Beyond knowledge acquisition: factors influencing family planning utilization among women in conservative communities in Rural Burundi.

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SONIA HAKIZIMANA, Emmanuel Nene Odjidja This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-24210/v4 This work is licensed under a CC BY 4.0 License Status: Under Review Version 4 posted 6 You are reading this latest preprint version Show more versions Abstract Background With a fertility rate of 5.4 children per woman, Burundi ranked as seventh country with the highest fertility rate in the world. Family planning is an effective way of achieving desirable family size, appropriate birth spacing and significant reduction in unintended pregnancies. Furthermore, family planning has been linked to improvements in maternal health outcomes. Yet, in spite of the overwhelming evidence on the benefits of family planning and despite high knowledge and free services, utilisation is low especially in rural communities with conservative people. Employing a mixed methods approach, this study first quantifies contraceptive prevalence and second, explores the contextual multilevel factors associated with low family planning utilisation among community members. Methods An explanatory sequential mixed study was conducted. Five hundred and thirty women in union were interviewed using structured and pre-tested questionnaire. Next, 11 focus group discussions were held with community members composed of married men and women, administrative and religious leaders (n=132). The study was conducted in eighteen collines of two health districts of Vyanda and Rumonge in Bururi and Rumonge provinces in Burundi. Quantitative data was analysed with SPSS and qualitative data was coded and deductive thematic methods were applied to find themes and codes. Results The overall contraceptive prevalence was 22.6%. From logistic modelling analysis, it was found that women aged 25 to 29 (aOR 5.04 (95% CI 2.09 – 10.27 p=0.038)), those that have completed secondary school and having four or less children were significantly associated with use of family planning (aOR 1.72 (95%1.35 – 2.01) p=0.002). Among factors why family planning was unused included experience with side effects and costs associated with its management in the health system. Religious conceptualisation and ancestral negative beliefs of family planning had also shaped how people perceived it. Furthermore, at the household level, gender imbalances between spouses had resulted in break in communication, also serving as a factor for non-use of family planning. Conclusion Given that use of family planning is rooted in negative beliefs emanating mainly from religious and cultural practices, engaging local religious leaders and community actors may trigger positive behaviours change needed to increase its use. Sexual & Reproductive Medicine Family Planning Contraception barriers perceptions rural Burundi sub-Saharan Africa Plain English Summary In the Burundian context, community members agree that large family sizes are difficult to maintain, yet, use of family planning remains consistently low. This study explored the factors behind this low utilisation of family planning in two health districts located in the South of Burundi. The findings suggest that fear of side effects is the main reason for family planning non-utilization or discontinuation. The culture and religious beliefs in Rural Burundi also espouse large family sizes and among men, this is conceived as a sign of wealth, power, and respect. Lack of spousal communication and unequal gender relations in household also impedes women from contributing decisions on family planning. The onus on making decisions on contraceptive use lies on men, whom usually, have limited understanding of family planning methods. In improving coverage of family planning in these communities, capacity of the health system, to provide quality, timely and people-driven family planning services should be strengthened. At the community level, the use of community health workers to deliver family planning services to the doorstep of community members could significantly increase uptake. Finally, men and religious leaders’ involvement in promoting family planning use can contribute to reducing the impact of cultural and religious barriers to uptake. Background Burundi, a small, landlocked country in East Africa is a home to 11,175,378 individuals [1]. The population density is estimated at 435 people per square kilometre thereby, making Burundi second most populated African nation. [1] Despite the scarcity of cultivable land, 87% of the rural population depend solely on subsistence farming [2]. With a fertility rate of 5.4 children to a woman, Burundi has been classified as among the top ten countries with the highest fertility, placing just seventh after Niger, Somalia, the Democratic Republic of the Congo, Mali, Chad and Angola [24]. High fertility rate has been identified as a major contributor to poor health outcomes such as increased maternal and child morbidity and mortality. Consistently, previous studies have suggested that grand multiparity (parity >=5) is associated with adverse pregnancy outcomes such as caesarean delivery, foetal macrosomia, diabetes mellitus and pregnancy induced hypertension. [4]. Additionally, Hendrik et.al (2014) found that short birth intervals negatively affect perinatal, neonatal and child health by increasing the incidence of preterm birth, low birth weight and perinatal death. [5] On the other hand, contraceptive use prevents pregnancies and associated risks of miscarriage, stillbirth and postpartum haemorrhage among others [6]. Research suggests that preventing births in mothers with five or more children could reduce maternal deaths by 58% and family planning could prevent around 272,000 maternal deaths in the world every year [7]. Recent evidence suggests that family size could also be a determinant to child nutritional status, morbidity, and mortality [8]. Moreover, socially, contraceptive use among women is an indicator for autonomy which is also accomplishment of fundamental human rights of decisions on how to use their bodies [9] and in fulfilment of sustainable development goals 3 [10]. Despite that modern contraceptive methods have shown to be effective in spacing births and avoiding unintended pregnancies, its low uptake is still a concern in many parts of the developing world particularly in Sub-Saharan Africa. 