This is to confirm that Naznin Mostary has worked under my supervision on “Divisional Variations of Contraceptive Use in Bangladesh: An Evidence from BDHS 2017-18 Data”. Higher prevalence of contraceptive use could be a reason to improve the health benefits of pregnancy spacing for maternal and child health and reduce maternal morbidity and mortality in Bangladesh. Contraceptive use among women of childbearing age was above 55 percent in 37 countries and below 20 percent in 23 countries in 2019 (Bongaarts, 2020).
By 1990, all other regions had already reached a prevalence of contraceptive use of more than 50 percent. In our country, the effective history of family planning programs led many researchers to investigate the determinants of contraceptive use in Bangladesh. Although many studies have examined the determinants of contraceptive use, none of the previous studies, to our knowledge, have explicitly examined the divisional variations in contraceptive use in Bangladesh based on a previous BDHS report 2017-18.
The aim of this study is to determine whether there are differences in contraceptive use among the eight administrative units of Bangladesh responsible for not achieving the target of 75% CPR by 2021.
Research Hypothesis
However, current contraceptive use poses a challenge for policymakers to achieve the HPNSDP and FP 2020 target of a 13% increase in contraceptive use over the next few years. Given the context of high fertility in this region, in order to meet these goals and show the way to policy makers, our study seeks to investigate regional differences and other factors such as socioeconomic, demographic, and other factors of women and/or families. of associated factors that actually influence contraceptive use among currently married women aged 15–49 years in Bangladesh.
Objective of the Study
Bangladesh Demographic and Health Survey 2017-18
We included only currently married women aged 15–49 years for analysis, given the nature of the outcome variable of interest (ie, contraceptive use). Women who were either pregnant or divorced/widowed/divorced at the time of the survey were excluded from the study.
Dependent and Independent Variables
We also excluded women who said they had never had sex and were infertile. higher), prosperity index (poorest, poorer, middle, richer and richest), current work status (working and not working), reading newspaper (yes and no), listening to radio (yes and no), watching television (yes and no), currently breastfeeding (yes and no), husband's education (no education, primary, secondary and higher), visit by family planning workers in the past six months (yes and no), number of living children (0, 1-2, > 2), number of sons gt;2), desire for more children (wants more children, does not want more children and others such as undecided and uncertain timing), desire of spouses for children (both want the same, husband wants more, husband wants less and don't know what the man wants).
Statistical Methodology
Ethical Consideration
Analysis of Data on Contraceptive Use
Descriptive Statistical Analysis
Mean and standard deviation (in brackets) of respondent's age and age at first birth, per division. The distribution of place of residence is not the same across divisions, with 75% of women in Mymensingh division coming from rural areas and only 41% of women in Dhaka division coming from rural areas. In each of the five wealth index categories, about 23% of women are the richest and the smallest (7%) and highest (34%) number of poorest women are from Dhaka and Rangpur divisions respectively.
The frequency distribution table of respondents' background characteristics (Table 3) shows that among the five categories of educational qualifications, most of women's educational qualifications are of secondary level and the total percentage is about 39, with the highest percentage found in Chattogram ( 45%), and the lowest is in Sylhet and Mymensingh division (33%). Among them, the highest percentage of working women live in Rangpur division (67%) and the lowest in Sylhet division (32%). A total of 63% of women watch television, the highest is in the Dhaka division (78%) and the lowest in the Barisal division (46%), but most women have no inclination to read newspapers or magazines and listen to the radio.
About 56% women have normal body mass index and among them the highest is from Rangpur division and the lowest is from Dhaka and Khulna division. Deciding whether to use contraception or not is the maximum in the joint decision of husband and wife, which is 78% and 63%. Maximum number of women (81%) reported that they were not visited by family planning workers in the last 6 months.
Approximately more than half of women mentioned having one or two children as the ideal number of children ever born and the number of living children. Maximum women had only one son and more than half of the total respondents did not want to have more children. Maximum husband's desire for more children was the same as their wife's and the percentage was 79.
