Health decision-making ability and modern contraceptive use


The major conclusion of a demographic and health survey of sexually active women from the sub-Saharan African country Chad is that education is key for adopting modern contraceptive methods.

“This is because the study has shown that when women make decisions with others, they are more likely to opt for the use of modern contraceptives and so a well-informed society will most likely have increased prevalence of modern contraceptive use,” wrote the authors.

Results of the 2014-2018 survey were published in the journal Contraception and Reproductive Medicine.

Chad has a modern contraceptive prevalence of only 7.7%. probably due to social, cultural and religious norms.

The country’s estimated population growth of 3.5% per year is relatively fast-paced, thus perhaps attributing to the region’s high fertility and low use of contraceptives.

Survey data was gleaned from 4,113 women, aged 15 to 49, who were in sexual union. Overall, 91% of respondents were married and 73.3% have partners who were sole decision-makers for health issues.

A mere 5.7% of respondents used a modern contraceptive method, which included female sterilization, an intrauterine contraceptive device (IUD), contraceptive injection, contraceptive implants (Norplant), contraceptive pill, condoms, emergency contraception, standard day method (SDM), vaginal methods (foam, jelly, suppository), lactational amenorrhea method (LAM) and country-specific modern methods, as well as a cervical cap or contraceptive sponge.

Traditional methods of proven effectiveness were periodic abstinence (rhythm, calendar method), withdrawal (coitus interruptus) and country-specific traditional techniques.

Folkloric methods of unproven effectiveness included herbs and amulets (including the Voodoo amulet gris-gris).

Women who collaborated on health decisions with another person were nearly three time as likely to use modern contraceptives than those who decided alone: adjusted odds ratio (aOR) = 2.71; 95% confidence interval (CI) =1.41 to 5.21.

Education, ability to refuse sex and employment were also linked to the use of modern contraceptives.

Women with at least a primary education were more than twice as likely to use modern contraceptives, while those with secondary or higher education were four times as likely.

Compared to their nonworking peers, the working class seeks to maintain its employment and devote more time to occupations than having children. “Also, working women are expected to have the financial backing to be able to make health decisions concerning their reproductive health,” wrote the authors.

Conversely, women who resided in rural settings were 53% less likely to use modern contraceptives than those in urban areas, perhaps because women in urban areas may have easier access to information and more interest in education. Other potential barriers for rural dwellers are poor transportation access, long distances to health facilities and shortage of contraceptives.

The survey also revealed that women who gave birth at least four times were 61% more likely to use modern contraceptives than those without birth experience.

In addition, women who could refuse sex were at least 50% more likely to use modern contraceptives than their counterparts who were unable to refuse sex.

But age, marital status or first age at sex were not associated with the use of modern contraceptives.


Adde KS, Ameyaw EK, Mottey BE, et al. Health decision-making capacity and modern contraceptive utilization among sexually active women: evidence from the 2014–2015 Chad Demographic and Health Survey. Contracept Reprod Med. doi:org/10.1186/s40834-022-00188-7

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