Effect modification of socioeconomic status in the association between contraception methods and couple's education: A secondary analysis of PDHS 2017-18.

Abstract

Globally, the region of South Asia reports the highest number of women (87 million) with unmet needs of contraception. Amongst the lower-middle-income countries of South Asia, Pakistan has performed poorly in enhancing contraceptive prevalence, as evident by the Contraceptive Prevalence Rate (CPR) of 34%. Factors including restricted access to contraception, a restricted selection of techniques, cultural/religious resistance, gender-based hurdles, and societal factors, such as the couple's education level, are among the most important causes for this gap in desire and usage. Thus, this study aimed to evaluate the association between couple's education level and their influence on their choice of contraception. In addition, the study also assessed the role of socioeconomic status in modifying the association between couple's education and contraception choice. Using PDHS 2017-18 data, couple's education status, preferences of contraceptive use and wealth quintiles were analyzed through multinomial logistic regression after adjusting for other confounding factors. The findings of our study revealed that out of the total sample of 14,368 women, 67.52% (n = 9701) were categorized as non-users, 23.55% (n = 3383) employed modern contraceptive methods, and 8.94% (n = 1284) utilized traditional contraceptive methods. Multivariable analysis showed that educated couples belonging to higher socioeconomic status (SES) had the highest adjusted odds ratio [7.66 (CI: 4.89-11.96)] of using modern contraceptives as opposed to uneducated couples of low socioeconomic statuses. Our analysis also revealed that the odds of using modern contraceptives were higher amongst mothers with five or more children [8.55 (CI:7.09-10.31)] as compared to mothers with less children when adjusted for other covariates. Thus, this study concludes the dynamic interplay between couple's level of education, contraceptive preference, and socioeconomic status This study contributes valuable insights for the policy makers and stakeholders to understand the intricate relationship between these factors.