21% percent of the 214 million women of childbearing age in developing countries who would like to avoid pregnancy but are not using any modern contraceptive method reside in Sub-Saharan Africa [7]. According to the DHS, only 23% of women in Burundi living with a partner and aged between 15-49 years use modern contraceptive methods of which 30% of these have an unmet need of family planning [3]. Although 97% have comprehensive knowledge on family planning, 40% of women using contraceptives in the last five years discontinued with 33% of women citing side effects as reasons for discontinuation [3]. This finding is consistent with other studies conducted in Sub-Saharan Africa and South Asia. A study conducted in Pakistan highlights that more than 80% of married women reported that the experience of side effects is the main reason of discontinuation of the last contraceptive method used [11].Another study by Bekele et al in South East Ethiopia has suggested that fear of side effects accounts for 48% of discontinued contraceptive method use among married women [12]. While Burundi is one of the countries with the least contraceptive prevalence, little research has been conducted from community’s perspective to understand the factors driving utilisation especially in communities (collines) with conservative traditional values. Little is known about how the sociocultural space facilitates or hinders the utilisation and continuation of family planning in the context of Burundi. This study aims to investigate the factors affecting FP utilisation in conservative communities in rural Burundi using an explanatory sequential mixed methods study. Through acquisition of quantitative and qualitative information, we sought to bring an in-depth comprehension of this complexity in this setting. Methods Study Design An explanatory sequential mixed design study was carried out from 1 st May to 28 th June 2019, commencing with quantitative information on a mass scale then using focus group discussions (qualitative methods), we explored and described patterns/relationships that emerged from the quantitative strand. To allow comparison with national figures, we adopted and adapted quantitative questionnaires from the DHS to understand contraceptive prevalence disaggregated by background characteristics. Questionnaires were deployed via an electronic system and administered by appointed enumerators and teams. Due procedures to ensure respondents’ rights and privacy were respected. We learned from family planning records from Kigutu Health centre which serve the community in the eighteen collines that women represented more than ninety per cent of the people who came for family planning service during the previous year. Having that background knowledge, this study has focused on married women during the quantitative phase and questionnaire was administered to a sample of this target population. Data from quantitative phase was collected and analysed and those interesting relationships were further explored using focus-group discussions. These groups comprised of married community members, opinion, and religious leaders. Those community representatives in the focus group discussion were selected because they qualify for family planning utilization or were in the position to influence family planning uptake. They were selected in all 18 collines, however in case of collines with similar characteristics, representatives of two or three collines were invited to join one discussion group. This qualitative phase used an open-ended questionnaire that assessed different topics including family planning. Although questions had been preconceived, it was general, and the direction of discussions were driven by study participants. An experienced and trained moderator was appointed and ensured that all respondents were given equal opportunity to speak and their views were respected. Study Area The study was conducted in rural districts of Bururi and Rumonge provinces located in South of Burundi, East Africa. Specifically, the study was conducted in 18 collines (districts) of the Vyanda and Rumonge commune (regions). While collines in the Vyanda commune were Mirango, Kabwayi, Migera, Mushishi, Kirungu, Kigutu, and Karirimvya, those in the Rumonge commune were Cabara, Mutambara, Karagara, Gitwe, Gatete, Gashasha, Kanenge, Mayengo, Nyakuguma and Busebwa. Outcome Variable The main outcome variable for investigation was current use of contraceptives which a binary variable (Yes/No). The definition of this variable was in line with that of the Burundian Demographic Health Survey [3]. To acquire information for this indicator, women in union were asked if they or their partners were doing something or using any method to avoid or delay pregnancy [13]. The population base used as a denominator was all women in union at the time of interview. Sampling Strategy The quantitative phase included a two-stage sampling strategy which comprised of cluster and systematic sampling. During the first stage, all collines, their population were considered as a possible sampling frame. A probability proportion to size (PPS) was applied to select a desired cluster size of 30. The calculated sample size was divided by this number to determine the sampling interval. Enumerators upon arrival at every colline, received household list from the colline administrator. The sampling interval applied to derive the interval of households to be selected systematically. Given the study objectives, the following criteria were applied to ensure enumerators were interviewing the right households: Inclusion Criteria Household with women aged 15 and 49 also classified as those in reproductive age Head of household and caregiver in the right state of mind to actively respond to questions Households whose head signed off the consent form Exclusion Criteria Households that did not meet the stated inclusion criteria Households whose women of reproductive age were currently pregnant Sample Size Calculation The sample size was calculated based on predetermined