Contraceptive use among women of reproductive age in Nigeria: A cross-sectional population-based survey (2011–2021)

INTRODUCTION

Contraceptive usage is a critical aspect of reproductive health, influencing not only population growth but also women’s autonomy over their fertility decisions. According to the World Health Organization (WHO), of the 1.9 billion women of reproductive age (15–49 years) globally in 2021, 1.1 billion required family planning services. Among them, 874 million individuals were utilizing modern contraceptive methods, whereas 164 million still lacked access to the contraception they needed.^[1] Across the globe, the use of contraceptives has been recognized as a key intervention in improving maternal health, reducing unintended pregnancies, and promoting gender equality.^[2] Despite worldwide initiatives to improve access to family planning services, the use of contraceptives continues to be limited in numerous low- and middle-income nations, especially across Sub-Saharan Africa.^[3,4]

Nigeria, known for having one of the most elevated fertility rates in Sub-Saharan Africa, has consistently recorded low adoption of modern contraceptive methods.^[5] In 2023, the Statista Research Department reported that the contraception prevalence rate among women of reproductive age in Nigeria was 18%.^[6] There are clear inequalities in contraceptive prevalence among women of reproductive age, with significant variation across different regions and socioeconomic backgrounds due to cultural, religious, and economic influences.^[7] Although Nigeria has made strides in increasing access to family planning services, disparities remain, with significant barriers preventing widespread adoption of contraceptives.^[5,8]

The role of education, wealth, and regional disparities in contraceptive use has been extensively documented in the literature. Research conducted throughout SubSaharan Africa consistently shows that women with greater educational attainment are more inclined to adopt modern contraceptive methods.^[7,9,10] In Ethiopia, for instance, women with secondary or higher education had significantly higher likelihood of using modern contraceptives compared to those with no formal education.^[8,11] Similarly, women from higher-income households and those living in urban settings tend to use contraceptives more frequently, largely due to improved access to health services and increased knowledge of family planning choices.^[11,12]

Religion and cultural beliefs serve as key drivers in the formation of attitudes toward contraceptive use. In predominantly Muslim countries such as Ethiopia and Kenya, Research indicates that women from Muslim communities are generally less inclined to use modern contraceptives than those from Christian backgrounds, likely due to religious teachings and sociocultural norms that discourage contraceptive use.^[7,8] This trend is also observed in Nigeria, where spiritual and cultural influences significantly affect family planning decisions, particularly in the northern regions.^[2,5] It is also important to acknowledge the potential influence of social desirability bias in self-reported contraceptive use, as participants may have overreported behaviors perceived as socially acceptable or underreported those considered culturally sensitive.^[13]

Regional disparities are a significant challenge in promoting contraceptive use across Nigeria. The country’s diverse geographic and cultural landscape contributes to varying levels of contraceptive uptake, with northern regions reporting lower usage than the southern regions.^[7,14] Research has shown that women in urban areas, especially in the South-East and South-West regions, had higher odds of using contraceptives compared to those living in rural or northern parts, where access to family planning services is limited.^[5,7] These regional differences highlight the need for targeted interventions that address the unique barriers faced by women in rural and underdeveloped areas.

The fluctuating trends in contraceptive use observed in Nigeria over the past decade underscore the complexity of the issue. For instance, in Yemen, contraceptive use was found to be relatively low, with only 32.8% of married women using modern contraceptive methods.^[14] Similarly, in Tanzania, Abeid et al.^[15] Reported low uptake of modern contraceptives, with cultural barriers and social stigma acting as significant deterrents. These findings relate to the challenges Nigeria faces in achieving sustained increases in contraceptive use despite ongoing efforts by the government and non-governmental organizations.

Against this backdrop, this study seeks to examine the patterns and factors influencing contraceptive use among women of reproductive age in Nigeria over the past decade (2011–2021). By examining the sociodemographic factors influencing contraceptive behavior and identifying key barriers to uptake, this study contributes to the growing body of evidence on family planning in Nigeria. The findings will contribute valuable information to guide policymakers and healthcare providers to design targeted interventions that promote equitable access to contraception services and improve reproductive health outcomes for women across the country.

MATERIAL AND METHODS

RESULTS

Contraceptive use among women of reproductive age

The use of contraceptives among reproductive age women is shown in Figure 1. The findings reveal that 77,106 (83.0%) no use of contraceptive methods, while 15,747 (17.0%) report using contraceptives.

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Figure 1:

Contraception usage among reproductive aged women.

