Agyekum Multilevel

Agyekum et al.
Reproductive Health (2022) 19:113

https://doi.org/10.1186/s12978-022-01417-7
RESEARCH Open Access
Unmet need for contraception and its

associated factors among women in Papua
New Guinea: analysis from the demographic
and health survey
Amma Kyewaa Agyekum1, Kenneth Setorwu Adde2, Richard Gyan Aboagye3, Tarif Salihu2* ,
Abdul‑Aziz Seidu4,5,6 and Bright Opoku Ahinkorah7
Abstract
Background: Unmet need for contraception is highest in low-and middle-income countries. In Papua New Guinea,
about 26% of married women and 65% of unmarried sexually active women have an unmet need for contraception.
This study investigated the prevalence and correlates of unmet need for contraception among women in Papua New
Guinea.
Methods: Data for the study were extracted from the most recent 2016–18 Papua New Guinea Demographic and
Health Survey. We included 7950 women with complete data on all variables of interest. Multilevel logistic regression
analysis was conducted to examine the factors associated with unmet needs for contraception using four models.
Adjusted odds ratios (AOR) and 95% confidence intervals (CIs) were used to present the results of the regression
analysis.
Results: We found that the overall unmet need for contraception was 32.2%. The odds of unmet needs for contra‑
ception was higher among cohabiting women [AOR = 1.25, 95% CI = 1.01, 1.56], women with 1–3 births [AOR = 1.57,
95% CI = 1.18, 2.08], and women with 4 or more births [AOR = 1.06, 95% CI = 1.13, 2.27]. Likewise, a higher probability
of unmet need was found among women whose partners decided on their healthcare as compared to those who
decided on their own healthcare [AOR = 1.35, 95% CI = 1.066, 1.71]. With regards to wealth, the likelihood of unmet
contraceptive need decreased with an increase in wealth status. With region, it was found that women in the Mamose
region had greater likelihood of unmet contraceptive need compared to those in Southern region [AOR = 1.33, 95%
CI = 1.09, 1.63].
Conclusion: Our study contributes to the discussion on unmet need for contraception in the context of Papua New
Guinea. We found the overall prevalence of unmet need for contraception to be relatively high among women in
Papua New Guinea. Public health interventions aimed at addressing women’s contraception needs should be encour‑
aged so that women can make informed decisions about contraceptive use. These interventions should be imple‑
mented taking into consideration significant socio-demographic characteristics of women as identified in this study.
Keywords: Unmet need, Contraception, Prevalence, Maternal health, Papua New Guinea
*Correspondence: [email protected]
2
Department of Population and Health, University of Cape Coast, Cape
Coast, Ghana
Full list of author information is available at the end of the article
© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the
original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or
other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line
to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory
regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this
licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco
mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Agyekum et al. Reproductive Health (2022) 19:113 Page 2 of 11
Plain language summary

Unmet need for contraception is highest in low-and middle-income countries. This study investigates the prevalence
and correlates of unmet need for contraception among women in Papua New Guinea. We extracted data from the
most recent Demographic and Health Survey conducted in Papua New Guinea. Our study involved 7950 women with
diverse contraceptive needs and those who have complete data on all variables of interest. We found that the overall
unmet need for contraception was 32.2%. Marital status, parity, decision maker on respondent’s healthcare, wealth
status, and region were found to have a significant relationship with unmet need for contraception. Cohabiting
women recorded a higher likelihood for unmet need for contraception as compared to those married. Women with at
least on child showed greater probability of unmet contraceptive need relative to women without children. Likewise,
a higher probability of unmet need was found among women whose partners decided on their healthcare as com‑
pared to those who decided on their own healthcare. With regards to wealth, the likelihood of unmet contraceptive
need decreased with an increase in wealth status. With region, it was found that women in the Mamose region had
greater likelihood of unmet contraceptive need compared to those in Southern region. Interventions aimed at reduc‑
ing unmet need for contraception should be implemented taking into consideration significant socio-demographic
characteristics of women as identified in this study.
Introduction New Guinea (PNG) is an island country to the North of

