Examining the Relationships between Contraceptive Use and Childhood Mortality in Nigeria: A Multilevel Analysis
Keywords:
Contraceptive use, Child mortality, Multiple Indicator Cluster Survey, Multilevel modelingAbstract
Background
Under-five mortality (U5M) in Nigeria continues to be high, while contraceptive use has not increased despite national and global commitments to improve reproductive health. This study examines the relationship between contraceptive use and childhood mortality. It further explores the direct and indirect pathways connecting contraceptive use to childhood mortality.
Methods
The research utilized data from the 2021 Nigeria Multiple Indicator Cluster Survey (MICS) that was carried out on a nationally representative sample of 38,768 women aged 15-49 years. Life table Stata ltable techniques were used to estimate child mortality rates from censored survival data, while logistic regression was employed to identify factors affecting contraceptive utilization. The Cox proportional hazards model was used to investigate the relationships between contraceptive use and under-five mortality.
Results
About two-thirds (62.2%) of the mothers were aged 25-34, 67.9% were rural residents, and 52.9% had given birth at home. The contraceptive prevalence rate (CPR) was 21.7%, while the under-five mortality rate was 103/1,000 live births.
Mothers who used contraception had a slower rate of experiencing childhood mortality compared to non-user mothers (aHR = 0.812, CI: 0.674–0.981). Children whose mothers were aged 35+ (aHR = 0.305, CI: 0.109 – 0.854) had a slower rate of experiencing childhood mortality compared to mothers aged 15–24. Higher maternal education was associated with reduced mortality risk (aHR = 0.231, CI: 0.083–0.640). The moderation analysis revealed a greater effect of contraceptive use in reducing child mortality among educated mothers (β = -0.054, 95% CI: -0.115 to -0.0113).
Conclusion
The study highlights the relationship between maternal age, education, marriage, and place of residence and use of contraception and child survival in Nigeria. Therefore, low levels of contraceptive use remain a contributing factor to under-five mortality in Nigeria. Hence, targeted and context-defined reproductive health interventions are required to improve child survival outcomes in Nigeria.
References
Nilima S. Under-Five child mortality in Bangladesh: Classical and Bayesian approaches to Cox proportional hazard model. Bangladesh J Sci Res. 2017, 30(1&2):45–54.
Wegbom, A. I., Essi, I. D., & Kiri, V. A. Survival Analysis of Under-five Mortality and Its Associated Determinants in Nigeria. 2019
Franciele, M., da Silva, F., Souza, R. T., & Guimarães, R. A. Maternal health care and under-five mortality: Evidence from low- and middle-income countries. Global Health Action 2023, 16(1), 2198797.
Gage, A. J. Barriers to family planning in sub-Saharan Africa: A review of the literature. Studies in Family Planning 2021, 52(1), 29–50.
UNICEF. Under-five mortality, United Nations Inter-agency Group for Child Mortality Estimation (UN IGME)., Available from 2020: https://data.unicef.org/topic/child-survival/under-five-mortality.
Fagbamigbe, Adeniyi & Nnanatu, Chibuzor. Modelling the Spatial Distribution and the Factors Associated with Under-Five Mortality in Nigeria. Spatial Demography 2021, 10. 10.1007/s40980-021-00078-7.
UN-IGME Child Mortality Estimates. 2021.
Yaya, S., Bishwajit, G., Okonofua, F., & Uthman, O. A. Under five mortality patterns and associated maternal risk factors in sub-Saharan Africa: a multi-country analysis. PloS one 2018, 13(10), e0205977.
Adebowale, S. A., Yusuf, O. B., & Fagbamigbe, F. A. Socioeconomic inequalities in childhood mortality in Nigeria: Trends and drivers. African Population Studies 2019, 33(2).
Adebowale, A. S., Fagbamigbe, A. F., Morakinyo, O., Obembe, T., Afolabi, R. F., & Palamuleni, M. E.Parental educational homogamy and under-five mortality in sub-Saharan Africa: Clarifying the association's intricacy. Scientific African 2021, 7, e00255.
Wegbom, A. I., Bademosi, A., Edet, C. K., Green, K. I., Sapira-Ordu, L., & Fagbamigbe, A. F. Rural–urban disparities in birth interval among women of reproductive age in Nigeria. Scientific Reports 2022, 12, 17488. https://doi.org/10.1038/s41598-022-22142- y PMC
Akinyemi, J. O., Bamgboye, E. A., & Ayeni, O. Gender and childhood mortality in sub-Saharan Africa. BMC Public Health, 2021, 21(1), 1001.
