The public-sector family planning program impact scores in association with long-acting reversible contraceptive use among young women in 22 Sub-Saharan African countries: A pooled multi-level analysis

Objective: The objective of this study was to evaluate the role of public-sector family planning program impact scores and other country-level factors on LARC use among young women aged 15 to 24. Study design: We conducted this research using a large population database covering several decades’ worth of multi-wave cross-sectional samples of the demographic health survey (DHS) and the World Bank website data. We carried out a multi-level analysis on data from 1990 to 2019 from 22 Sub-Saharan African countries, with 163,242 participants. Results: We found LARC use was at 3.1% of all young women under study. Sierra Leone, 2019 survey had the highest LARC use at 21,961 per 100,000. A 10% increase in public-sector family planning program impact scores was positively associated with LARC use with odds ratio of 1.44, 95% CI, 1.43−1.45). We also noted that a 1% increase in HIV prevalence was associated with a reduced odds ratio of LARC use at 0.75 (95% CI, 0.70−0.81). Conclusions: Findings from this study provide empirical evidence highlighting the importance of country-level factors in influencing LARC use among young women in sub-Saharan Africa Implications: For young women in Africa, policymakers need to increase their effort on national family planning programs especially in the public sector. Broader societal level interventions to improve LARC use are required. Specific interventions must address the complexities of HIV prevention and LARC use to benefit young women living in countries with a high HIV prevalence.