Department of Biological Sciences
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Item Trends and inequalities in modern contraceptive use among women in Sierra Leone, 2008–2019(BioMed Central, 2024-11-19) Osborne, AugustusBACKGROUND: Despite the known benefits of modern contraceptives in preventing unwanted pregnancies and reducing unsafe abortions, their use remains low among women of reproductive age in several sub-Saharan African countries, including Sierra Leone. This study investigated the inequalities in modern contraceptive use among women in Sierra Leone based on data from 2008 to 2019. METHODS: We used data from the Sierra Leone Demographic Health Survey data rounds (2008, 2013, and 2019). The World Health Organization's Health Equity Assessment Toolkit (WHO's HEAT) software was used to calculate both simple measures; Difference (D) and Ratio (R) and complex measures of inequality: Population Attributable Risk (PAR) and Population Attributable Fraction (PAF). The inequality assessment was done for five stratifiers: age, economic status, level of education, place of residence, and sub-national province. RESULTS: The study found that the prevalence of modern contraceptive use among women in Sierra Leone increased from 6.7% in 2008 to 20.9% in 2019. There was an increase in age-related inequality from a Difference of 5.9 percentage points in 2008 to 7.0 percentage points in 2019. PAF decreased from 5.7% in 2008 to 1.6% in 2019, indicating that the national average of modern contraceptive use would have increased by 5.7% in 2008 and 1.6% in 2019 in the absence of age-related inequalities. For economic status, the Difference decreased from 14.9 percentage points in 2008 to 9.9 percentage points in 2019. PAF decreased from 166.3% in 2008 to 23.3% in 2019, indicating that the national average of modern contraceptive use would have increased by 166.3% in 2008 and 23.3% in 2019 in the absence of economic-related inequalities. For education, the Difference decreased from 15.1 percentage points in 2008 to 12.4 percentage points in 2019. The PAF shows that the national average of modern contraceptive use would have reduced from 189.8% in 2008 to 39.5% in 2019, in the absence of education-related inequality. With respect to place of residence, the Difference decreased from 10.4 percentage points in 2008 to 7.6 percentage points in 2019, and PAF decreased from 111.2% in 2008 to 23.0% in 2019. The decline in PAF indicates that the national average of modern contraceptive use would have increased by 111.2% in 2008 and 23.0% in 2019 without residence-related inequality. Provincial-related inequality decreased from a Difference of 15.5% in 2008 to 8.5% in 2019. The PAF results showed a decrease in inequality from 176.3% in 2008 to 16.7% in 2019, indicating that province would contribute 176.3% and 16.7% in 2008 and 2019 respectively to the national average of modern contraceptive use. CONCLUSION: The use of modern contraceptives among women of reproductive age in Sierra Leone increased between 2008 and 2019 reflecting positive progress in reproductive health initiatives and access to family planning resources. The reductions in inequalities related to economic status, education, residence, and province indicate that efforts to promote equity in contraceptive access are yielding results, although age-related inequalities persist. To build on these advancements, it is recommended that policymakers continue to strengthen educational campaigns and healthcare services, particularly targeting younger women. Additionally, enhancing access to contraceptive methods through community-based programs and addressing socio-economic barriers will be crucial in further reducing inequalities and improving overall reproductive health outcomes in Sierra Leone.Item Inequalities in contraceptive prevalence among married women of reproductive age in Sierra Leone, 2008–2019(BioMed Central, 2025-06-18) Osborne, AugustusBACKGROUND: Family planning, through access to safe and effective contraception, empowers women to make informed choices about their reproductive health. It is crucial in reducing unintended pregnancies, maternal mortality, and improving overall well-being. However, achieving equitable access to contraception remains a challenge in many low- and middle-income countries, including Sierra Leone. This study investigated the inequalities in contraceptive prevalence among married women of reproductive age (15-49 years) in Sierra Leone in 2008, 2013 and 2019. METHODS: This study employed time-trend study design utilizing data from three rounds of the Sierra Leone Demographic Health Survey conducted in 2008, 2013, and 2019. The health equity assessment toolkit software, developed by the World Health Organisation, was utilised to calculate various inequality measures. These include simple measures such as difference and ratio, as well as complex measures such as population attributable risk and fraction. RESULTS: The prevalence of contraceptive use among reproductive-aged married women in Sierra Leone increased from 8.2% in 2008 to 21.2% in 2019. The inequality in married women's age in contraceptive prevalence between older and younger women decreased slightly from 7.5 percentage points in 2008 to 7.2 percentage points in 2019. The ratio also decreased, indicating a narrowing gap in contraceptive prevalence between the age groups over time. Inequality in economic status in contraceptive prevalence between married women in the richest and poorest wealth index decreased from 15.7 percentage points in 2008 to 9.9 percentage points in 2019. The population attributable fraction and population attributable risk decreased notably, suggesting that economic status became less of a determinant factor in contraceptive prevalence over time. The educational inequality in contraceptive prevalence between married women with secondary or higher education and those with no education experienced a decline from 16.5 percentage points in 2008 to 12.6 percentage points in 2019. Place of residence inequality in contraceptive prevalence between married women in urban and rural areas decreased from 11.2 percentage points in 2008 to 7.4 percentage points in 2019. Provincial inequality in contraceptive prevalence between married women in the Western area and Northwestern province decreased from 16.7 percentage points in 2008 to 8.6 percentage points in 2019. CONCLUSION: The prevalence of contraceptive use among reproductive-aged married women in Sierra Leone has notably increased over the past decade, accompanied by notable reductions in inequalities across age, economic status, education, place of residence, and geographic provinces. While inequalities persist, the narrowing gaps underscore progress in improving equitable access to contraceptive services. These findings underscore the importance of sustained efforts to address remaining inequalities and further enhance access to family planning resources for all women, particularly those in underserved populations.