The use of contraceptives as a relevant fertility regula- Australia with a low middle income. PNG is the largest
tor has been accepted globally and serves as a significant Pacific Island country in terms of land area and the only
factor in the health and wellbeing of women [1]. Further- Pacific Island country that shares a border with Indo-
more, maternal health as a topical issue is highlighted nesia. It is one of the countries with sub optimal health
under the Sustainable Development Goal (SDG) 3 which outcomes [10]. Evidence suggests that the incidence of
focuses on ensuring global access to sexual and repro- unmet need for contraception among women in unions
ductive health services and reducing maternal mortality between 15 and 49 years did not improve in PNG dur-
by 2030 [2, 3]. These unmet needs contribute to unsafe ing the two decades from 1990 to 2010, making it one of
abortions, sexually transmitted infections, increased fer- 42 nations worldwide with an unmet need of more than
tility rate connected to poverty, high maternal mortality 25% [6]. However, it has reduced a bit from 37% in 2006
rates, and low employment [4]. to 32% in 2016–2018 [11]. Specifically, it is estimated that
Unmet need for contraception is defined by Bradley as of 2015, about 317,000 women of reproductive age in
[4] as the percentage of sexually active women (married PNG had unmet need for contraception and this number
or cohabiting) or fecund women not using any form of is expected to rise to 337,000 by 2030 [12]. The 2016–
contraception but wish to postpone their next birth for 2018 Demographic and Health Survey (DHS) in PNG
a minimum of 2 years or halt childbearing permanently. (PNG DHS) indicated that about 26% of married women
Kantorová et al. [5] revealed that in 2019, women of and 65% of unmarried sexually active women have an
reproductive age group (15–49 years) were 1.9 billion, unmet need for contraception [13]. Unmet need for con-
1.1 billion of them had a need for family planning; out of traception could prevent nearly half (47.4%) of all mater-
these, 270 million had an unmet need for contraception nal fatalities in PNG [14]. Although, maternal mortality
while about 800 million relied on contraception. Projec- has reduced over the years in PNG, with 733 deaths per
tions made revealed the worldwide unmet need for fam- 100, 000 births in 2006 to 171/100,000 deaths per birth
ily planning to be above 10% by 2030 [6]. The pronounced currently, this is still high and urgent attention in terms
cause of unmet need is globally attributed to inadequate of policies and improving maternal health [11, 12].
knowledge on contraceptive usage, side effects of contra- There is therefore, more room for improvement in
ceptives, health concerns, behavioural requirements and attaining the SDG of ensuring the health and wellbeing of
objections from husbands, religious or cultural restraints all [11, 13]. There is limited research on unmet need for
[7, 8]. Generally, unmet need for contraception or fam- contraception among women in PNG. PNG has a record
ily planning is recorded to be higher in women living in of inadequate basic health care, shortage of medical sup-
rural areas, young women and those with low level of plies, lack of skilled health personnel to provide required
education [9]. services and limited policies to facilitate maternal health
Wemakor et al. [9] opined that unmet need for con- [15]. However, attaining adequate access to contracep-
traception is common in low and middle-income coun- tion is a key mandate of the PNG National Health Plan in
tries with scanty information on its determinants. Papua achieving the SDGs and reducing maternal mortality rate
by 2030. In an attempt to recommend measures to policy 30–34, 35–39, 40–44, 45–49), educational level (no edu-
creators, this study seeks to investigate the prevalence cation, primary, secondary, higher), marital status (mar-
and correlates of unmet need for contraception among ried, cohabiting), current working status (yes, no), parity
women in PNG. (0, 1–3, 4 or more), frequency of watching television (not
at all, less than once a week, at least once a week), fre-
Methods quency of listening to radio (not at all, less than once a
Data source and study design week, at least once a week), frequency of reading news-
This study involved a secondary analysis of the 2016–18 paper or magazine (not at all, less than once a week, at
PNG DHS which was collected using a cross-sectional least once a week), heard of family planning from news-
study design. PNG DHS collects data from respondents paper or magazine in the last few months (yes, no), heard
on health and social indicators including contraceptive of family planning from radio in the last few months (yes,
use. The data was collected using a structured question- no), heard of family planning from television in the last
naire. PNG DHS employed a two-stage cluster sampling few months (yes, no), and person who usually decides
technique to recruit the respondents for the survey. on respondent’s health care (respondent alone, respond-
The first stage entailed the selection of 800 census units ent and partner, partner alone, someone else or other).
(CUs). This was accomplished by using a probability pro- DHS calculated the wealth index based on the ownership
portional to the size of the CU. The second stage involved of family assets, such as access to drinking water, kind
selecting 24 households from each cluster using random of toilet, type of cooking fuel, and possession of a televi-
sampling, resulting in a total of 19,200 households. The sion and refrigerator. A principal component analysis was
detailed study methodology can be found at https:// adopted for the creation of the wealth index. Based on
dhsprogram.com/public ations/public ation-f r364-dhs- this, wealth index was divided into five categories based
final-reports.cfm. In this study, a total of 7950 women of on individual rankings: poorest, poorer, middle, richer,
reproductive age (15-49) with complete cases on varia- and richest. Sex of household head (male, female), place
bles of interest were included in the study. The PNG DHS of residence (urban, rural), and region (Southern, High-
dataset can be freely accessed at https://dhsprogram. lands, Momase, Islands) were the household/ community
com/data/dataset_admin/index.cfm. level variables used in the study.
Variables Statistical analyses