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Trend on the use of contraceptive among women of reproductive age 2011–2021

Figure 2 illustrates the trend of the usage of contraceptive among reproductive age women in Nigeria from 2011 to 2021. It shows from 2011 to 2021, women’s utilization of contraceptives in Nigeria showed a fluctuating trend. In 2011, 19.6% used contraceptives, which declined to 13.8% in 2016/2017. By 2021, usage slightly increased to 17.7%.

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Figure 2:

Trend of contraception usage among reproductive aged women 2011–2021. The blue line indicates prevalence of contraceptive use

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Contraceptive methods usage among reproductive aged women

Figure 3 reveals various methods of contraception usage among women of reproductive aged. Among these women in Nigeria, the most commonly used contraceptive methods are fertility awareness-based methods, accounting for 6.18%, followed by short-acting hormonal methods at 5.55%, and barrier methods at 4.07%. Long-acting reversible contraception is used by 2.54%, while other methods and permanent methods are less common, with 0.79% and 0.23% usage, respectively. Spermicidal Methods are the least used, at just 0.03%.

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Figure 3:

Contraceptive methods use among women of reproductive age.

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Reasons for not using contraceptive among women of reproductive age

Figure 4 shows the reasons some reproductive aged women do not use contraceptives. Among reproductive aged women in Nigeria who do not use contraceptives, the most common reasons are breastfeeding (4.00%) and infrequent or no sex (3.76%). Other significant reasons include being menopausal (1.89%) and trying to conceive unsuccessfully for 2 years (1.07%). Less common reasons are never menstruating (0.95%), feeling too old (0.64%), and postpartum amenorrhea (0.22%). Fatalistic beliefs (0.10%) and having had a hysterectomy (0.16%) are the least cited reasons.

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Figure 4:

Reasons for not using contraceptive among reproductive aged women.

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DISCUSSION

The overall contraceptive rate observed in this study was 17.0%, with a notable fluctuating trend over the period. This prevalence is comparable to that reported in Boah et al.^[14] who found 32.8% of women who use contraceptive in Yemen. While the prevalence in Yemen is higher than in Nigeria, both countries demonstrate low overall usage rates. Similarly, Beyene et al.^[8] found that modern contraceptive use (MCU) in Ethiopia stayed at 28%, slightly higher than in Nigeria, but still reflecting the general trend of underutilization in Sub-Saharan region of Africa. The study is conducted in conjunction with Kibria et al.^[16] who reported a high prevalence of the use of contraception (81.3%) among reproductive aged women in Bangladesh. These differences may be attributed to variations in study populations, cultural contexts, and access to contraceptive services.

The study observed a fluctuating trend in contraception usage among reproductive age women from 2011 to 2021. Contraceptive use decreased from 19.6% in 2011 to 13.8% in 2016/2017, before slightly increasing to 17.7% in 2021. The observed decline in contraceptives aligns with trends reported by Bolarinwa,^[5] who noted an surge in contraception usage from 8.25% in 2003 to 12.01% in 2018 in Nigeria. In contrast, Sidibé et al.^[17] documented significant increases in MCU from 8.4% in 1999 to 12.8% in 2018 among urban women in Guinea. The slight increase observed in 2021 may indicate the impact of recent interventions to improve family planning outreach or services. Both studies highlight the influence of socioeconomic, educational, and regional factors on contraceptive trends, with fluctuations possibly influenced by changes in policy, provision of family planning options, and sociocultural barriers.

The present study found that age, marital status, education, wealth, religion, and region significantly influenced contraceptive use. Participants aged 21–30, 31–40, and 41 and above were substantially higher likelihood to use contraceptives in contrast to those aged 20 and below, with AORs of 2.490, 2.788, and 2.426, respectively. Women aged 21–30 had the highest odds of using contraceptives, a finding consistent with Mahfouz et al.^[12] who discovered that women aged 20–34 had a greater likelihood of using contraceptives in Jazan, Saudi Arabia.

Wealthier individuals had higher odds of contraception usage. Those in the middle wealth category (AOR = 1.292) and the rich (AOR = 1.650) had higher odds than the poor. Higher educational attainment was linked with higher usage of contraceptive. Participants with primary education (AOR = 1.606) and secondary education or higher (AOR = 1.898) had higher chances of using contraceptives in contrast to those without formal education. The increased likelihood of contraception usage among wealthier and more educated women observed in this study mirrors findings from Beyene et al.^[8] (2023) and Bolarinwa,^[5] where those with higher education and wealth indices had higher odds of adopting contraceptive methods. In Ethiopia, for example, Beyene et al.^[8] reported that those with secondary or higher education significantly had lower odds of using modern contraceptives (OR = 1.71).

