Spatial variation in the non-use of modern contraception and its predictors in Bangladesh

Objective We assessed spatial variations in the non-use of modern contraception in Bangladesh, and identified associated individual, household and community level factors. Methods We analysed data from 16,135 women extracted from the 2017/18 Bangladesh Demographic and Health Survey. The study outcome was non-use of modern contraception (yes, no), and the explanatory variables were factors at the individual (e.g., women’s education), household (e.g., husband education) and community level (e.g., community level poverty and illiteracy). Moran’s I statistics was applied to examine whether any geographical heterogeneity in non-use of modern contraception exists in Bangladesh. The Gettis-ord Gi * was calculated to measure how spatial autocorrelation differed across study locations. A geographically weighted regression model was used to assess the relationship of non-use of modern contraception at the cluster level. Results Overall, 42.8% (95% CI, 41.6-43.8) of respondents reported non-use of modern contraception in Bangladesh with a significant variation across geographical locations (p<0.001). Clusters of high non-use of modern contraception (hot spots) were found mostly located in the Sylhet, Barishal and part of the Chattogram divisions while clusters of low use of modern contraception(cold spots) were mostly located in the Rangpur, Mymensingh and part of the Rajshahi divisions. The likelihood of non-use of modern contraception was strongest among women and parteners with low levels of education. Other risk factors analysed including partner’s occupation, community-level illiteracy and poverty had varying effects on the non-use of modern contraception across the locations (clusters) of the country included in the survey. Conclusion Prevalence of, and risk factors for, modern contraception non-use in Bangladesh differed depending on geographical location. This suggests a need for targeted area-specific policies and programs to improve knowledge and uptake of modern contraception.