Adeniyi Francis Fagbamigbe, Chibuzor Christopher Nnanatu; Modelling the Spatial Distribution and the Factors Associated with Under Five Mortality in Nigeria Spatial Demography 2022 10:255–282
Fagbamigbe, A. F., Hurricane-Ike, E., & Yusuf, O. B. (2020). Regional differences and determinants of child mortality in Nigeria: An analysis of the 2018 demographic and health survey. BMC Public Health 2021, 20, 1384.
Shapiro, D., & Tambashe, B. O. Women's marital status and child mortality in sub-Saharan Africa. Population Studies 2019, 73(3), 253–270.
Hug L, Alexander M, You D, Alkema L. Estimation UNI-a GfCM. National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis. Lancet Glob Health 2019. 7(6):e710–e20.
Serwanja Q, Musaba MW, Mukunya D. Prevalence and factors associated with modern contraceptives utilization among female adolescents in Uganda. BMC Women’s Health 2021, 21:61.
Sinai I, Omoluabi E, Jimoh A, Jurczynska K. Unmet need for family planning and barriers to contraceptive use in Kaduna, Nigeria: culture, myths, and perceptions. Cult Health Sex 2020, 22 11,1253–1268.
BioMed Research International. Use and unmet need for contraception among Nigerian women. Vol. 2019, Article ID 2019, 9103928.
Britton LE, Judge-Golden CP, Wolgemuth T. E, Zhao X, Mor MK, Callegari LS, et al. Associations between perceived susceptibility to pregnancy and contraceptive use in a national sample of women veterans. Perspect Sex Reprod Health 2019, 51(4):211–8.
Akinyemi, J. O., Odimegwu, C. O., & Adebowale, A. S. Urban–rural variations in neonatal mortality: evidence from 67 countries in sub-Saharan Africa. Health & Place, 2020, 63, 102339.
Bankole, A., Rodriguez, M. I., & Zlidar, V. M. Meeting women’s contraceptive needs in Nigeria: prospects and challenges. Guttmacher Institute Repor 2020t.
Budu, E., Dadzie, L.K., Salihu, T. Socioeconomic inequalities in modern contraceptive use among women in Benin: a decomposition analysis. BMC Women's Health 2020, 23,444
Kundu Habtamu Tamene, Minyahil Ayele, Feleke Dana, Simon Heliso, Sanjanthi Velu, Tsega Berhanu, Guda Alemayehu, Lindsey Leslie and Michelle Kaufman: Applying a gender lens to social norms, couple communication and decision making to increase modern contraceptive use in Ethiopia, a mixed methods study Nandita Kapadia. 2022, https://doi.org/10.1186/s12978 022 01440 8
National Population Commission (NPC) [Nigeria] and ICF Macro.. Nigeria Demographic and Health Survey 2023-24. Abuja, Nigeria: National Population Commission and ICF Macro.
National Bureau of Statistics (NBS) and United Nations Children’s Fund (UNICEF). August, Multiple Indicator Cluster Survey 2021, Survey Findings Report. Abuja, Nigeria: National Bureau of Statistics and United Nations Children’s Fund.
Obasanjo Afolabi Bolarinwa , Zemenu Tadesse Tessema, James Boadu Frimpong, Abdul-Aziz Seidu, Bright Opoku Ahinkorah: Spatial distribution and factors associated with modern contraceptive use among women of reproductive age in Nigeria: A multilevel analysis. Published 2021. December 8, 2021
Owoo, N. S., Lambon-Quayefio, M., & Onuoha, E. The effects of family planning and reproductive health services on maternal and child health in developing countries: Evidence from sub-Saharan Africa. Health Economics Review 2021, 11(1), 1-14.
Smith, J. P., & Taylor, M. C. Maternal age and child health outcomes: A global perspective. Lancet Global Health 2020, 8(4), e550-e559.
Wulifan, J. K., Brenner, S., Jahn, A., & 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 2021, 21, 116.
Zavier, A. J. F., Santhya, K. G., & Jejeebhoy, S. J. Factors influencing contraceptive use and unmet need among young married women in India. Asian Population Studies 2021, 17(1), 52–68.
