Determinants of Contraceptive Practice Among Married Women, in the Health District of Dahra, Senegal

Introduction In Senegal, the contraceptive prevalence rate among married women was estimated in 2015 at 22% at the national level. It was particularly weak in the health district of Dahra where it was 14%. The health district has, since, benefited from the support of the United Nations Population Fund (UNFPA) and the Mother and Child Health Support Project/“Projet d’Appui a la Sante de la Mere et de l’Enfant (PASME)”. PASME is funded by the French Development Agency/“Agence francaise de developpement (AFD)”. Thus, several interventions focused on communication and strengthening health care were made. At the end of the first year, the objective of this study was to re-evaluate the contraceptive prevalence and its main determinants in order to propose strategies for its improvement. Methodology The cross-sectional, descriptive and analytical study was conducted from 8 to 22 June 2016 in the health district of Dahra whose area is 7, 980 square kilometers for 161, 446 inhabitants (22 inhabitants per square kilometer). It was centered on women of childbearing age (15–49 years), married, and residing in the health district for, at least, 6 months. These women were selected according to a two-stage cluster survey (village/neighborhood then concession). The sample, calculated with the Schwartz formula and taking into account the cluster effect, was n = [1,962 × p × q]/I2 × 2 = 162 × 2 = 370. It was adjusted to 450 in order to have 30 clusters of 15 women to investigate at the household-level. The dependent variable was contraceptive practice. The independent variables were related to socioeconomic characteristics, knowledge and attitudes about family planning. Data were collected in households using a questionnaire in individual interviews. They were, then, entered and analyzed using the Epi-Info software version 3.5.3. Results The number of respondents was 433 (96%). The age, variable from 15 to 49 years, had an average of 29 (± 7.8). The majority of women were from rural area (69.3%) and in monogamous marital regime (62.3%). Among them, 89% knew family planning; and 52.7% had a husband who approves family planning. The contraceptive prevalence was estimated at 28.4% and the injectable methods were the most used (44.7%). The proportion of women with unmet need for family planning was 20.3%. Contraceptive practice was greater among those who: resided in urban area (P = 0.009, OR = 1.78 [1.14–2.76]), had an income-generating activity (P = 0.035, OR = 1.58 [1.03–2.43]), and/or had a husband who approves family planning (P  Conclusion At the health district of Dahra, the contraceptive prevalence rate has been raised but remains low. Its improvement requires a real global and inclusive dynamics for all actors. This calls for a multi-sectorial and interdisciplinary approach, aimed at empowering women and involving husbands, especially in rural areas.


Introduction
In Senegal, the contraceptive prevalence rate among married women was estimated in 2015 at 22% at the national level [1]. It was particularly weak in the health district of Dahra (14%). The health district has, since, benefited from the support of the United Nations Population Fund (UNFPA) and the Mother and Child Health Support Project / Projet d' Appui à la Santé de la Mère et de l'Enfant (PASME). PASME is funded by the French Development Agency / Agence Française de Développement (AFD). Thus, several interventions focused on communication and strengthening health care were made. At the end of the first year, the objective of this study was to re-evaluate the contraceptive prevalence and its main determinants in order to propose recommendations.

Method
A cross-sectional, descriptive and analytical study was conducted from 8 to 22 June 2016 in the health district of Dahra (6,980 km 2 for 151,446 inhabitants). It was centered on women of childbearing age (15-49 years), married, and residing in the health district for, at least, 6 months. These women were selected according to a two-stage cluster survey (village then concession). The sample, calculated with the Schwartz formula and taking into account the cluster effect, was n = ([1,962❊p❊q]/I2)❊2 = 185❊2 = 370. It was adjusted to 450 in order to have 30 clusters of 15 women to investigate. Data, collected in households using a questionnaire in individual interviews, were entered and analyzed with Epi Info software 3.5.3.

Result
The number of respondents was 433 (96%). The age, variable from 15 to 49 years, had an average of 29(±7.8). The majority of women were from rural area (69,3%) and in monogamous marital regime (62.3%). Among them, 89% knew family planning (FP); and 66.1% of husbands approved FP. The contraceptive prevalence reached 28.4% and the injectable methods were the most used (44.7%). The proportion of women with unmet need for FP was 20.3%. Contraceptive practice was greater among those who: resided in urban area, had an income-generating activity, and/or had a husband who approves FP.

Discussion
The limits of this study are of three kinds [2,3]: Unmarried women who represent 35% of the women of childbearing have been overshadowed. The characteristics of women with unmet need for FP were not studied. The peculiarities of the service offer were not detailed.The estimated prevalence (28.4%) is above the national average of 22%. Four main factors influenced contraceptive practice: husband's attitude, place of residence, economic occupation and age of the last child. These data are comparable to the Faye M series in Ngaye Mékhé District, which found a contraceptive prevalence of 28.6% in 2015 [4].The unmet need for family planning (20.3%) was similar to that of the 2014 demographic and health survey (DHS), which found that 25.6% of women had a SNB in FP, of which 19.2% for spacing and 6.3% for limiting births [1].

Conclusion
At the health district of Dahra, the contraceptive prevalence rate has been raised but remains low. Its improvement requires a real global and inclusive dynamics for all actors. This calls for a multi-sectorial and interdisciplinary approach, aimed at empowering women and involving husbands, especially in rural areas.