Outcome variable Data extraction, cleaning, and analysis were carried out
Unmet need for contraception was the outcome variable using Stata software version 16.0. Percentages were used
in this study. From the DHS, unmet need was the aggre- to summarise the prevalence of unmet needs for contra-
gated sum of unmet needs for spacing and limiting and ception among the respondents. Cross-tabulation was
reproductive-age women who were married, fecund, and/ later adopted to examine the distribution of unmet needs
or sexually active have unmet needs if they do not want across the explanatory variables. The results of the cross-
any more children or want to postpone their next birth tabulation were presented using percentages with their
for at least 2 years but are not using contraception. Also, corresponding confidence intervals. Also, Pearson chi-
pregnant or amenorrheic women who had unwanted square test was used to examine the explanatory variables
or mistimed pregnancies or births were considered to significantly associated with unmet needs for contracep-
have unmet need if they did not use contraception at the tion. Next, we carried out a multicollinearity test and
time they conceived [16–19]. Unmet need was coded as a realized no collinearity among the explanatory variables
binary variable; thus, no = 0 and yes = 1 and used in the (minimum = 1.04, mean = 2.40, maximum = 5.41). Sub-
final analysis. This coding was based on studies that used sequently, a multivariable multilevel regression analysis
the DHS dataset [16–18]. was performed to determine the factors associated with
unmet needs for contraception. Four models were built
Explanatory variables to examine the factors associated with unmet needs. The
Explanatory variables included in the study were selected first model (Model O) consisted of only unmet needs
based on their significant association with unmet needs (outcome variable). The results signified the variance in
for contraception [16–19] and their availability in the unmet needs attributed to the clustering at the primary
DHS dataset. The variables were grouped into the indi- sampling units (PSUs). Model I was built to contain the
vidual level and household/community level (contextual) individual-level variables whilst Model II consisted of
variables based on the review of literature that utilized the household/community level variables. In Model III,
the DHS dataset [16, 18]. The individual level variables all the explanatory variables were put together to exam-
consisted of age of the women (15–19, 20–24, 25–29, ine their association with unmet needs. The results were
presented using adjusted odds ratio (AOR) with their whereas women in the Southern region recorded the
respective 95% confidence intervals. We used Akaike’s lowest (28.3%). Finally, all the explanatory variables con-
Information Criterion (AIC) to analyze model fitness sidered in the analysis were significantly related with
and model comparability.The women’s sample weights unmet contraceptive need with the exception of age, cur-
(v005/1,000,000) were utilized to achieve unbiased esti- rent working status, parity, and sex of household head
mates. The Stata survey command ’svy’ was used to cor- (see Table 1).
rect for the data’s complex sampling structure in the Model III of Table 2 summarizes the multilevel analy-
chi-square and regression analyses as recommended by sis of factors associated with unmet need for contracep-
the DHS. tion among women in PNG. The analysis reveals higher
likelihood of unmet contraceptive need among cohabit-
ing women compared to those married [AOR = 1.25,
Ethical consideration 95% CI = 1.01, 1.56]. In terms of parity, women with 1–3
Ethical approval was not sought for this study since births [AOR = 1.57, 95% CI = 1.18, 2.08] and women
publicly available data was used. However, the 2016–18 with 4 or more births [AOR = 1.60, 95% CI = 1.13, 2.27]
PNG DHS stated that the ICF Institutional Review Board showed greater probability of unmet contraceptive need
granted ethical clearance. Written informed consent was relative to women without births. A higher probability
obtained during data collection. In this study, we com- of unmet need was found among women whose part-
plied with the guidelines concerning the use of second- ners decided on their healthcare as compared to those
ary data for publication. Further information about the who decided on their own healthcare [AOR = 1.35, 95%
data and ethical standards can be assessed at http://goo. CI = 1.06, 1.71]. The likelihood of unmet contraceptive
gl/ny8T6X. need decreased with an increase in wealth status. Par-
ticularly, women in the richest wealth quintile had the
Results lowest unmet contraceptive need relative to those in
Socio‑demographic characteristics and prevalence
the poorest wealth quintile [AOR = 0.59, 95% CI = 0.43,
of unmet need for contraception
0.80]. With region, it was discovered that women in the
Table 1 provides the results of the distribution of unmet Mamose region had greater likelihood of unmet con-
need for contraception among women in PNG by the traceptive need compared to those in the Southern
explanatory variables. The overall prevalence of unmet region [AOR = 1.33, 95% CI = 1.09, 1.63].
needs for contraception was 32.2%. A high prevalence
of unmet need for contraception (38.0%) was found Discussion
among women with no education. Unmet contraceptive The present study sought to examine the prevalence
need was prevalent among cohabiting women (37.9%). and factors associated with unmet need for contracep-
In terms of mass media, women who did not watch tel- tion among women in PNG. We found that the overall
evision at all (34.3%), those who did not listen to radio unmet need for contraception was 32.2%. The prevalence
at all (35.5%), and those who failed to read newspaper or observed in the present study is consistent with prior
magazine at all (34.9%) had higher proportion of unmet research in Burundi [20], Cameroon [21], Ghana [22]
contraceptive need. It was also revealed that women who and PNG [10]. However, the result is higher than what
did not hear of family planning from newspaper or maga- was found in several previous studies including 11.5%
zine in the last few months (33.1%), those who did not in Mexico [23], 16.2% in Ethiopia [24], 18% in Northern
hear of family planning from radio in the last few months Nigeria [25], 12.7% in Egypt [26] and 17% in Indonesia
(33.2%), and those who did not hear of planning from tel- [27].The significant prevalence of unmet contraceptive
evision in the last few months (32.8%) recorded higher needs in the current study relative to earlier studies could
prevalence of unmet contraceptive need. High propor- be attributed to the varied target group and sample size
tion of unmet need was also found among persons who in this and prior studies as well as socio-cultural norms
usually decided on respondent partner’s healthcare alone and gender inequity which prevent women in PNG from
(39.0%). With wealth index, the highest prevalence of accessing contraceptives [10, 28].
unmet contraceptive need was observed among women The study revealed that cohabiting women exhibited
in the poorest wealth quintile (41.3%), whereas the low- a higher likelihood of unmet contraceptive needs com-
est was observed among those in the richest wealth quin- pared to married women. This finding corroborates prior
tile (24.4%). High prevalence of unmet need was also studies in Nigeria [29], Mexico [23] and sub-Saharan
found among rural women (33.2%). In terms of place of Africa [17] where cohabiting women were more likely
residence, women in the Mamose region recorded the to have unmet contraceptive need than married women.
highest proportion of unmet contraceptive need (35.5%) One possible reason for higher odds among cohabiting
Table 1 Distribution of unmet need across explanatory variables

Variable Weighted N Weighted % Unmet needs for contraception
No (%) 67.8% Yes (%) 32.2% P-value
Women’s age (years) 0.096