methodology of the Demographic Health Survey. Using this rigorous methodology, a sample size of 952 households were selected and distributed equally among the clusters. Details of the sample size calculation has been published elsewhere [3]. The qualitative phase employed 11 focus groups with an average size of 12. Members of these groups were purposively selected to represent a mix of community representatives and members. Data Analysis Quantitative analysis was initially cleaned via quality check for completeness and consistency. The analysis in this paper is based on knowledge of contraceptive methods and current use of contraceptive methods. Women who never had child or wanted another child within 2 years were excluded in the analysis regarding current use of contraceptive methods. These indicators were analysed quantitatively using IBM software-SPSS Statistic version 20 [13]. Chi-squares were used to assess relationships between outcomes and exposure variables. A logistic regression controlling for cofounders such as place of residence, wealth quintile and religion was used to predict the adjusted odds of a woman using contraceptives. Significance of statistical relationships was considered at 95%CI (two tailed). For the qualitative analysis, focus group discussions were recorded, transcribed, and translated from Kirundi to French then to English. In ensuring consistency in translation, all transcripts were reviewed by two native Kirundi and French speakers with an advanced fluency in English. When there was a disagreement on translated word, a third advice was sought from a third person. After this, deductive mechanisms consisting of desired number of children, facilitators and barriers of family planning were employed to detect emerging themes and codes. The generated codes were applied to all transcripts for quotes which were in line to themes. Ethical Considerations A signed letter approval was granted for this study by the local health authorities in the Bururi and Rumonge province which is a representative body of the National Ethics committee at the province level. Study participants signed a consent form ahead of interview and careful steps were taken to ensure respondent’s rights and privacy were respected at all times. Results Socio Demographics Characteristics A total of 530 women in union at the time of data collection were interviewed from 930 households, accounting for a response rate of 95.4%. The mean age of the respondents was 30.76(± 6.872 SD) with a minimum age of 18 years (Table 1). More than half percent of women (51.7%) were between the age of 25 and 34 years. The mean age at the first pregnancy was 20.17(±3.53SD) years. More than a quarter (26.6%) of women in union has not attended formal education while only 12.3% of those who attended formal education had completed secondary education. The average number of children a woman had was 4.3(± 2.4 SD). 216 women (42%) had five or more children. Additionally, 37.7% of women spaced the last two children less than 24 months. 14% of the participants reported that they had ever lost a child less than 5 years old. Family Planning In this study, 94.3% of women, reported to know at least one type of contraception with 94.2% knowing at least a source of acquiring contraceptives. Only 22.6% of women who desired to space their next birth more than 2 years were using a contraception method at the time of interview. The most prevalent modern contraceptive method was the injectable accounting for 40%, followed by implants used by 24.6% of women. The male preservative, Intra Uterine Device (IUD), pills and sterilization represented 10.8%, 6.2%, 3.1% and 1.5% respectively. 13.8% of women who adhered to any form of contraception reported to be using natural contraceptive methods. Among women not on any form of contraceptives, the following reasons were cited: side effects (51%), absence of menses since delivery which is considered as postpartum or postpartum amenorrhea in case it exceeds six weeks (18.8%), religious beliefs (12.9%), partner opposition (8.4%), partner absenteeism (6.4%) and lack of awareness about family planning services (2.5%). Among women on modern contraception, 68% reported that they were not informed about eventual side effects at the time they started utilization. Table 1: Socio-demographic and obstetric characteristics Characteristics Categories n (%) 95% CI P-value Age of mother 18-24 104 (19.6) 18.3 – 20.1 0.105 25-29 136 (25.7) 21.4 – 26.6 30-34 138 (26.7) 22.3 – 29.5 35-39 83 (15.7) 12.7 – 18.6 40-44 46 (8.7) 7.2 – 9.5 45+ 23 (4.3) 3.9 – 5.2 Educational level of Women No formal education 141 (26.6) 23.5 – 28.6 0.118 Uncompleted Primary education 197 (37.2) 32.3 – 40.2 Completed primary education 49 (9.2) 7.2 – 10.8 Uncompleted secondary education 91 (17.2) 14.3 – 19.5 Completed Secondary School 48 (9.1) 8.4 – 10.9 University education 4 (0.8) 0.2 – 1.9 Parity ≤4 298 (58) 56.6 - 60.7 0.034* 5-7 162 (31.5) 27.5 – 33.1 ≥8 54 (10.5) 6.2 – 14.8 Birth interval between the last two children <24 months 173 (37.7) 37.7 <0.001* ≥24months 286 (62.3) 62.3 *Chi-square relationship statistically significant There was a statistically significant negative association between last two children birth intervals and family planning utilisation (p-value <0.001). Those who had longer intervals between the two last births were less likely to adopt any family planning method as spacing had been considered as a natural family planning method. Table 2: Adjusted Odds Ratio (controlling for cofounders) predicting women’s use of family planning based on background characteristics Characteristic aOR (95%CI) P-value Age of Mother 18-24 4.26 (1.88 – 9.45) 0.070 25-29 5.04 (2.09 – 10.27) 0.038* 30-34 3.17 (2.68 – 7.75) 0.142 35-39 2.15 (1.42 – 9.83) 0.354 40-44 2.03 (1.37 – 10.83) 0.412 45+ Ref Ref Educational level of Women 1.31 (1.11 – 1.49) 0.183 No formal education 1.21 (0.89 – 5.53) 0.621 Uncompleted Primary education 1.32 (1.13 – 2.31) 0.319 Completed primary education 2.91 (0.72 – 4.12) 0.213 Uncompleted secondary education 3.11 (1.31 – 5.40) 0.081 Completed Secondary School 1.94 (0.86 – 5.28) 0.003* University education Ref Ref Parity ≤4 1.72 (1.35 – 2.01) 0.002* 5-7 1.03 (0.76 – 3.82) 0.172 ≥8 Ref Ref Birth interval between the last two children <24 months 2.84 (1.92 – 3.41) <0.001* ≥24months Ref Ref * Statistically significant associations at 95% CI (two tailed) from logistic regression Logistic regression showed that women aged 25 to 29 were 5.04 times (95%CI 2.09 – 10.27 p=0. 