Drivers of contraceptive use choice in Zambia

Promise M. Nduku, Beatrice D. Simo-Kengne


Modern approaches of birth control have emerged as broadly accepted family planning methods in replacement of traditional alternatives. However, the effectiveness of modern contraceptives has been challenged by serious side effects, either experienced or expected, with inhibiting consequences on the acceptability and utilisation of family planning service. This paper disentangles the drivers of none-use, traditional and modern contraceptive use in Zambia using the 2018 Zambian Demographic Health Surveys (DHS) data. The Conditional logit choice modelling technique is employed to account not only for the differences in alternative contraceptive options but also the socioeconomic and demographic characteristics of individual woman making the choice. Empirical results indicate that educated, older and poorer women are likely to adopt the traditional contraceptive methods whereas employed women are indifferent between traditional and modern birth control options. Furthermore, Christian women and those from other religions as well as women with no education prefer no birth control method. The study concludes that employment has the potential to serve as an alternative and safer birth control tool in developing countries and namely in Zambia. Therefore, government’s effort to expand family planning program should mainly target non-educated women while promoting safer contraceptive methods. This can be achieved through women education and job creation. (Afr J Reprod Health 2022; 26[5]:13-27).

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Greene M, Joshi S and Robles OJ. By choice, not by chance: family planning, human rights and development. United Nations Population Fund; 2012.

World Health Organization. Annexes: ensuring human rights in the provision of contraceptive information and services: guidance and recommendations. World Health Organization; 2014.

Gaffield ME, Egan S and Temmerman M. It's about time: WHO and partners release programming strategies for postpartum family planning. Global Health: Science and Practice. 2014 Feb 1;2(1):4-9.

Zambia Ministry of Health: Family planning services.: Costed Eight Year Integrated

Family Planning Scale up 2013-2020. Lusaka, Zambia: Government of the republic of

Zambia: 2013

Desa UN. Transforming our world: The 2030 agenda for sustainable development. 2016

Zambia Statistics Agency, Ministry of Health (MOH) Zambia, and ICF. (2019). 2018 Zambia Demographic Health Survey Summary Report. Lusaka, Zambia: 2019

World Health Organisation (2018, February 8). Family planning / contraception. [ONLINE]. Available at [Accessed 15 November 2020].

Rabiu A. The role of traditional contraceptive methods in family planning among women attending primary health care centers in Kano. Annals of African medicine. 2018 Oct;17(4):189.

Jalang’o R, Thuita F, Barasa SO and Njoroge P. Determinants of contraceptive use among postpartum women in a county hospital in rural KENYA. BMC public health. 2017 Dec;17(1):1-8.

Gonie A, Worku C, Assefa T, Bogale D and Girma A. Acceptability and factors associated with post-partum IUCD use among women who gave birth at bale zone health facilities, Southeast-Ethiopia. Contraception and reproductive medicine. 2018 Dec;3(1):1-8.

Schrumpf LA, Stephens MJ, Nsarko NE, Akosah E, Baumgartner JN, Ohemeng-Dapaah S and Watt MH. Side effect concerns and their impact on women’s uptake of modern family planning methods in rural Ghana: a mixed methods study. BMC women's health. 2020 Dec;20(1):1-8.

Staveteig S. Fear, opposition, ambivalence, and omission: Results from a follow-up study on unmet need for family planning in Ghana. PloS one. 2017 Jul 31;12(7):e0182076.

Rademacher KH, Sergison J, Glish L, Maldonado LY, Mackenzie A, Nanda G and Yacobson I. Menstrual bleeding changes are NORMAL: proposed counseling tool to address common reasons for non-use and discontinuation of contraception. Global Health: Science and Practice. 2018 Oct 3;6(3):603-10.

Sedgh G and Hussain R. Reasons for contraceptive nonuse among women having unmet need for contraception in developing countries. Studies in family planning. 2014 Jun;45(2):151-69.

Wulifan JK, Brenner S, Jahn A and De Allegri M. A scoping review on determinants of unmet need for family planning among women of reproductive age in low and middle income countries. BMC women's health. 2015 Dec;16(1):1-5.