15–19 365 4.6 65.2 [57.6, 72.2] 34.8 [27.8, 42.4]
20–24 1472 18.5 64.0 [59.9,68.0] 36.0 [32.0, 40.1]
25–29 1820 22.9 69.8 [66.6, 72.8] 30.2 [27.2, 33.4]
30–34 1554 19.5 70.2 [67.0, 73.2] 29.8 [26.8, 33.0]
35–39 1371 17.3 68.1 [64.0, 72.0] 31.9 [28.0, 36.0]
40–44 854 10.7 64.7 [60.2, 69.0] 35.3 [31.0, 39.8]
45–49 514 6.5 70.5[65.1, 75.4] 29.5 [24.6, 34.9]
Level of education 0.003
No education 1982 24.9 62.0 [57.9, 65.9] 38.0 [34.1, 42.1]
Primary 3928 49.4 67.6 [65.7, 69.5] 32.4 [30.5, 34.3]
Secondary 1716 21.6 74.3 [71.3, 77.1] 25.7 [22.9, 28.7]
Higher 324 4.1 71.6 [57.0, 82.7] 28.4 [17.3, 43.0]
Marital status 0.004
Married 6594 82.9 69.0 [67.2, 70.7] 31.0 [29.3, 32.8]
Cohabiting 1356 17.1 62.1 [57.6, 66.4] 37.9 [33.6, 42.4]
Current working status 0.914
No 5389 67.8 67.9 [66.0, 69.7] 32.1 [30.3, 34.0]
Yes 2561 32.2 67.7 [64.8, 70.5] 32.3 [29.5,35.2]
Parity 0.077
Zero 632 8.0 74.3 [68.5,79.3] 25.7 [20.7,31.5]
1–3 births 4119 51.8 67.6 [65.4,69.7] 32.4 [30.3,34.6]
4 or more births 3199 40.2 66.8 [64.0,69.6] 33.2 [30.4,36.0]
Frequency of watching television < 0.001
Not at all 6139 77.2 65.7 [63.7,67.6] 34.3 [32.4,36.3]
Less than once a week 729 9.2 74.7 [68.8,79.8] 25.3 [20.2,31.2]
At least once a week 1082 13.6 75.3 [71.6,78.7] 24.7 [21.3,28.4]
Frequency of listening to radio < 0.001
Not at all 5118 64.4 64.5 [62.3,66.7] 35.5 [33.3,37.7]
Frequency of reading newspaper or magazine
Not at all 5198 65.4 65.1 [63.0,67.2] 34.9 [32.8,37.0]
Heard of family planning from newspaper or magazine last few months 0.009
No 6975 87.7 66.9 [65.1,68.7] 33.1 [31.3,34.9]
Yes 975 12.3 74.1 [69.2,78.5] 25.9 [21.5,30.8]
Heard of family planning from radio last few months < 0.001
No 6912 86.9 66.8 [65.0,68.6] 33.2 [31.4,35.0]
Yes 1038 13.1 74.5 [71.2,77.6] 25.5 [22.4,28.8]
Heard of family planning from television last few months 0.002
No 7314 92.0 67.2 [65.4,68.9] 32.8 [31.1,34.6]
Yes 636 8.0 75.3 [70.8,79.4] 24.7 [20.6,29.2]
Person who usually decides on respondent’s health care 0.031
Respondent alone 2346 29.5 67.3 [63.8,70.6] 32.7 [29.4,36.2]
Respondent and partner 4392 55.2 70.0 [67.6,72.2] 30.0 [27.8,32.4]
Partner alone 1080 13.6 61.0 [55.9,65.8] 39.0[34.2,44.1]
Table 1 (continued)
Variable Weighted N Weighted % Unmet needs for contraception
No (%) 67.8% Yes (%) 32.2% P-value
Someone else or other 132 1.7 63.0 [43.9,78.7] 37.0 [21.3,56.1]

Wealthindex < 0.001
Poorest 1471 18.5 58.7 [55.0,62.3] 41.3 [37.7,45.0]
Poorer 1529 19.2 64.0 [60.1,67.7] 36.0 [32.3,39.9]
Middle 1582 19.9 68.2 [64.5,71.7] 31.8 [28.3,35.5]
Richer 1656 20.8 71.0 [67.9,73.9] 29.0 [26.1,32.1]
Richest 1712 21.5 75.6 [73.0,78.1] 24.4 [21.9,27.0]
Sex of household head 0.224
Male 6916 87.0 67.4 [65.7,69.1] 32.6 [30.9,34.3]
Female 1034 13.0 70.4 [65.6,74.8] 29.6 [25.2,34.4]
Place of residence < 0.001
Urban 1011 12.7 75.0 [72.3,77.5] 25.0 [22.5,27.7]
Rural 6939 87.3 66.8 [64.9,68.6] 33.2 [31.4,35.1]
Region 0.009
Southern region 1583 19.9 71.7 [69.1,74.1] 28.3 [25.9,30.9]
Highlands region 3007 37.8 67.0 [63.8,70.1] 33.0 [29.9,36.2]
Momase region 2172 27.3 64.5 [61.3,67.6] 35.5 [32.4,38.7]
Islands region 1188 14.9 70.7 [66.9,74.1] 29.3 [25.9,33.1]
women could be due to objection from partners [26, 30]. of children upsurges, peoples’ craving to have more chil-
Additionally, it could be that in most countries includ- dren decreases [41].
ing PNG, the need for childbearing is restricted during The present study found women whose partners
cohabitation relative to wedlock because of socio-cul- usually decided on their healthcare to be significantly
tural values about childbearing outside of marriage [31, associated with unmet need for contraception. That
32]. However, this finding contrast those of Klinzing [33] is, women whose partners had an ultimate decision on
in Hungary, who reported that married women had a their healthcare showed a greater probability of unmet
greater likelihood of unmet contraceptive need. contraceptive need compared to those who decided on
In this study, high unmet contraceptive need was real- their own healthcare. This finding is comparable with
ized among women with 1–3 children and those with other studies in Burundi [20] and Ghana [42] which
four or more children compared with women with- revealed that partners decisions towards their wives’
out children. Thus, the study found a positive associa- reproductive health such as denial of contraceptive
tion between parity and unmet need for contraception. use due to desire for children augmented the likeli-
This result is in line with prior studies conducted in hood of unmet contraceptive need for them. Partners
low-and middle-income countries [34], sub-Saharan are frequently wary of approving any contraceptive use
Africa [17], Nigeria [25], and Pakistan [7] which indi- for fear of losing their position as family heads and/or
cated that as the number of kids for a woman increase, implicitly pushing their women to be disloyal or pro-
so does her unmet contraceptive need. This could be miscuous [36]. In sub-Saharan Africa, men are usu-
attributed to strong patriarchal mores, a higher priority ally the ones who make decisions about their wives’
placed on male children than female children, and mostly healthcare due to sociocultural norms and a lack of
rural systems assuring economic or social stability cen- economic independence among women [21]. Males
tered on huge family sizes that demand women to bear should, therefore, be included in all phases of the sexual
numerous children [35, 36]. Prior studies conducted in and reproductive health program (SRHP) so that they
Burkina Faso [37, 38], Egypt [26], Ethiopia [18], Zambia may be educated to back their women in utilizing con-
[39], and India [40], however, showed a negative relation- traceptives and foster inter-spousal fertility discourse
ship between parity and unmet need for contraception. [42]. This finding is however, contrary to other Ethio-
The reason for this could be that as the overall number pian studies [24, 43], which found that women who
made decisions on their own health with practitioners
Table 2 Fixed and random effect analysis of factors associated with unmet needs for contraception
Variable Model O Model I Model II Model III
AOR [95% CI] AOR [95% CI] AOR [95% CI]
Fixed effect results