038) likely to use family planning methods compared to those aged above 45 years. Furthermore, completing secondary school was significantly associated with using family planning (aOR 1.94 95%CI 0.86 – 5.28 p=0.003 ). Women with four or less children were 1.72 times likely to use family planning in comparison to those with eight or more children (Table 2). Findings from Focus-Group Discussions The participants of the focus group discussion were women of reproductive age (between 15 to 49 years old), men whose spouses’ age was within 15 to 49 years, administrative and religious leaders. Each of the 18 collines was represented by an even number of women and men selected from the above group of people. The results of the quantitative phase showed low uptake of the family planning methods. The qualitative phase was undertaken to understand the reasons justifying the quantitative results. Large family size emerged as a key theme which resonated with most participants irrespective of the colline of residence. Considering the desired number of children expressed by each group, the discussion was directed towards the different barriers that hamper the achievement of the ideal family size as many families were having more children than they wished to have. Desired number of children Both men and women agreed that it was very hard to sustain a large family in the present socio-economic situation. Most participants suggested that at most four children was ideal to achieve a decent standard of living. A female participant in a colline, Gatete described how she would have preferred to practice family planning earlier in her life: “ I have five children, but I wish I had three because life is very expensive nowadays .” (FGD woman, Gatete colline) “I think four children are enough to be brought up and educated properly ”. (FGD man, Gitwe colline) Barriers of Contraceptive use Fear of side effects From the findings, fear of contraceptives’ side effects was reported as the main reason for underutilisation and discontinuation modern contraceptive methods. Rumours regarding the side effects of family planning which included bleeding, cancer and infertility propagated by other community members had largely contributed to this communal fear. “ I know one lady who started using modern contraceptive after her second pregnancy. Later on she abandoned to get the third child but failed to conceive .” (FGD Woman, Migera colline) This climate of fear had been used as an avenue exploited by religious leaders and other anti-family planning people to make contraceptives unpopular: A male participant said, “ Church leaders often instruct the faithful that the use of modern contraception is the cause of the increase of cancer cases that occur nowadays. ” (FGD man, Gashasha colline) In addition, some participants had shared their personal experience with side effects and how this was conceived by their spouses and the community as a whole. Personal experiences had deeply shaped continuation of family planning and although there was wide community consensus on the adverse effects of family planning, side effects created preconception which encouraged family planning discontinuation as soon as side effects emerged: “ I have used injectable and I experienced continuous bleeding. I went back to the hospital and obtained some medicines and I have since abandoned the modern contraceptives method .” (FGD woman, Cabara colline) In addition, the issue of side effect management at the health system level was raised during the discussions. “ There should be qualified personnel to deliver quality health care to follow those side effects cases closely and inform the people who are coming for family planning services about the side effects that may occur. If the health practitioner cannot give medicines to resolve the side effects issue, the patient will give up the use of family planning methods .” (FGD man, Mushishi colline) Further, participants were concerned about increased fees to treatment of side effects despite receiving the family planning for free. This concern had metamorphosed into a fear which served as a disincentive for not only initiating family planning but also, continuation for those that subscribed: “ I know a woman who have used an IUD but experienced side effects. This woman had to pay a lot of money for her treatment and then discouraged other women to consider any modern contraceptive methods .” (FGD man, Mushishi colline) Religious beliefs In conservative communities, religion forms an integral section of the life and in the case of deciding the use and continuation of family planning, religion is a major determinant. From the focused group discussions, we learned that natural family planning which consists in identifying the signs and symptoms of fertility during a menstrual cycle and practising sexual abstinence during the fertile period to avoid pregnancy was the only method that most of the religions recommended. This influence from religious leaders and conceptualization of modern family planning as a sin served as a deterrent for most women: “ Our community health workers always sensitize about family planning but their teachings conflict with church teachings which say that modern family planning is a sin of killing. When it is known that a church follower has adhered to one of those methods, she will be suspended from the church services. That is the reason many individuals have given up the use of modern contraceptive methods .” (FGD man, Kabwayi colline) Cultural beliefs Culture as expected, was found as a determinant of family planning and this emerged as a theme from the focus group discussions. For some participants they cannot limit the family size when they have only girls on the other hand, they prefer many children because some of their offspring may eventually die and in that case, they hope that at least some will survive and support the family. Other women perceived increased family size of a man as a security to their marriage: “ In Burundian