PREVALENCE AND FACTORS ASSOCIATED WITH COVERT CONTRACEPTIVE USE AMONG CURRENTLY MARRIED WOMEN IN NIGERIA

Abstract

Unplanned and untimed pregnancy poses a major challenge to the health and wellbeing of women of reproductive age in developing nations. This has prompted the practice of Covert Contraceptive Use (CCU) especially in settings where contraceptive utilisation is low or culturally unpopular in Nigeria. However, previous studies have not adequately explored the major factors that play important roles in covert use of contraceptives. This study was conducted to determine the pattern and factors associated with CCU among married women in Nigeria. This retrospective cross-sectional study utilised data from the 2008 Nigeria Demographic and Health Survey (NDHS) with questions on CCU. Data for 3439 currently married women of reproductive age ( 15-49 years) who were using any method of contraception and their spouses were analysed. The data was weighted to adjust for the stratified two-stage cluster sampling technique adopted during the survey, consisting of Enumeration Areas (EAs) and Households (HH). The dependent variable was CCU and was based on current use of any method of contraception and husband's knowledge of respondent's use of contraception. The independent variables were demographic, socio-economic and fertility behavioral characteristics. Pregnant or menopausal women and women not currently using any method of contraceptive within two months before the survey were excluded. Data were analysed using descriptive statistics, Chi-square tests and multiple logistic regression models at P =0.05. Mean ages of the women and spouses were 33.1±7.3 and 41.7±9.8 years respectively. About 55% of the respondents were urban dwellers, while over 70.0% were from the Southern region (S/S, S/W and S/E) and 72.9% respondents were found in the rich wealth quintile. Overall, 17.3% of the respondents were covert users with CCU more prevalent among respondents aged 25-34 years (18.9%) and those who had more than four living children (19.5%). About 18.0% of respondent s' spouse desired more children while 26.1% of the respondents experienced sexual violence. The methods most covertly used were contraceptive injections (26.6%), lactational amenorrhea (21.8%), and contraceptive pills (14.7%). There was an association between CCU and ethnicity as CCU was higher among the Hausas (32%), followed by the Yorubas (15%), and lesser among the lgbos (12.2%). Practice of CCU was significantly higher among respondents whose spouses' age was >50 years (22.1%) compared to those <30 years (16.6%). Respondents who attained a higher education were less likely to practice CCU compared to those who had no education (OR-0.31, CI=0.18-0.52). Respondents with higher education (OR=0.44. Cl=0.19-0.97), desiring more children (OR=0.39, CI=0.21-0.72) and who were involved in decision making for contraceptive use (OR=0.06, CI=0.04-0.09) were less likely to practice CCU. Respondents experience of sexual violence (OR= 2.04, CI= 1.22-3.39) and husbands desire for more children (OR=2.16, CI=1.46-3.19) were significant risk factors for CCU. The high prevalence of covert contraceptive use observed was significantly associated with spouses' desire for more children and respondents experience of sexual violence. The identified factors have implications for policy makers and concerned stakeholders in addressing these challenges to married women of reproductive age.