Fadeyibi O, Alade M, Adebayo S, Erinfolami T, Mustapha F and Yaradua S. Household Structure and Contraceptive Use in Nigeria. Front. Glob. Womens Health 2022, 3:821178. doi: 10.3389/fgwh.2022.821178
Oyedokun, A. O., Oluwatoyin, A. O., & Olusola, A. O. The impact of family planning on maternal and child health in Nigeria. Journal of Public Health in Africa, 2020, 11(1), 123-135.
UNICEF. (2022). State of the World’s Children: A fair chance for every child. New York: United Nations Children’s Fund. 2022
UNICEF Data: Monitoring the situation of children and women. 2020 https://data.unicef.org/country/nga/.
Dadzie, L. K., Essuman, M. A., Budu, E., Ameyaw, E. K., Aboagye, R. G., & Ahinkorah, B. O. Wealth-related inequalities in the utilisation of modern contraceptives in Papua New Guinea: evidence from the 2016-2018 Demographic and Health Survey data. BMJ open 2024, 14(10), e085990.
Bongaarts, J. Trends in fertility and fertility preferences in sub-Saharan Africa: The roles of education and family planning programs. Genus, 2020, 76(1), 32.
Buchmann, N., Field, E., & Glennerster, R. Education and child health: Evidence from multiple studies. World Development 2021, 142, 105408.
Budu, E., Dadzie, L.K., Salihu, T. Socioeconomic inequalities in modern contraceptive use among women in Benin: a decomposition analysis. BMC Women's Health 2023, 23,444.
Cleland, J., and van Ginneken, J. Maternal education and child survival in developing countries: The search for pathways of influence. Social Science & Medicine 2019, 38(9), 1357–1368.
Curtis KM, Nguyen AT, Tepper NK, et al. U.S. Selected Practice Recommendations for Contraceptive Use, 2024. MMWR Recomm Rep 2024; 73(No. RR-3):1–77.
Finlay, J. E., Özaltin, E., & Canning, D. Maternal age and child mortality in low- and middle-income countries. BMC Public Health 2015, 11(1), 174.
Golam Rabbi Khan, Abdul Baten and Md. Abul Kalam Azad. Influence of contraceptive use and other socio-demographic factors on under-five child mortality in Bangladesh: semi-parametric and parametric approaches 2023, 8:22
Jacob, R. J. Association between family planning and child mortality in low- and middle-income countries. JAMA 2023, 329(10), 831-840.
Li, Z., Li, M., & Liu, Y. The effect of family planning on child health outcomes in low- and middle-income countries. BMC Public Health 2020, 20(1), 123-135.
Mekonnen, B. D., Wubneh, C. A., & Geremew, A. B. Determinants of child mortality in Ethiopia under the age of five: Bayesian approach. PLOS ONE 2022, 17(2), e0263616.
Wegbom, A. I., Edet, C. K., Osaro, B. O., Oji, A. L., Onyema, C., & Samuel, G. K. Determinants of short birth intervals in Northern and Southern Nigeria: Analysis of Demographic and Health Survey data. International Journal of Health Sciences and Research 2023, 13(7), 321–331. https://doi.org/10.52403/ijhsr.20230744
Gakidou, E., Afshin, A., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., & Murray, C. J. L. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet 2019, 392(10159), 1736–1788.
Odimegwu, C., et al. Household wealth and child mortality in Nigeria. Journal of Epidemiology and Community Health 2020, 74(3), 253-259.
Gage, A. J. Family planning, maternal and child health services and gender equity. Population Research and Policy Review 2021, 40(3), 521–545.
Doctor, H. V., Bairagi, R., Findley, S. E., Helleringer, S., & Dahiru, T. Maternal education and child under-five mortality in Nigeria: The roles of socioeconomic status and birth intervals. Health Education & Behavior 2018, 45(5), 732-741.
Ewerling, F., Victora, C. G., Raj, A., Coll, C. V. N., Hellwig, F., & Barros, A. J. D. Demand for family planning satisfied with modern methods among sexually active women in low- and middle-income countries: Who is lagging behind? BMJ Global Health 2018, 3(1), e000763.
Ahinkorah, B. O., Budu, E., Seidu, A. A., Adu, C., Osei, D., & Yaya, S. Demographic and socioeconomic factors associated with contraceptive use among adolescent girls and young women in sub-Saharan Africa: A multilevel analysis. PLOS ONE 2021, 16(1), e0245827.