culture we are afraid of having few children. For instance, if we go for vasectomy and death takes all the children, it will not be possible to reproduce again .” (FGD man, Kanenge colline) “ In our community, women with many children think that their husband will not seek extra marital children and therefore do not adhere to family planning methods. ” (FGD woman, Kanenge colline) Spousal communication gap Both men and women agreed that they do not openly discuss the optimal number of children and how family resources could support child upbringing. “ I could say that there is a lack of communication between husband and wife. Otherwise, if they were communicating effectively, they could convince each other and reach a common understanding on how to achieve family planning .” (FGD woman, Kabwayi colline) Unbalanced power and gender roles Group discussions also reflected the fact that men do not participate in family planning sensitization and do not take any responsibility towards family planning, yet they have a predominant role in family decision-making including childbearing. “ Women are victims of men who do not understand family planning policies. They spend most of the time in bars and when they come at home, they are drunk and force us into sexual intercourse while we are in our fertile period and we get unplanned pregnancies in that way. ” (FGD woman, Karagara colline) Discouragement from family planning adherence by health practitioners Some participants shared that in their health facility, they have encountered health practitioners who were religious and discouraged patients in adopting family planning methods. They advise them to consider only natural methods and emphasize the fact that modern contraceptive methods have many side effects. “ Some medical staff are against modern contraceptive methods because of their side effects. If the health practitioners doubt on those methods, we will be more doubtful about adopting any form of modern contraception methods .” (FGD man, Migera colline) Discussion This mixed-methods study assessed the factors that hindered uptake of family planning methods among women of reproductive age (15 to 49 years) in rural collines of Vyanda and Rumonge districts of Burundi. The study found that knowledge on contraception methods was high with 94.3% of respondents able to cite at least one modern contraceptive method whereas utilization was low (22.6 %). This confirms the BDHS finding which suggested that 97% of men and women know at least one contraceptive method but only 29% used any family planning method at the time of the survey [3]. To understand the increased gap between the knowledge and the utilization of contraceptive methods, a qualitative study involving focus group discussions with men, women, community, and church leaders was conducted. Five recurring themes emerged from the qualitative analysis. Firstly, the fear of side effects from use of contraceptives and its management which is not handled appropriately by health workers. Second, religious beliefs and influence of religious actors which significantly impede uptake of modern contraceptives also emerged as a major determinant affecting uptake. Third, cultural norms and social constructs on childbearing was found to be another contributory factor. At the household level, lack of communication between spouses in having common understanding of how planning a family also served as a barrier. Also, low family planning methods uptake is explained by unbalanced power and gender roles which give men prerogatives to control woman’s procreative power while the men are less knowledgeable about reproductive health. Finally, some health practitioners discourage utilization of modern contraceptive methods, citing reasons of religion and/or side effects. This study highlights key lessons which should be considered for future program interventions. Fear of perceived side effects emerged as the first and most important factor affecting utilisation of family planning methods. After experiencing unpleasant side effects especially from using modern contraceptives, a significant fraction of women discontinue utilisation. These negative experiences are shared with social networks which, as a result, heighten the worries of side effects, serving as a deterrent for others to adopt these modern methods. Other studies in similar contexts in Africa have found consistent findings [14, 15]. In many instances, these side effects are also misconstrued especially by religious actors as ‘payment for the sin of using family planning’ and discontinuing it would be the only way to relief and freedom. This belief is held in other African contexts and this has been captured by academic literature [16, 17]. Spousal miscommunication, unbalanced power and gender roles and non-involvement of male in family planning awareness program hinder the success of family planning interventions in such conservative communities. This is exacerbated by cultural norms in favour of large families and patriarchal society where family planning decisions must be approved by men who are considered as head of the family despite having limited knowledge in this area. Generally, patriarchy in rural communities especially in sub-Saharan Africa have always been a determinant of reproductive decisions inclusive of family planning. This has become a political issue which remains unattended even at national and international levels [18, 19]. In our communities, men who accepted family planning could not own up and defend their decision publicly as it was recognised as a sign of weakness and contravention to the cultural norms which strongly upheld increased household size as a wealth and power. Our work suggests that family planning uptake can be increased in conservative rural communities via overall health systems strengthening including health workers’ capacity to administer family planning methods with dignity and without blemish. Communication of side effects at the onset of utilisation of family planning is key, as such, health staff especially those at primary healthcare should be well-trained to advise accordingly. Out-of-pocket payments associated with management of side effects are hindering factors, therefore implementing interventions to reduce