Impact of internal female migration on unmet need for modern contraception in Zambia

Posted by Nicole Moran on December 3, 2019 at 12:35 pm



Background

There is limited evidence about how migrating impacts women’s family planning. This study aims to address this gap in research by assessing how different migration patterns affect the chances for women to have their reproductive needs (i.e. contraception) unfulfilled (i.e. unmet). An estimated 225 million women in low- and middle-income countries want to avoid pregnancy but use no form of modern contraception (e.g. condoms, the pill). Women at highest risk are typically young, poor, of low education and unmarried, the same population most likely to migrate. Women account for roughly half (48%) of the worlds’ migrants, yet there is a gap in knowledge around how migrating affects women’s ability to plan their families by limiting or delaying future childbirth. In this study, we analysed data from the 2013–2014 Zambia Demographic and Health Survey and compared the chances of having an unmet need for contraception between migrant women and rural non-migrant women to that of urban non-migrant women. We found that rural-to-rural migrants were 30% more likely to have an unmet need and rural non-migrants were 40% more likely compared to urban non-migrants. Regardless of migration status, poor rural women were most likely to have an unmet need compared to rich urban women. In Zambia, a focus on rural-rural migrants, rural non-migrants and the poorest could improve the health of the entire population. More research is needed to improve our understanding of factors that both obstruct and facilitate contraceptive use and how they may be affected by migration over time.

Methods

Data on sexually active, fecund, reproductive-aged (15–49 years) women from the 2013–14 Zambia Demographic and Health Survey were analysed through univariate and multivariate logistic regression models.

Results

Unmet need for modern contraceptive methods was significantly higher among rural to rural migrant women (OR 1.30, 95%CI 1.00–1.70 p < 0.05) and rural non-migrant women (OR 1.41, 95%CI 1.06–1.85 p < 0.01) compared to urban non-migrant women after controlling for age, marital status, parity, religion, education and wealth.

Conclusion

Women residing in, and migrating between, rural areas were significantly more likely to have an unmet need for contraception. Our findings highlight the importance of understanding migration and migrant streams to strengthen family planning programs. In Zambia, a focus on rural-rural migrants, rural non-migrants and the poorest could improve the health of the entire population.


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