 95% CI: 0.70, 0.97; p=0.023).
Women from medium wealth or rich households had reduced chances of unmet need compared to women who belong to poor households {(AOR=0.78; 95% CI:0.65, 0.94; p=0.007) and (AOR=0.86; 95% CI:0.67, 1.10; p=0.004), respectively}.
Table 3
Multivariate regression analysis examining variations in contraceptive use and unmet need for family planning among married women age 15-49. 2018 DHS, Zambia
Background Characteristics
|
Contraceptive use
|
Unmet need for family planning
|
AOR
|
p-values
|
[95% CI]
|
AOR
|
p-values
|
[95% CI]
|
Age
|
|
|
|
|
|
|
15-24
|
1.000
|
|
|
1.000
|
|
|
25-34
|
1.307
|
0.004
|
(1.087 1.571)
|
0.608
|
<0.001
|
(0.471 0.784)
|
35-49
|
2.038
|
<0.001
|
(1.703 2.621)
|
0.625
|
0.004
|
(0.453 0.863)
|
Residence
|
|
|
|
|
|
|
Rural
|
1.000
|
|
|
1.000
|
|
|
Urban
|
1.114
|
0.203
|
(0.943 1.316)
|
0.941
|
0.525
|
(0.781 1.134)
|
Education level
|
|
|
|
|
|
|
No education
|
1.000
|
|
|
1.000
|
|
|
Primary
|
0.641
|
<0.001
|
(0,525 0.782)
|
0.929
|
0.459
|
(0.751 1.149)
|
Secondary
|
0.509
|
<0.001
|
(0.399 0.650)
|
0.832
|
0.205
|
0.625 1.107)
|
Tertiary
|
0.559
|
0.001
|
(0.400 0.779)
|
0.907
|
0.654
|
(0.589 1.394)
|
Children Ever Born
|
|
|
|
|
|
|
0-1
|
1.000
|
|
|
1.000
|
|
|
2-3
|
0.397
|
<0.001
|
(0.328 0.479)
|
1.188
|
0.041
|
(0.934 1.500)
|
4-5
|
0.278
|
<0.001
|
(0.223 0.346)
|
1.918
|
<0.001
|
(1.449 2.516)
|
6+
|
0.249
|
<0.001
|
(0.196 0.316)
|
2.480
|
<0.001
|
(1.799 3.486)
|
Household Wealth index
|
|
|
|
|
|
|
Poor
|
1.000
|
|
|
1.000
|
|
|
Medium
|
0.726
|
<0.001
|
(0.622 0.846)
|
0.781
|
0.007
|
(0.652 0.935)
|
Rich
|
0.730
|
0.004
|
(0.597 0.874)
|
0.856
|
0.226
|
(0.665 1.101)
|
Region
|
|
|
|
|
|
|
Western
|
1.000
|
|
|
1.000
|
|
|
Central
|
0.463
|
<0.001
|
(0.335 0.639)
|
0.609
|
0.001
|
(0.451 0.823)
|
Copperbelt
|
0.485
|
<0.001
|
(0.356 0.662)
|
0.811
|
0.140
|
(0.613 1.071)
|
Eastern.
|
0.361
|
<0.001
|
(0.265 0.491)
|
0.696
|
0.016
|
(0.518 0.934)
|
Luapula.
|
0.736
|
0.069
|
(0.530 1.024)
|
0.946
|
0.740
|
(0.682 1.313)
|
Lusaka.
|
0.424
|
<0.001
|
(0.312 0.578)
|
0.685
|
0.026
|
(0.492 0.955)
|
Muchinga
|
0.306
|
<0.001
|
(0.224 0.419)
|
0.451
|
<0.001
|
(0.312 0.655)
|
Northern
|
0.570
|
0.001
|
(0.409 0.796)
|
0.608
|
0.006
|
(0.428 0.863)
|
North-Western
|
0.587
|
0.001
|
(0.424 0.814)
|
0.752
|
0.105
|
(0.533 1.062)
|
Southern
|
0.707
|
0.039
|
(0.507 0.982)
|
0.859
|
0.336
|
(0.629 1.172)
|
Current Employment Status
|
|
|
|
|
|
|
Employed
|
1.000
|
|
|
1.000
|
|
|
Not employed
|
0.892
|
0.098
|
(0.779 1.021)
|
0.890
|
0.126
|
(0.766 1.033)
|
Visited health facility 12 months prior to survey
|
|
|
|
|
|
|
No
|
1.000
|
|
|
1.000
|
|
|
Yes
|
0.811
|
0.002
|
(0.709 0.929)
|
0.992
|
0.08
|
(0.825 1.192)
|
Knowledge of family planning method
|
|
|
|
|
|
|
Knows no method/knows only traditional method
|
1.000
|
|
|
1.000
|
|
|
Know modern method
|
0.536
|
0.004
|
(0.007 0.380)
|
1.110
|
0.839
|
(0.406 3.030)
|
Exposure to media FP messages
|
|
|
|
|
|
|
No
|
1.000
|
|
|
1.000
|
|
|
Yes
|
1.017
|
0.807
|
(0.890 1.160)
|
0.820
|
0.018
|
(0.695 .967)
|
AOR = Adjusted Odds Ratio, CI=Confidence Interval, Confidence Interval, p-value≤0.05 is statistically significant |
In terms of province (region) of residence, the findings suggest that married women living in Central, Eastern, Lusaka, Muchinga and Northern provinces were less likely to have unmet need compared to those living in Western Province {AOR=0.61; 95% CI: 0.45, 0.82; p=0.001}, {AOR=0.70; 95% CI: 0.52, 0.93; p=0.016}, {AOR=0.69; 95% CI: 0.49, 0.96; p=0.026}, {AOR=0.45; 95% CI: 0.31, 0.66; p<0.001}, and {AOR=0.61; 95% CI: 0.43, 0.86; p=0.006}, respectively.