Abstract
Purpose This dissertation examined contraceptive use in the broader social-structural perspective, particularly how individual, social-structural, and Program effort factors have affected contraceptive use as well as utilization of sources of contraception in Sub-Saharan African countries with a particular interest in younger women.
Methods The analysis was conducted utilizing a large population database covering numerous decades of cross-sectional studies using the demographic health surveys (DHS), family planning effort index (FPE) datasets, and the World Bank databank from a total of 25 countries in sub-Saharan Africa conducted between 1989 and 2019.
Results This dissertation’s main contribution to knowledge is that in Kenya contraceptive use increased from 24.0% to 42.6%, with a change % of 77.5%. Despite changes in women’s characteristics, these characteristics posed little on the time trend of contraceptive use in Kenya. In addition, the policy component of FPE scores had a positive association with contraceptive use with negligible change after adjusting for social and demographic factors 1.055 (1.046–1.065). In addition, young women existing in nations with a more vigorous national family planning program effort showed by the Public-sector Family Planning Impact score were extra probable to utilize Long-Acting Reversible Contraceptive methods, an odds ratio of 1.44, 95% CI, 1.43−1.45. While a young woman who lives in a country with a higher HIV prevalence rate had the least likelihood of using LARC methods. 0.75 (95% CI, 0.70−0.81). This dissertation also contributes to an understanding of young women’s accessibility and affordability to obtain various sources of contraceptives, particularly private sources. Whereby, urban residents utilized more private sources, especially in low-income (Beta coefficient, B=0.980) and upper-middle-income countries (B=1.123). Wealthy young women were more likely to access private sources in countries of all income levels, (B=0.958 for “rich” and B=0.433 for “middle”).
Conclusions Connecting the gap stuck between policy and implementation is desirable to realize a continued rise in contraceptive use. Country-level factors play an important role in prompting LARC usage amongst young women in sub-Saharan Africa. Wider societal level interventions to advance LARC usage are obligatory. Even though young women might prefer private sources for their confidentiality and flexible opening hours, it is clear that such sources benefit richer and urban young women more than poor and rural women. Differential accessibility and affordability might have accounted for the urban-rural and rich-poor disparities, respectively in using contraceptive sources; and a country’s income level is likely to modify such disparities.

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