the burden of payment could be critical and essential to uptake and continuation of modern contraceptives. Accessibility to family planning in this setting is key and evidence from elsewhere has shown the importance of using community health workers in offering doorstep service especially in hard to reach places. One study in Uganda proved that in addition to pills and condoms, community health workers in Uganda could effectively provide injectable services and offer side effects counselling services effectively [21]. Successful uptake of family planning in Ethiopia, Malawi and Rwanda all underscores the distinct contribution of health extension workers and overall health system strengthening strategy [22]. Men and religious leaders at the community level should be involved in family planning awareness initiatives. An assessment of a male motivator project in Malawi provided evidence that men involvement in family planning program significantly increased spousal communication on family planning and effectively promote contraceptive uptake [20]. Moreover, religion plays a critical role in shaping people’s ideas, views and thoughts. Therefore, incorporating aspects of religion into family planning interventions could yield some positive impacts [23]. Adedini et al. [23] shared evidence of Nigerian urban Reproductive Health Initiative which suggests that there is a significant association between contraceptive uptake and exposure to family planning messages delivered by religious leaders. Limitation of the study Studies that employ responses from retrospective activities could result in recall bias. Recall bias could result in either overestimating or underestimating results presented here. To reduce the impact of recall bias, an exploratory approach in the form of focus group discussion was undertaken to validate and explain results from the quantitative research phase. Focus group discussions, if not moderated effectively could bring about differences in power dynamics among participants which, resulting in unequal contributions from study participants and skew results to only reflect the most powerful and vocal participants. This could have been our case, however, the employment of an experienced focus group facilitator for all the sessions, to a larger extent, averted all possibilities of this bias. Conclusion This study emphasizes that the knowledge of contraceptive methods and the desire to limit the family size do not translate in contraceptive uptake. This information contributes to the existing body of knowledge on family planning in the context of Burundi and to a lesser extent, sub-Saharan Africa. Given that Burundi is among the countries with the least use of family planning methods, this study brings more clarity to the idiosyncratic factors affecting use especially among those living in conservative rural areas. The multifaceted impediments to increased contraceptive utilization must be considered by policy makers and program implementers in order to develop tailored interventions that are more integrated and likely to yield best results. To make strides towards universal access to family planning, government and partners should tackle the issue of side effect management and promote community-based family planning approach. The latter may include religious leaders’ engagement to share scriptural messages in favour of family planning during mass campaign as it is anticipated that they can influence behaviour change of their followers. Capacity building and equipping community health workers to provide family planning counselling services, addressing community misbeliefs around family planning and door-step delivery of modern contraceptives could be an effective strategy worth the investment. Abbreviations Acronym Meaning DHS Demographic Health Survey FGD Focus Group Discussion FP Family Planning IUD Intra Uterine Device PPS Probability Proportion to size SD Standard Deviation SPSS Statistical Product and Service Solutions Declarations Ethics approval and consent to participate. A signed approval was obtained for this study from the local ethics committee and health authorities in the Bururi and Rumonge province after presentation of a study protocol and questionnaires. The study was also internally commissioned and approved by senior management of the organisation after review of the study protocol and questionnaires. Study participants also signed a consent form ahead of interview and child anthropometric measurements. Consent for publication Not Applicable Availability of data and materials The data used for analysis in this manuscript are available from the Research, Monitoring and Evaluation Department of VHW. Data is restricted but available from the authors upon reasonable request. Competing interests The authors declare no competing interests Funding Not Applicable Authors' contributions SH and ENO conceptualised the study. SH supervised data collection, analysed both qualitative and quantitative and wrote first draft of the manuscript. ENO reviewed the first draft, provided technical comments, and made edits when necessary. All authors read and approved the final manuscript. Acknowledgements The authors are grateful to all field assistants and measurers who spent an extended time in the community collecting these data. References World Bank, 2020. Burundi | Data . [online] Data.worldbank.org. Available at: [Accessed 12 April 2020]. World Bank, 2020. Rural Population (% Of Total Population) | Data . [online] Data.worldbank.org. Available at: [Accessed 12 April 2020]. Ministère à la Présidence chargé de la Bonne Gouvernance et du Plan [Burundi] (MPBGP), Ministère de la SantéPublique et de la Lutte contre le Sida [Burundi] (MSPLS), Institut de Statistiques et d’Études Économiques duBurundi (ISTEEBU), et ICF. 2017. Troisième Enquête Démographique et de Santé. Bujumbura, Burundi :ISTEEBU, MSPLS, et ICF Alsammani, M.A. and Ahmed, S.R., 2015. Grand multiparity: risk factors and outcome in a tertiary hospital: a comparative study. Materia socio-medica , 27 (4), p.244. De Jonge, H.C., Azad, K., Seward, N., Kuddus, A., Shaha, S., Beard, J., Costello, A., Houweling, T.A. and Fottrell, E., 2014. Determinants and consequences of short birth interval in rural Bangladesh: a cross-sectional