Women’s age (years)
15–19 1 [1.00,1.00] 1 [1.00,1.00]
20–24 1.02 [0.69,1.52] 1.04 [0.70,1.55]
25–29 0.69 [0.45,1.06] 0.70 [0.46,1.08]
30–34 0.68 [0.44,1.06] 0.70 [0.45,1.09]
35–39 0.70 [0.44,1.12] 0.73 [0.45,1.17]
40–44 0.82 [0.53,1.29] 0.87 [0.55,1.37]
45–49 0.64 [0.39,1.03] 0.67 [0.41,1.08]
Level of education
No education 1 [1.00,1.00] 1 [1.00,1.00]
Primary 0.92 [0.76,1.12] 0.97 [0.80,1.18]
Secondary 0.78 [0.61,1.00] 0.87 [0.67,1.13]
Higher 1.09 [0.48,2.45] 1.27 [0.56,2.88]
Marital status
Married 1 [1.00,1.00] 1 [1.00,1.00]
Cohabiting 1.28* [1.03,1.60] 1.25* [1.01,1.56]
Current working status
No 1 [1.00,1.00] 1 [1.00,1.00]
Yes 1.08 0.93,1.26] 1.09 [0.94,1.28]
Parity
Zero 1 [1.00,1.00] 1 [1.00,1.00]
1–3 births 1.57** [1.19,2.09] 1.57** [1.18,2.08]
**
4 or more births 1.64 [1.15,2.33] 1.60** [1.13,2.27]
Frequency of watching television
Not at all 1 [1.00,1.00] 1 [1.00,1.00]
Less than once a week 0.80 [0.56,1.14] 0.86 [0.60,1.23]
At least once a week 0.90 [0.66,1.23] 1.01 [0.73,1.39]
Frequency of listening to radio
Not at all 1 [1.00,1.00] 1 [1.00,1.00]
Frequency of reading newspaper or magazine
Not at all 1 [1.00,1.00] 1 [1.00,1.00]
Heard of family planning from newspaper or magazine last few months
No 1 [1.00,1.00] 1 [1.00,1.00]
Yes 1.02 [0.69,1.50] 1.05 [0.71,1.54]
Heard of family planning from television last few months
No 1 [1.00,1.00] 1 [1.00,1.00]
Yes 1.02 [0.61,1.71] 1.05 [0.63,1.75]
Heard of family planning from radio last few months
No 1 [1.00,1.00] 1 [1.00,1.00]
Yes 0.93 [0.72,1.21] 0.94 [0.73,1.22]
Person who usually decides on respondent’s health care
Respondent alone 1 [1.00,1.00] 1 [1.00,1.00]
Respondent and partner 0.87 [0.72,1.06] 0.86 [0.71,1.04]
Partner alone 1.37* [1.08,1.74] 1.35* [1.06,1.71]
Table 2 (continued)
Variable Model O Model I Model II Model III
AOR [95% CI] AOR [95% CI] AOR [95% CI]
Someone else or other 1.20 [0.55,2.61] 1.19 [0.55,2.57]