Chebet JJ, McMahon SA, Greenspan JA, Mosha IH, Callaghan-Koru JA, Killewo J, Baqui AH and Winch PJ. “Every method seems to have its problems”-Perspectives on side effects of hormonal contraceptives in Morogoro Region, Tanzania. BMC women's health. 2015 Dec;15(1):1-2.

Bellizzi S, Mannava P, Nagai M and Sobel HL. Reasons for discontinuation of contraception among women with a current unintended pregnancy in 36 low and middle-income countries. Contraception. 2020 Jan 1;101(1):26-33.

Williams SL, Parisi SM, Hess R and Schwarz EB. Associations between recent contraceptive use and quality of life among women. Contraception. 2012 Mar 1;85(3):282-7.

Zethraeus N, Dreber A, Ranehill E, Blomberg L, Labrie F, von Schoultz B, Johannesson M and Hirschberg AL. A first-choice combined oral contraceptive influences general well-being in healthy women: a double-blind, randomized, placebo-controlled trial. Fertility and sterility. 2017 May


Casey PM, MacLaughlin KL and Faubion SS. Impact of

contraception on female sexual function. Journal of Women's Health. 2017 Mar 1;26(3):207-13.

Worly BL, Gur TL and Schaffir J. The relationship between progestin hormonal contraception and depression: a systematic review. Contraception. 2018 Jun 1;97(6):478-89.

Pörtner CC, Beegle K and Christiaensen L. Family planning and fertility: Estimating program effects using cross-sectional data. World Bank Policy Research Working Paper. 2011 Sep 1(5812)

Rossier C and Corker J. Contemporary use of traditional contraception in sub-Saharan Africa. Population and Development Review. 2017 May;43(Suppl 1):192.

Machiyama K and Cleland J. Unmet need for family planning in Ghana: the shifting contributions of lack of access and attitudinal resistance. Studies in Family Planning. 2014 Jun;45(2):203-26.

Ochako R, Mbondo M, Aloo S, Kaimenyi S, Thompson R, Temmerman M and Kays M. Barriers to modern contraceptive methods uptake among young women in Kenya: a qualitative study. BMC public health. 2015 Dec;15(1):1-9.

Muanda MF, Ndongo GP, Messina LJ and Bertrand JT. Barriers to modern contraceptive use in rural areas in DRC. Culture, health & sexuality. 2017 Sep 2;19(9):1011-23.

Darroch JE and Singh S. Trends in contraceptive need and use in developing countries in 2003, 2008, and 2012: an analysis of national surveys. The Lancet. 2013 May 18;381(9879):1756-62.

Loaiza E and Blake S. How universal is access to reproductive health. A review of the evidence. New York (NY): United National Population Fund:2010

Glasser W. Choice theory: A new psychology of personal freedom. Harper Perennial; 1999.

Ayanore MA, Pavlova M and Groot W. Unmet reproductive health needs among women in some West African countries: a systematic review of outcome measures and determinants. Reproductive health. 2015 Dec;13(1):1-0.

Okech TC, Wawire NW and Mburu TK. Contraceptive use among women of reproductive age in Kenya’s city slums.. Available at [Accessed 11 November 2020].

Ankomah A, Anyanti J and Oladosu M. Myths, misinformation, and communication about family planning and contraceptive use in Nigeria. Open Access Journal of Contraception. 2011 Jun 21;2:95-105.

Salway S and Nurani S. Postpartum contraceptive use in Bangladesh: understanding users' perspectives. Studies in Family Planning. 1998 Mar 1:41-57.

Eliason S, Baiden F, Quansah-Asare G, Graham-Hayfron Y, Bonsu D, Phillips J and Awusabo-Asare K. Factors influencing the intention of women in rural Ghana to adopt postpartum family planning. Reproductive health. 2013 Dec;10(1):1-8.

Rijsdijk LE, Bos AE, Lie R, Ruiter RA, Leerlooijer JN and Kok G. Correlates of delayed sexual intercourse and condom use among adolescents in Uganda: a cross-sectional study. BMC Public Health. 2012 Dec;12(1):1-0.

Nalwadda G, Mirembe F, Byamugisha J and Faxelid E.