study. BMC pregnancy and childbirth , 14 (1), p.427. Stover, J. and Ross, J., 2010. How increased contraceptive use has reduced maternal mortality. Maternal and child health journal , 14 (5), pp.687-695. Ahmed, S., Li, Q., Liu, L. and Tsui, A.O., 2012. Maternal deaths averted by contraceptive use: an analysis of 172 countries. The Lancet , 380 (9837), pp.111-125. Ndayizigiye, M., Fawzi, M.S., Lively, C.T. and Ware, N.C., 2017. Understanding low uptake of contraceptives in resource-limited settings: a mixed-methods study in rural Burundi. BMC health services research , 17 (1), p.209. World Health Organisation, 2020. Family Planning/Contraception . [online] Who.int. Available at: [Accessed 12 April 2020]. Güney, T., 2017. POPULATION GROWTH AND SUSTAINABLE DEVELOPMENT IN DEVELOPED-DEVELOPING COUNTRIES: AN IV (2SLS) APPROACH GELİŞMİŞ-GELİŞMEKTE OLAN ÜLKELERDE NÜFUS ARTIŞI VE SÜRDÜRÜLEBİLİR KALKINMA: BİR IV (2SLS) YAKLAŞIMI. Population , 22 (4), pp.1255-1277. Thobani R, Jessani S, Azam I, Reza S, Sami N, Rozi S, et al. (2019) Factors associated with the discontinuation of modern methods of contraception in the low income areas of Sukh Initiative Karachi: A community-based case control study. PLoS ONE 14(7): e0218952. https://doi.org/10.1371/journal.pone.0218952 Bekele T, Gebremariam A, Tura P (2015) Factors Associated with Contraceptive Discontinuation in Agarfa District, Bale Zone, South East Ethiopia. Epidemiology (sunnyvale) 5: 179. doi :10.4172/2161-1165.1000179 Verma, J.P., 2012. Data analysis in management with SPSS software . Springer Science & Business Media Gonie A, Wudneh A, Nigatu D, Dendir Z. Determinants of family planning use among married women in bale eco-region, Southeast Ethiopia: a community based study. BMC Womens Health. 2018;18(1):50. Published 2018 Mar 12. doi:10.1186/s12905-018-0539-7 Chebet JJ, et al. “Every method seems to have its problems”-perspectives on side effects of hormonal contraceptives in Morogoro region, Tanzania. BMC Womens Health. 2015;15(1):1 Belda SS, et al. Modern contraceptive utilization and associated factors among married pastoralist women in Bale eco-region. BMC Health Serv Res. 2017;17:194 Abdalla AAA, Ahmmed EH (2017) Evaluate Use and Barriers to Accessing Family Planning Services among Reproductive Age Women in the White Nile, Rural Districts, Sudan. Health Sci J. Vol. 11 No. 6: 531. Mbadu Fidèle Muanda, Gahungu Parfait Ndongo, Lauren J. Messina & Jane Bertrand (2017) Barriers to modern contraceptive use in rural areas in DRC, Culture, Health & Sexuality, 19:9, 1011-1023, DOI: 10.1080/13691058.2017.1286690 Vouking MZ, Evina CD, Tadenfok CN. Male involvement in family planning decision making in sub-Saharan Africa- what the evidence suggests. Pan Afr Med J . 2014;19:349. Published 2014 Dec 3. doi:10.11604/pamj.2014.19.349.5090 Shattuck D, Kerner B, Gilles K, Hartmann M, Ng'ombe T, Guest G. Encouraging contraceptive uptake by motivating men to communicate about family planning: the Malawi Male Motivator project. Am J Public Health . 2011;101(6):1089–1095. doi:10.2105/AJPH.2010.300091 Guttmacher Institute, 2020. Male Motivator Project, Malawi . [online] Guttmacher Institute. Available at: [Accessed 12 April 2020]. Family Health International 360, 2020 [online] Fhi360.org. Available at: [Accessed 12 April 2020] Adedini, S.A., Babalola, S. Ibeawuchi, C., Omotoso, O., Akiode, A. and Odeku, M., 2018. Role of religious leaders in promoting contraceptive use in Nigeria: evidence from the Nigerian Urban Reproductive Health Initiative. Global Health: Science and Practice , 6 (3), pp.500-514 World Bank, 2020. Fertility rate, total (births per woman) | Data . [online] Data.worldbank.org. Available at: [Accessed 19 August 2020]. Cite Share Download PDF Status: Under Review Version 4 posted Editorial decision: Minor revision 23 Feb, 2021 Reviewer # 1 agreed at journal 08 Feb, 2021 Reviewers invited by journal 03 Feb, 2021 Editor assigned by journal 24 Jan, 2021 Submission checks completed at journal 24 Jan, 2021 Editor invited by journal 24 Jan, 2021 You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-24210","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":10389079,"identity":"2e1101d0-c2bf-4b1e-a21e-c12e850a7db5","order_by":0,"name":"SONIA HAKIZIMANA","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3ElEQVRIiWNgGAWjYPCCBB4GBuYDQIaEDCla2BJAWniI1gLEPAYgFmEtBsfbn0ndbEuTkW8/8/nVjRoLHgb2w0c34NVy5kCadG5bDg9jT+4265xjQIfxpKXdwKvlRsIxoJYKHmaG3G3GOWxALRI8Zvi13H/YBtbCxv/mmXHOP2K03GBmAzuMRyKH+XFuGxFaJM+kMVvnnEvjkZB4Zsac2yfBw0bIL3zHjz+8nVOWbC/fn/z4c863Ojl+9sPH8GpROIBgs0mASXzKQUC+AcFm/kBI9SgYBaNgFIxMAADqJENgweV33gAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0003-3065-4614","institution":"Village Health Works","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"SONIA","middleName":"","lastName":"HAKIZIMANA","suffix":""},{"id":10389080,"identity":"45f37566-d991-45d7-a2aa-05872c5bc48b","order_by":1,"name":"Emmanuel Nene Odjidja","email":"","orcid":"","institution":"Village Health Works","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Emmanuel","middleName":"Nene","lastName":"Odjidja","suffix":""}],"badges":[],"createdAt":"2020-04-21 12:34:55","currentVersionCode":4,"declarations":"","doi":"10.21203/rs.3.rs-24210/v4","doiUrl":"https://doi.org/10.21203/rs.3.rs-24210/v4","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13657076,"identity":"b19a54ff-84a4-4a22-ba2c-c0bbef420552","added_by":"auto","created_at":"2021-09-17 10:08:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":413680,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-24210/v4/9daa64bd-360e-4c09-ab21-f89639d80593.pdf"}],"financialInterests":"","formattedTitle":"Beyond knowledge acquisition: factors influencing family planning utilization among women in conservative communities in Rural Burundi.","fulltext":[{"header":"Plain English Summary","content":"\u003cp\u003eIn the Burundian context, community members agree that large family sizes are difficult to maintain, yet, use of family planning remains consistently low. This study explored the factors behind this low utilisation of family planning in two health districts located in the South of Burundi. The findings suggest that fear of side effects is the main reason for family planning non-utilization or discontinuation. The culture and religious beliefs in Rural Burundi also espouse large family sizes and among men, this is conceived as a sign of wealth, power, and respect. Lack of spousal communication and unequal gender relations in household also impedes women from contributing decisions on family planning. The onus on making decisions on contraceptive use lies on men, whom usually, have limited understanding of family planning methods.