Conversely, married women in Nigeria showed reduced likelihood of contraceptive use compared to singles AOR = 0.787), which is in contrast to findings by Mankelkl et al.^[7] in Kenya, where being married was positively associated with contraceptive use (AOR = 1.593). This difference might be attributed to cultural norms and variations in family planning awareness between the two countries.

Religion played a significant role in determining contraceptive use, with Muslims (AOR = 0.490) and Christians (AOR = 0.862) having lower odds of usage compared to participants of other faiths. This result is consistent with findings from Beyene et al.^[8] in Ethiopia, where being Muslim was associated with a reduced likelihood of MCU (AOR = 0.25). Similarly, Mankelkl et al.^[7] reported a lower likelihood of contraceptive use among Muslims in Kenya. The lower contraceptive use among religious populations may be attributed to spiritual teachings that discourage contraception use or lack of adequate family planning education within these communities.

This study revealed notable regional differences in contraceptive use, with women in the South-East (AOR = 2.759) and South-West (AOR = 1.222) showing a higher likelihood of contraceptive usage in contrast to their counterparts in the North-Central region. This finding aligns with Bolarinwa,^[5] who also highlighted regional inequalities in Nigeria, with women in urban areas having greater links to and higher usage of contraceptives. This result may reflect differences in cultural norms, availability of services, and educational levels across the regions. Sidibé et al.^[17] also found that administrative region was associated with MCU in Guinea. The observed regional differences highlight the importance of implementing focused interventions in underdeveloped and rural regions to promote equal access to family planning services.

Participants who had ever given birth had higher odds of using contraceptives (AOR = 1.977). This result links with the work of Oppong et al.,^[18] who noted increased the usage of contraceptive among women with prior pregnancies in Ghana. Similarly, Ahinkorah et al.^[19] reported that in Mali, Women with four or more children showed a greater inclination to use modern contraceptives (AOR = 1.85). Based on this finding, childbearing experience may likely increase the desire to space or limit further pregnancies.

In this study, the most commonly used contraceptive methods were fertility awareness-based methods, short-term hormonal contraceptives, and physical barrier methods. This research is somewhat consistent with the findings by Hale et al.^[20] that short-acting hormonal methods are the most commonly used popular (26.3%) among women in southeastern U.S. states. However, in Ethiopia, injectables were the most commonly used method (32%), as reported by Apanga et al.^[9] demonstrating regional variations in preferred contraceptive methods.

The barriers to contraceptive use identified in the Nigerian study, such as breastfeeding and infrequent sexual activity, were also observed in Abeid et al.^[15] in Tanzania, where fear of divorce and social stigma were cited as major deterrents to contraceptive adoption. The finding is also consistent with Agyemang et al.^[21] who found that perceived side effects and infrequent sexual activity were reasons for non-use among sexually active women in Ghana. Cohen et al.^[22] highlighted the importance of counseling to address misconceptions and improve contraceptive initiation. These results indicate that cultural and societal norms significantly influence contraceptive practices, necessitating interventions that address both knowledge gaps and sociocultural beliefs. This finding is supported by Taiwo et al.^[23] who found that early marriage, pressure to prove fertility, and strong disapproval of premarital contraception were key cultural barriers, reinforced by family and community actors in Northern Nigeria. These norms significantly discouraged MCU among women.

CONCLUSION

This study provides a comprehensive analysis of the usage of contraceptive and its associated factors among reproductive age women in Nigeria. The findings reveal a relatively low prevalence of contraceptive use (17.0%) despite a steady increase in usage between 2016/2017 and 2021. Sociodemographic factors such as age, marital status, education, wealth status, and religious affiliation significantly influenced contraceptive use. Notably, older age groups, higher educational attainment, and wealthier individuals had higher odds of using contraceptives. Conversely, religious and regional differences contributed to variations in contraceptive uptake. The findings underscore the importance of focused interventions to enhance access to family planning services, particularly for younger, less educated, and socioeconomically disadvantaged groups. Addressing cultural, religious, and social barriers will be crucial in promoting broader contraception usage and supporting reproductive health among reproductive aged women in Nigeria. Future research should also consider the role of social desirability bias in self-reported data, as it may influence the accuracy of contraceptive prevalence estimates.