Persistent high fertility in Uganda: young people recount obstacles and enabling factors to use of contraceptives. BMC public health. 2010 Dec;10(1):1-3.

Kiene SM, Hopwood S, Lule H and Wanyenze RK. An empirical test of the Theory of Planned Behaviour applied to contraceptive use in rural Uganda. Journal of health psychology. 2014 Dec;19(12):1564-75.

Hung KJ, Scott J, Ricciotti HA, Johnson TR and Tsai AC. Community-level and individual-level influences of intimate partner violence on birth spacing in sub-Saharan Africa. Obstetrics & Gynecology. 2012 May 1;119(5):975-82.

Stephenson R, Baschieri A, Clements S, Hennink M and Madise N. Contextual influences on modern contraceptive use in sub-Saharan Africa. American journal of public health. 2007 Jul;97(7):1233-40.

Ketende C, Gupta N and Bessinger R. Facility-level reproductive health interventions and contraceptive use in Uganda. International family planning perspectives. 2003 Sep 1:130-7.

Ensor T and Cooper S. Overcoming barriers to health service access: influencing the demand side. Health policy and planning. 2004 Mar 1;19(2):69-79.

Eliason S, Awoonor-Williams JK, Eliason C, Novignon J, Nonvignon J and Aikins M. Determinants of modern family planning use among women of reproductive age in the Nkwanta district of Ghana: a case–control study. Reproductive health. 2014 Dec;11(1):1-0.

Mekonnen W and Worku A. Determinants of low family planning use and high unmet need in Butajira District, South Central Ethiopia. Reproductive health. 2011 Dec;8(1):1-8.

Asiimwe JB, Ndugga P, Mushomi J and Ntozi JP. Factors associated with modern contraceptive use among young and older women in Uganda; a comparative analysis. BMC public health. 2014 Dec;14(1):1-1.

Tekelab T, Melka AS and Wirtu D. Predictors of modern contraceptive methods use among married women of reproductive age groups in Western Ethiopia: a community based cross-sectional study. BMC women's health. 2015 Dec;15(1):1-8.

Rutaremwa G, Galande J, Nviiri HL, Akiror E and Jhamba T. The contribution of contraception, marriage and postpartum insusceptibility to fertility levels in Uganda: an application of the aggregate fertility model. Fertility research and practice. 2015 Dec;1(1):1-8.

Rasooly MH, Ali MM, Brown NJ and Noormal B. Uptake and predictors of contraceptive use in Afghan women. BMC women's health. 2015 Dec;15(1):1-7.

Kidayi PL, Msuya S, Todd J, Mtuya CC, Mtuy T and Mahande MJ. Determinants of modern contraceptive use among women of reproductive age in Tanzania: evidence from Tanzania demographic and health survey data. Advances in Sexual Medicine. 2015;5(03):43.

Apanga PA and Adam MA. Factors influencing the uptake of family planning services in the Talensi District, Ghana. Pan African Medical Journal. 2015 Mar 6;20(1).

Adebowale SA, Adedini SA, Ibisomi LD and Palamuleni ME. Differential effect of wealth quintile on modern contraceptive use and fertility: evidence from Malawian women. BMC women's health. 2014 Dec;14(1):1-3.

Ajayi AI, Adeniyi OV and Akpan W. Maternal health care visits as predictors of contraceptive use among childbearing women in a medically underserved state in Nigeria. Journal of Health, Population and Nutrition. 2018 Dec;37(1):1-0.

Palamuleni ME. Socio-economic and demographic factors affecting contraceptive use in Malawi. African journal of reproductive health. 2013 Sep 6;17(3):91-104.

Worku AG, Tessema GA and Zeleke AA. Trends of modern contraceptive use among young married women based on the 2000, 2005, and 2011 ethiopian demographic and health surveys: a multivariate decomposition analysis. PloS one. 2015 Jan 30;10(1):e0116525.

Tiruneh FN, Chuang KY, Ntenda PA and Chuang YC. Factors associated with contraceptive use and intention to use contraceptives among married women in Ethiopia. Women & health. 2016 Jan 2;56(1):1-22.

