Can family planning outreach bridge the urban-rural divide in Zambia? Public Deposited

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Creator
  • White, Justin S
    • Affiliation: Carolina Population Center
    • Other Affiliation: MEASURE Evaluation
  • Speizer, Ilene
    • Affiliation: Gillings School of Global Public Health, Department of Maternal and Child Health, Carolina Population Center
    • Other Affiliation: MEASURE Evaluation
Abstract
  • Abstract: Background: Zambia experienced declining aggregate fertility and increasing aggregate contraceptive use from 1990 to 2000. Yet, in rural Zambia, progress in family planning has lagged far behind the advances made in Zambia's urban areas. The contraceptive prevalence rate in Lusaka and other urban areas outstripped the rate in rural Zambia by nearly 25 percentage points (41.2 percent versus 16.6 percent) in 2001. The total fertility rate varied between urban and rural areas by 2.5 children (4.3 versus 6.9 children). This paper considers the urban-rural differentials in Zambia and assesses family planning outreach as a tool to narrow this divide. Methods: This study uses the Zambia Demographic and Health Survey (DHS) data, collected between 2001 and 2002. Logistic regression techniques were employed to examine factors associated with contraceptive use. The first analysis tested modern contraceptive use versus traditional method use and no use. In addition, separate models were run for samples stratified by type of residence (rural or urban) to determine if different factors were associated with use by residence. A simulation determined the effect of all women receiving at least one household visit from a health worker if all other variables were held constant. Results: Differences in modern contraceptive use between urban and rural areas persist (OR: 1.56, 95 percent CI: 1.24–1.96) even after adjusting for a number of demographic, socioeconomic, cognitive, and attitudinal factors. Household visits by a community health worker significantly increased the likelihood of modern contraceptive use among rural women (OR: 1.83; 95 percent CI: 1.29–2.58). If all rural women received at least one outreach visit per year, the prevalence rate for modern contraceptive methods would be expected to increase for this group by 5.9 percentage points, a marked increase but less than one-quarter of the total urban-rural differential. Conclusion: Outreach in the form of health worker visits can improve access to family planning services, but it does not eliminate barriers to access or address continued high-fertility desires in Zambia. Until policymakers consider strategies that address both family planning demand creation and supply of services, progress in Zambia and the rest of sub-Saharan Africa will continue to lag behind the rest of the world.
Date of publication
Identifier
  • 17803805
  • doi:10.1186/1472-6963-7-143
Resource type
  • Article
Rights statement
  • In Copyright
Rights holder
  • Justin S White et al.; licensee BioMed Central Ltd.
License
Journal title
  • BMC Health Services Research
Journal volume
  • 7
Journal issue
  • 1
Page start
  • 143
Language
  • English
Is the article or chapter peer-reviewed?
  • Yes
ISSN
  • 1472-6963
Bibliographic citation
  • BMC Health Services Research. 2007 Sep 05;7(1):143
Access
  • Open Access
Publisher
  • BioMed Central Ltd
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