Logistic Regression Model
Because the number of obese women was very small, the BMI categories for obese and overweight were combined. Due to a large number of missing observations, we omitted four variables (the man's desire for more children, the total number of children ever born, the decision maker on contraceptive use, and the decision maker on not using contraceptives) from this model. . Table 5 shows that there is a significant difference in the prevalence of contraceptive use among women from different divisions as the probability of contraceptive use for women from Chattogram division is about 29.5% lower than that of Barisal division and the decrease of the odds are higher than that of women from Chattogram division. statistically significant (p<0.05).
There is no significant difference in the odds of contraceptive use for women in Barisal and other wards. In addition, women living in rural areas were found to have 22 percent [95% CI lower odds of contraceptive use compared to their counterparts living in urban areas. For one year increase in age, the odds of using contraceptives decreased by 3.5% (p < 0.001), which showed that age is a significant factor associated with the use of contraceptives in Bangladeshi women.
The followers of Islam were less likely to use contraceptives compared to followers of other religions (OR:0.60) and the difference is statistically significant (p < 0.001). The women who were currently working, received a visit from a family planning worker in the last six months, watched television and read a newspaper were significantly more likely to use contraception compared to matched reference categories. The study respondents who had no children and did not have a son had statistically significant lower odds of using contraception compared to the respondents who had more than 1 child or a son.
48.9% and 60% respectively) than women who were not interested in having more children and the decrease in odds is statistically significant (p < 0.001). On the other hand, there were no significant effects of other covariates considered in the model, e.g.
Discussion
To increase CPR, family planning programs in Bangladesh should place more emphasis on providing family planning services and focus on allocating more resources in rural areas than in urban areas in general. Consistent with other research, we also found that rural women are less likely to use contraceptives than urban women (Kamal and Islam, 2010; Kamal, 2015; Kibria et al., 2016; Islam and Haque, 2020). Contraceptive use also varies depending on religious affiliation, with family planning beliefs and other cultural trends potentially reducing the prevalence of contraceptive use (Srikanthan and Reid, 2008).
Studies and analyzes in some other research articles show that religion does not have any significant effect on contraceptive use, although some articles emphasize the impact of religion on contraceptive use (Kamal and Islam, 2010; Islam et al., 2010; Sahu and Hutter, 2012). Although the high level of contraceptive use among young women is generally attributed to their reluctance to have children, the decline in current contraceptive use among older women is generally attributed to their declining fertility (Goni and Rahman, 2012). Another effective indirect strategy to significantly reduce inter-divisional disparities in contraceptive use could be to increase female employment in Bangladesh.
This is supported by the findings of this study that women who were currently employed had higher rates of contraceptive use compared to those who were unemployed. Our results support findings from several other studies showing that women who had a family planning worker's visit in the past six months had the greatest impact on contraceptive use (Kamal and Islam, 2010; Kamal, 2015; Kibria et al., 2016; Islam. and Haque, 2020). This is an encouraging result that has implications for promising future trends in family planning utilization.
On the other hand, we found that women's education, wealth index, age at first birth, BMI, current breastfeeding status and whether radio listening had no significant association with contraceptive use when adjusted for other factors. We did not find the positive effect of men's education on contraceptive use in this study when other factors were taken into account (Islam and Haque, 2020). Like previous studies, the desire for more children and boys has a great impact on the use of contraceptives (Kamal and Islam, 2010; Kamal, 2015; Islam et al., 2010; Sahu and hutter, 2012), our study also showed that the respondents who had no children and not a boy had a statistically significant lower chance of using contraception compared to the respondents who had more than 1 child or a boy.
Conclusion
Finally, those living in rural areas and Chattogram wards should be targeted for increased and tailored services to raise the standard of living of their population. Although the findings of this study simplify the adaptation of a national approach to increase contraceptive use in backward parts of the country, unidentified barriers and reasons for low contraceptive use should be uncovered or identified through a more in-depth analysis separately in each division of Bangladesh in the future, which will provide clear insights for planners. programs and policy makers.
Prevalence and determinants of contraceptive use among employed and unemployed women in Bangladesh. International Journal of MCH and AIDS (IJMA), 5 (2). Socio-economic factors associated with contraceptive use and method choice in urban slums of Bangladesh.Asia Pac.