Wealthindex
Poorest 1 [1.00,1.00] 1 [1.00,1.00]
Poorer 0.85 [0.67,1.08] 0.86 [0.68,1.10]
Middle 0.73** [0.58,0.91] 0.75* [0.60,0.94]
***
Richer 0.65 [0.51,0.83] 0.69** [0.53,0.90]
***
Richest 0.51 [0.40,0.66] 0.59*** [0.43,0.80]
Sex of household head
Male 1 [1.00,1.00] 1 [1.00,1.00]
Female 0.86 [0.68,1.09] 0.87 [0.68,1.10]
Place of residence
Urban 1 [1.00,1.00] 1 [1.00,1.00]
Rural 1.15 [0.94,1.42] 1.08 [0.87,1.33]
Region
Southern region 1 [1.00,1.00] 1 [1.00,1.00]
Highlands region 1.07 [0.89,1.29] 1.05 [0.86,1.27]
Momase region 1.35** [1.11,1.64] 1.33** [1.09,1.63]
Islands region 1.08 [0.88,1.33] 1.10 [0.89,1.36]
Random effect model
PSU variance (95% CI) 0.398 [0.299, 0.531] 0.343 [0.251, 0.471] 0.328 [0.237, 0.453] 0.322 [0.232, 0.447]
ICC 0.1079641 0.0945348 0.0905374 .0891375
Wald chi-square Reference 115.40 (< 0.001) 86.56 (< 0.001) 169.18 (< 0.001)
Model fitness
Log-likelihood − 4839.6637 − 4755.7949 − 4799.8545 − 4735.382
AIC 9683.327 9565.59 9621.709 9542.764
N 7950 7950 7950 7950
Number of clusters 763 763 763 763
Exponentiated coefficients; 95% confidence intervals in brackets; AOR adjusted odds ratios, CI confidence interval; 1 = Reference category; PSU primary sampling unit;
ICC intra-class correlation, AIC Akaike’s Information Criterion. *p < 0.05, **p < 0.01, ***p < 0.001
showed a reduced likelihood of unmet contraceptive contemporary contraceptives than those from poorer
need. It is worth noting that different women have vari- families because they could afford both the direct and
ous health concerns and reproductive health goals, so indirect costs of contraceptive use [7].
making contraceptive decision on their own was prefer- Furthermore, women in this group are more likely to
able as making an informed decision was good for con- be informed about contraceptive use [15]. However, the
tinued use of the contraceptive method of their choice results of this research are inconsistent with other studies
[24]. in Ethiopia [24, 46] where they discovered that affluent
The current study also found wealth status to be women had higher odds of unmet contraceptive needs.
inversely associated with an unmet need for contra- This indicates that having a high wealth index does not
ception. Women in the richest wealth quintile were assure that your contraception needs will be addressed.
discovered to have the lowest likelihood of unmet con- The current study discovered that geographic location
traceptive need compared to their counterparts in the has a statistically significant relationship with unmet con-
poorest wealth quintile. This indicates that the odds of traceptive needs. This finding showed that there were
unmet need reduced with augmented in wealth status. A variations among various regions of PNG for unmet
similar relationship was found in prior studies conducted contraceptive need. The Mamose region recorded the
in different parts of the globe including Libya [44], Nige- highest rate of unmet contraceptive needs, indicating
ria [45], Pakistan [7], Ethiopia [24], PNG [10] and sub- healthcare gaps in the delivery of critical family planning
Saharan Africa [16]. One possible reason is that women services in one of the country’s most populous areas.
from wealthy families have more accessible contact with Compared with women staying in the Southern region,
those in the Mamose region were found to have greater stages. Currently, the WHO [50] indicates that PNG
risk of unmet contraceptive need. This could be due to UHC index on family planning and reproductive health
geographic barricades and a broadly dispersed popula- in general is very low. In addition, from the WHO SDG
tion, which impedes the smooth delivery of reproduc- performance score care for the Asia Pacific region, PNG
tive health services [10] in the region where women have has attained only 7% as far as the need for family plan-
habitually had the maximum fertility levels, but now have ning is concerned. This finding is also a wakeup call to
a bigger need to use contraception to delay childbear- the government to step up their game on reproductive
ing [23]. It may also be challenging to deliver contracep- health services provision in PNG [51, 52].
tive services to address the unmet contraceptive need
due to sensitivities regarding sexual and reproductive Conclusions
health, cultural obstacles, and religious beliefs [10]. It is The overall prevalence of unmet need for contraception
worth mentioning that unmet contraceptive needs vary was found to be high in this study. This emphasizes the
by location due to societal differences and differences in necessity for the country’s contraception programs to
geographic and economic access to reproductive health be redesigned. This study also found some critical fac-
services for women [46, 47]. tors associated with unmet contraceptive needs among
Papua New Guinean women. Marital status, parity, the
Strengths and limitations person who normally decides on a respondent’s health-
One of the study’s strengths is the utilization of a nation- care, wealth status, and region all showed significant
ally representative dataset to examine the factors asso- association with unmet contraceptive need. We believe
ciated with unmet contraception needs among women that public health interventions aimed at addressing
in PNG. Also, in cross sectional studies, the use of large women’s contraception needs should be encouraged to
sample size is relatively important and this has helped to make informed decisions about contraception use. Con-
strengthen the validity and generalizability of the study traceptive services should be prioritized for cohabiting
findings. Furthermore, the results obtained using scien- women, women in the poorest wealth quintile, women
tific study standards and appropriate techniques perfectly with multiple children, and women in the country’s poor-
agree with past research findings. This study would help est regions. Further studies could explore the association
PNG allocate contraceptive resources more effectively by between women’s autonomy, gender-based violence and
indicating contraceptive needs. However, women may their association with contraception use in PNG.
give socially acceptable responses and may find it difficult
to recall past experiences, resulting in recall bias in the Abbreviations
study. AOR: Adjusted odds ratio; AIC: Akaike’s information criterion; CI: Confidence
interval; PSU: Primary sampling unit; ICC: Intra-class correlation; SDG: Sustain‑
able development goal; DHS: Demographic and Health Survey; PNG: Papua
New Guinea; PNGDHS: Papua New Guinea Demographic and Health Survey.
Policy implications
The significant level of unmet need for contraception Author contributions
necessitates immediate program retorts and interces- AS and BOA conceptualized the study. RGA performed the analysis. AA, KSA,
RGA, AS, BOA and TS contributed to the draft. All authors read and approved
sions from the health division to improve contraceptive the final manuscript.
availability and use for every woman in PNG. According
to previous studies, well-organized contraceptive service Funding
None.
programs reduce unmet contraceptive needs directly
and indirectly [48, 49]. The PNG government should Availability of data and materials
strengthen inclusion of family planning services and con- https://dhsprogram.com/data/dataset_admin/index.cfm.
traception delivery as part of universal health coverage