Achana FS, Bawah AA, Jackson EF, Welaga P, Awine T, Asuo-Mante E, Oduro A, Awoonor-Williams JK and Phillips JF. Spatial and socio-demographic determinants of contraceptive use in the Upper East region of Ghana. Reproductive health. 2015 Dec;12(1):1-0.

Balew GJ, Cho Y, Tammy Kim C and Ko W. Structural determinants in family planning service utilization in Ethiopia: EDHS 2011 analysis. BioMed research international. 2015 Dec 9;2015.

Solanke BL. Factors influencing contraceptive use and non-use among women of advanced reproductive age in Nigeria. Journal of Health, Population and Nutrition. 2017 Dec;36(1):1-4.

Yaya S, Uthman OA, Ekholuenetale M and Bishwajit G. Women empowerment as an enabling factor of contraceptive use in sub-Saharan Africa: a multilevel analysis of cross-sectional surveys of 32 countries. Reproductive health. 2018 Dec;15(1):1-2.

Shapiro D and Tambashe BO. Education, employment, and fertility in Kinshasa and prospects for changes in reproductive behavior. Population Research and Policy Review. 1997


Laskar MS, Mahbub MH, Yokoyama K, Inoue M and Harada N. Factors associated with contraceptive practices of married women in Bangladesh with respect to their employment status. The European Journal of Contraception & Reproductive Health Care. 2006 Jan 1;11(3):220-7.

Islam AZ, Mondal MN, Khatun ML, Rahman MM, Islam MR, Mostofa MG and Hoque MN. Prevalence and determinants of contraceptive use among employed and unemployed women in Bangladesh. International Journal of MCH and AIDS. 2016;5(2):92.

Pekkurnaz D. Employment Status and Contraceptive Choices of Women With Young Children in Turkey. Feminist Economics. 2020 Jan 2;26(1):98-120.

Dayioglu M and Kirdar MG. Determinants of and trends in labor force participation of women in Turkey Dayıoğlu M, Kırdar MG. Determinants of and trends in labor force participation of women in Turkey. 2010 (No. 75467, pp. 1-80). The World Bank.

Van den Broeck G. Women’s employment and family planning in rural Uganda. Women & health. 2020 May 27;60(5):517-33.

Xu Y, Bentley RJ and Kavanagh AM. Gender equity and contraceptive use in China: An ecological analysis. Women & health. 2011 Nov 30;51(8):739-58. Blackstone SR. Women’s empowerment, household status and contraception use in Ghana. Journal of biosocial science. 2017 Jul;49(4):423-34.

Blackstone SR. Women’s empowerment, household status and contraception use in Ghana. Journal of biosocial science. 2017 Jul;49(4):423-34.

Lasong J, Zhang Y, Gebremedhin SA, Opoku S, Abaidoo CS, Mkandawire T, Zhao K and Zhang H. Determinants of modern contraceptive use among married women of reproductive age: a cross-sectional study in rural Zambia. BMJ open. 2020 Mar 1;10(3):e030980.

Chola M, Hlongwana K and Ginindza TG. Patterns, trends, and factors associated with contraceptive use among adolescent girls in Zambia (1996 to 2014): a multilevel analysis. BMC Women's Health. 2020 Dec;20(1):1-1.

Stanfors M and Larsson C. Women’s education, empowerment, and contraceptive use in sub-Saharan Africa: findings from recent demographic and health surveys. Etude de la Population Africaine. 2014;28(2):1022-34.

Moono H. Modern contraceptive use and method choice among women in Zambia. 2011.The University of Oxford

Fushayi N. The determinants of contraceptive use in Zambia (Master's thesis, University of Cape Town).

Greene WH. Econometric analysis. 2018 (Eight Edition).

Hausman J and McFadden D. Specification tests for the multinomial logit model. Econometrica: Journal of the econometric society. 1984 Sep 1:1219-40.DHS Program. Demographic and Health Survey (DHS). (n.d.).

DHS Program. Demographic and Health Survey (DHS). (n.d.).

Olaomi JO and Ama NO. Family planning desires of older adults (50 years and over) in Botswana. South African Family Practice. 2019 Feb 1;61(1):30-8.


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