Factors Determining Intention to Use Contraception Among Sexually Active Women in South Africa: A Multilevel Modelling Approach

Abstract

Background: At least six in 10 women use contraception in South Africa. Although there is considerable contraceptive use, there is a need to understand the factors associated with intention to use contraception later among sexually active women who are not using contraception. Women's intention to use contraception is the best predictor of contraceptive use because it usually translates into actual contraceptive use. This study aimed to investigate the multilevel factors determining intention to use contraception among sexually active women in South Africa. Methods: We used cross-sectional secondary data from the 2016 South Africa Demographic and Health Survey (SADHS). This study used a sample of 1684 women who were not using contraception at the time of the survey. The data were analysed using descriptive statistics and multilevel (random effect) logistic regression. Results: Overall, the prevalence of sexually active women's intention to use contraception was (40.7%, 95% CI: 37.3-44.2) in South Africa. We found that age, marital status, population group, parity, ideal number of children, desire to delay childbearing, exposure to family planning messages/advice, place of residence, and province were associated with intention to use contraception. Moreover, the odds of women's intention to use contraception were lower among women aged 40-49 years (AOR: 0.13, 95% CI: 0.07-0.23), women who had no exposure to family planning messages/advice (AOR: 0.68, 95% CI: 0.52-0.88), and womenfrom the Free State province (AOR: 0.49, 95% CI: 0.26-0.95). Conclusion: The results showed that age, population group, parity, ideal number of children, desire to delay childbearing, exposure to family planning messages/advice, and province were key predictors of women's intention to use contraception. The findings suggest the need for targeted education initiatives about contraception, particularly among older women. There is also a need to involve community leaders and the local media in sexual and reproductive health campaigns.