(UHC), focusing on the very susceptible groups, includ- Declarations
ing rural women. Beyond the health sector, action must Ethics approval and consent to participate
be taken to promote societal norms and policy measures Ethical approval was not sought for this study since a secondary data was
that promote sexual and reproductive liberties. Collabo- used which was obtained from measuredhs.
ration and partnership between public health services Consent for publication
and faith-based health services should be fostered even No consent is needed to publish this study.
more in order to improve access to a variety of contem-
Competing interests
porary contraceptive techniques at a low cost [10]. The The authors declare no competing interests.
findings of this study could help the PNG government
track progress toward UHC at the national and regional
Author details 17. Ahinkorah BO, Ameyaw EK, Seidu AA. Socio-economic and demographic
1
Department of Construction Technology and Management, Kwame predictors of unmet need for contraception among young women in
Nkrumah University of Science and Technology, Kumasi, Ghana. 2 Depart‑ sub-Saharan Africa: evidence from cross-sectional surveys. Reprod Health.
ment of Population and Health, University of Cape Coast, Cape Coast, Ghana. 2020;17(1):1–1.
3
Department of Family and Community Health, School of Public Health, 18. Yalew M, Adane B, Kefale B, Damtie Y. Individual and community-level
University of Health and Allied Sciences, Hohoe, Ghana. 4 College of Public factors associated with unmet need for contraception among repro‑
Health, Medical and Veterinary Sciences, James Cook University, Townsville, ductive-age women in Ethiopia; a multi-level analysis of 2016 Ethiopia
Australia. 5 Department of Real Estate Management, Takoradi Technical Univer‑ Demographic and Health Survey. BMC Public Health. 2020;20(1):1–9.
sity, P.O.Box 256, Takoradi, Ghana. 6 Centre for Gender and Advocacy, Takoradi 19. Dingeta T, LemessaOljira AW, Berhane Y. Unmet need for contraception
Technical University, P.O. Box 256, Takoradi, Ghana. 7 School of Public Health, among young married women in eastern Ethiopia. Open Access J Con‑
Faculty of Health, University of Technology Sydney, Sydney, Australia. tracept. 2019;10:89.
20. Nzokirishaka A, Itua I. Determinants of unmet need for family planning
Received: 23 November 2021 Accepted: 14 April 2022 among married women of reproductive age in Burundi: a cross-sectional
study. Contracept Reprod Med. 2018;3(1):1–3.
21. Edietah EE, Njotang PN, Ajong AB, Essi MJ, Yakum MN, Mbu ER. Contra‑
ceptive use and determinants of unmet need for family planning; a cross
sectional survey in the North West Region, Cameroon. BMC Womens
References Health. 2018;18(1):1–8.
1. Ahmed S, Li Q, Liu L, Tsui AO. Maternal deaths averted by contraceptive 22. Wulifan JK, Mazalale J, Kambala C, Angko W, Asante J, Kpinpuo S, Kalolo A.
use: an analysis of 172 countries. Lancet. 2012;380(9837):111–25. Prevalence and determinants of unmet need for family planning among
2. World Health Organization. Health in 2015: from MDGs, millennium married women in Ghana—a multinomial logistic regression analysis of
development goals to SDGs, sustainable development goals. the GDHS, 2014. Contracept Reprod Med. 2019;4(1):1–4.
3. Grove J, Claeson M, Bryce J, Amouzou A, Boerma T, Waiswa P, Victora C. 23. Juarez F, Gayet C, Mejia-Pailles G. Factors associated with unmet need for
Maternal, newborn, and child health and the Sustainable Development contraception in Mexico: evidence from the National Survey of Demo‑
Goals—a call for sustained and improved measurement. The Lancet. graphic Dynamics 2014. BMC Public Health. 2018;18(1):1–8.
2015;386(10003):1511–4. 24. Tadele A, Abebaw D, Ali R. Predictors of unmet need for family planning
4. Bradley SE. Revising unmet need for family planning. ICF International; among all women of reproductive age in Ethiopia. Contracept Reprod
2012. Med. 2019;4(1):1–9.
5. Kantorová V, Wheldon MC, Ueffing P, Dasgupta AN. Estimating progress 25. Solanke BL, Oyinlola FF, Oyeleye OJ, Ilesanmi BB. Maternal and commu‑
towards meeting women’s contraceptive needs in 185 countries: a Bayes‑ nity factors associated with unmet contraceptive need among childbear‑
ian hierarchical modelling study. PLoS Med. 2020;17(2): e1003026. ing women in Northern Nigeria. Contracept Reprod Med. 2019;4(1):1–2.
6. Alkema L, Kantorova V, Menozzi C, Biddlecom A. National, regional, and 26. Hassan EE, Ghazawy ER, Amein NM. Currently married women with an
global rates and trends in contraceptive prevalence and unmet need for unmet need for contraception in Minia governorate, Egypt: profile and
family planning between 1990 and 2015: a systematic and comprehen‑ determinants. Open J Prev Med. 2017;7(11):225.
sive analysis. Lancet. 2013;381(9878):1642–52. 27. Ayuningtyas D, Oktaviana W. Factors contributing to unmet need for
7. Asif MF, Pervaiz Z. Socio-demographic determinants of unmet need for contraception in Nusa Tenggara Barat, Indonesia. J Reprod Contracept.
family planning among married women in Pakistan. BMC Public Health. 2015;26(4):239–48.
2019;19(1):1–8. 28. Bell MC, Edin K, Wood HM, Mondé GC. Relationship repertoires, the
8. Krakowiak-Redd D, Ansong D, Otupiri E, Tran S, Klanderud D, Boakye price of parenthood, and the costs of contraception. Soc Service Rev.
I, Dickerson T, Crookston B. Family planning in a sub-district near 2018;92(3):313–48.
Kumasi, Ghana: side effect fears, unintended pregnancies and misuse 29. Oginni AB, Ahonsi BA, Adebajo S. Trend and determinants of unmet
of a medication as emergency contraception. Afr J Reprod Health. need for family planning services among currently married women and
2011;15(3):135–47. sexually active unmarried women aged 15–49 in Nigeria (2003–2013). Afr
9. Wemakor A, Garti H, Saeed N, Asumadu O, Anyoka B. Prevalence and Popul Stud. 2015;29(1):1483–99.
determinants of unmet need for contraception in North Gonja district, 30. Khan HR, Shaw E. Multilevel logistic regression analysis applied to binary
Ghana. BMC Womens Health. 2020;20(1):1–9. contraceptive prevalence data. J Data Sci. 2011;9:93–110.
10. Pham BN, Whittaker M, Okely AD, Pomat W. Measuring unmet need for 31. Avogo WA, Somefun OD. Early marriage, cohabitation, and childbearing
contraception among women in rural areas of Papua New Guinea. Sex in West Africa. J Environ Public Health. 2019;13:2019.
Reprod Health Matters. 2020;28(2):1848004. 32. Odimegwu C, Frade S. The influence of adolescent age at first union on
11. Seidu AA, Agbaglo E, Dadzie LK, Ahinkorah BO, Ameyaw EK, Tetteh JK, physical intimate partner violence and fertility in Uganda: a path analysis.
Yaya S. Modern contraceptive utilization and associated factors among S Afr J Child Health. 2018;2018(1):s51–6.
married and cohabiting women in Papua New Guinea: a population- 33. Klinzing ML. Denying reparation for slave and forced laborers in World
based cross-sectional study. Contracept Reprod Med. 2020;5(1):1–11. War II and the ensuing humanitarian rights implications: a case study of
12. United Nations, Department of Economic and Social Affairs, Population the ICJ’s recent decision in jurisdictional immunities of the state (Ger. V. It.:
Division. 2015. Trends in Contraceptive Use Worldwide 2015 (ST/ESA/ Greece Intervening). Ga J Int Comp Law. 2012;41:775.
SER.A/349). 34. Wulifan JK, Brenner S, Jahn A, De Allegri M. A scoping review on determi‑
13. Thanenthiran S. Access to contraception and family planning in Asia and nants of unmet need for family planning among women of reproduc‑
the Pacific region. Asian-Pacific resource and research center for women. tive age in low and middle income countries. BMC Womens Health.
2019. 2015;16(1):1–5.
14. Ahmed S, Choi Y, Rimon JG, Alzouma S, Gichangi P, Guiella G, et al. Trends 35. Kabagenyi A, Jennings L, Reid A, Nalwadda G, Ntozi J, Atuyambe L. Barri‑
in contraceptive prevalence rates in sub-Saharan Africa since the 2012 ers to male involvement in contraceptive uptake and reproductive health
London Summit on Family Planning: results from repeated cross-sec‑ services: a qualitative study of men and women’s perceptions in two rural
tional surveys. Lancet Glob Health. 2019;7(7):e904–11. districts in Uganda. Reprod Health. 2014;11(1):1–9.
15. Gupta S, McGeechan K, Bernays S, Mola G, Kelly-Hanku A, Bolnga JW, 36. Mosha I, Ruben R, Kakoko D. Family planning decisions, perceptions and
Black KI. Fertility preferences, contraceptive use, and the unmet need for gender dynamics among couples in Mwanza, Tanzania: a qualitative
contraception in Papua New Guinea: key findings from 1996 to 2016. Asia study. BMC Public Health. 2013;13(1):1–3.
Pac J Public Health. 2021;33(6–7):780–3. 37. Adebowale SA, Palamuleni ME. Determinants of unmet need for modern
16. Ahinkorah BO. Predictors of unmet need for contraception among ado‑ contraception and reasons for non-use among married women in rural
lescent girls and young women in selected high fertility countries in sub- areas of Burkina Faso. Afr Popul Stud. 2014;28(1):499–514.
Saharan Africa: a multilevel mixed effects analysis. PLoS ONE. 2020;15(8): 38. Wulifan JK, Jahn A, Hien H, Ilboudo PC, Meda N, Robyn PJ, Hamadou TS,
e0236352. Haidara O, De Allegri M. Determinants of unmet need for family planning
in rural Burkina Faso: a multilevel logistic regression analysis. BMC Preg‑

