The Use of Female Permanent Contraception Among Women Desiring to Limit Childbearing in Sub-Saharan Africa: Analyses of the Spatial Pattern and Individual- and Country-Level Determinants

Female permanent contraception (FPC) is the most commonly used contraceptive method, globally. It is a convenient, safe, and cost-effective modern contraceptive method that permanently stops childbearing among women. Despite its benefits, previous reports suggest that the increasing proportion of women who desire to limit childbearing in sub-Saharan Africa (SSA) rely more on less effective contraceptive methods, predisposing them to unintended pregnancies and their associated consequences. This study aimed to add to the sparse body of evidence on the use of FPC and the associated determinants among women with demand for limiting childbearing in SSA. Using data from Demographic and Health Surveys (2010-2018) and other global data repositories, this study investigated the proportion of demand for limiting childbearing satisfied with FPC, spatial pattern in the proportion of demand for limiting childbearing satisfied with FPC, and individual- and country-level factors associated with the use of FPC among married or in-union women with demand for limiting childbearing in 33 countries in SSA. Weighted descriptive statistics, exploratory spatial data analysis, and multilevel logistic regression analysis were performed. The findings showed that 6.7% (95% confidence interval [CI]=6.2-7.1%) of the demand for limiting childbearing was satisfied with FPC, ranging from 0.3% (95%CI=0.1-0.8%) in Angola to 27.0% (95%CI=25.3-28.7%) in Malawi. Across all countries, the proportion of demand for limiting childbearing satisfied with FPC was highest among women: 40 years and older (10.4%), with 3-4 living children (7.8%), with secondary education or higher (7.9%), from rich households (8%), and residing in urban areas (7.2%). There was a significant positive spatial autocorrelation in the proportion of demand for limiting childbearing satisfied with FPC (global Moran’s I =0.1,