nancy Childbirth. 2017;17(1):1–1.
39. Imasiku EN, Odimegwu CO, Adedini SA, Ononokpono DN. Variations in
unmet need for contraception in Zambia: does ethnicity play a role? J
Biosoc Sci. 2014;46(3):294–315.
40. Kandel NR. Unmet need for contraception and its associated factors
among married women of reproductive age in Simichaur VDC of Gulmi
District. Health Prospect J Public Health. 2012;11:11–4.
41. Hailemariam A, Haddis F. Factors affecting unmet need for family plan‑
ning in southern nations, nationalities and peoples region, Ethiopia.
Ethiop J Health Sci. 2011;21(2):77–90.
42. Staveteig S. Fear, opposition, ambivalence, and abstinence: understand‑
ing unmet need in Ghana. In 2016 Annual Meeting 2016 Apr 2. PAA.
43. Chafo K, Doyore F. Unmet need for family planning and associated factors
among currently married women in Misha District, southern Ethiopia: a
cross sectional study. J Women’s Health Care. 2014;3(165):2167-0420
44. Juárez F, Gayet C. Transitions to adulthood in developing countries. Ann
Rev Sociol. 2014;30(40):521–38.
45. Fagbamigbe AF, Afolabi RF, Idemudia ES. Demand and unmet needs of
contraception among sexually active in-union women in Nigeria: dis‑
tribution, associated characteristics, barriers, and program implications.
SAGE Open. 2018;8(1):2158244017754023.
46. Dejenu G, Ayichiluhm M, Abajobir AA. Prevalence and associated factors
of unmet need for family planning among married women in Enemay
District, Northwest Ethiopia: a comparative cross-sectional study. Glob J
Med Res. 2013;13(4).
47. Mihret N. Magnitude and associated factors of unmet need for con‑
traceptive methods among currently married women in west Belessa
District, North Western Ethiopia. Int J Innov Res Dev. 2015;4(10).
48. Cleland J, Harbison S, Shah IH. Unmet need for contraception: issues and
challenges. Stud Fam Plann. 2014;45(2):105–22.
49. Bongaarts J. The impact of family planning programs on unmet need and
demand for contraception. Stud Fam Plann. 2014;45(2):247–62.
50. World Health Organization. 2018. UHC and SDG country profiles 2018.
51. Ahmed S, Li Q, Liu L, Tsui AO. Maternal deaths averted by contraceptive
use: an analysis of 172 countries. Lancet. 2020;380:111–25. https://doi.
org/10.1016/S0140-6736(12)60478-4.
52. Alkema L, Kantorova V, Menozzi C, Biddlecom A. National, regional, and
global rates and trends in contraceptive prevalence and unmet need for
family planning between 1990 and 2015: a systematic and comprehen‑
sive analysis. Lancet. 2020;381:1642–52. https://doi.org/10.1016/S0140-
6736(12)62204-1(2020).
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in pub‑
lished maps and institutional affiliations.
Ready to submit your research ? Choose BMC and benefit from:
• fast, convenient online submission

• thorough peer review by experienced researchers in your field
• rapid publication on acceptance
• support for research data, including large and complex data types
• gold Open Access which fosters wider collaboration and increased citations
• maximum visibility for your research: over 100M website views per year
At BMC, research is always in progress.
Learn more biomedcentral.com/submissions

Agyekum Multilevel

Uploaded by

Copyright:

Available Formats

Agyekum Multilevel

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Agyekum Multilevel

Uploaded by

Copyright:

Available Formats

Agyekum et al.

Reproductive Health (2022) 19:113

RESEARCH Open Access

Unmet need for contraception and its

Plain language summary

Introduction New Guinea (PNG) is an island country to the North of

Variables Statistical analyses

Table 1 Distribution of unmet need across explanatory variables

Women’s age (years) 0.096

Someone else or other 132 1.7 63.0 [43.9,78.7] 37.0 [21.3,56.1]

Fixed effect results

Someone else or other 1.20 [0.55,2.61] 1.19 [0.55,2.57]

traception delivery as part of universal health coverage

in rural Burkina Faso: a multilevel logistic regression analysis. BMC Preg‑

Ready to submit your research ? Choose BMC and benefit from:

• fast, convenient online submission

At BMC, research is always in progress.

Learn more biomedcentral.com/submissions

You might also like