\u003c/p\u003e\n\u003cp\u003eIn improving coverage of family planning in these communities, capacity of the health system, to provide quality, timely and people-driven family planning services should be strengthened. At the community level, the use of community health workers to deliver family planning services to the doorstep of community members could significantly increase uptake. Finally, men and religious leaders\u0026rsquo; involvement in promoting family planning use can contribute to reducing the impact of cultural and religious barriers to uptake.\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eBurundi, a small, landlocked country in East Africa is a home to 11,175,378 individuals [1]. The population density is estimated at 435 people per square kilometre thereby, making Burundi second most populated African nation. [1] Despite the scarcity of cultivable land, 87% of the rural population depend solely on subsistence farming [2]. With a fertility rate of 5.4 children to a woman, Burundi has been classified as among the top ten countries with the highest fertility, placing just seventh after Niger, Somalia, the Democratic Republic of the Congo, Mali, Chad and Angola [24]. High fertility rate has been identified as a major contributor to poor health outcomes such as increased maternal and child morbidity and mortality. Consistently, previous studies have suggested that grand multiparity (parity \u0026gt;=5) is associated with adverse pregnancy outcomes such as caesarean delivery, foetal macrosomia, diabetes mellitus and pregnancy induced hypertension. [4]. Additionally, Hendrik et.al (2014) found that short birth intervals negatively affect perinatal, neonatal and child health by increasing the incidence of preterm birth, low birth weight and perinatal death. [5]\u003c/p\u003e\n\u003cp\u003eOn the other hand, contraceptive use prevents pregnancies and associated risks of miscarriage, stillbirth and postpartum haemorrhage among others [6]. Research suggests that preventing births in mothers with five or more children could reduce maternal deaths by 58% and family planning could prevent around 272,000 maternal deaths in the world every year [7]. Recent evidence suggests that family size could also be a determinant to child nutritional status, morbidity, and mortality [8]. Moreover, socially, contraceptive use among women is an indicator for autonomy which is also accomplishment of fundamental human rights of decisions on how to use their bodies [9] and in fulfilment of sustainable development goals 3 [10].\u003c/p\u003e\n\u003cp\u003eDespite that modern contraceptive methods have shown to be effective in spacing births and avoiding unintended pregnancies, its low uptake is still a concern in many parts of the developing world particularly in Sub-Saharan Africa. 21% percent of the 214 million women of childbearing age in developing countries who would like to avoid pregnancy but are not using any modern contraceptive method reside in Sub-Saharan Africa [7]. According to the DHS, only 23% of women in Burundi living with a partner and aged between 15-49 years use modern contraceptive methods of which 30% of these have an unmet need of family planning [3]. Although 97% have comprehensive knowledge on family planning, 40% of women using contraceptives in the last five years discontinued with 33% of women citing side effects as reasons for discontinuation [3].\u003c/p\u003e\n\u003cp\u003eThis finding is consistent with other studies conducted in Sub-Saharan Africa and South Asia. A study conducted in Pakistan highlights that more than 80% of married women reported that the experience of side effects is the main reason of discontinuation of the last contraceptive method used [11].Another study by Bekele et al in South East Ethiopia has suggested that fear of side effects accounts for 48% of discontinued contraceptive method use among married women [12].\u003c/p\u003e\n\u003cp\u003eWhile Burundi is one of the countries with the least contraceptive prevalence, little research has been conducted from community\u0026rsquo;s perspective to understand the factors driving utilisation especially in communities (collines) with conservative traditional values. Little is known about how the sociocultural space facilitates or hinders the utilisation and continuation of family planning in the context of Burundi.\u003c/p\u003e\n\u003cp\u003eThis study aims to investigate the factors affecting FP utilisation in conservative communities in rural Burundi using an explanatory sequential mixed methods study. Through acquisition of quantitative and qualitative information, we sought to bring an in-depth comprehension of this complexity in this setting.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn explanatory sequential mixed design study was carried out from 1\u003csup\u003est\u003c/sup\u003e May to 28\u003csup\u003eth\u003c/sup\u003e June 2019, commencing with quantitative information on a mass scale then using focus group discussions (qualitative methods), we explored and described patterns/relationships that emerged from the quantitative strand. To allow comparison with national figures, we adopted and adapted quantitative questionnaires from the DHS to understand contraceptive prevalence disaggregated by background characteristics. Questionnaires were deployed via an electronic system and administered by appointed enumerators and teams. Due procedures to ensure respondents\u0026rsquo; rights and privacy were respected. \u003cbr /\u003e We learned from family planning records from Kigutu Health centre which serve the community in the eighteen collines that women represented more than ninety per cent of the people who came for family planning service during the previous year. Having that background knowledge, this study has focused on married women during the quantitative phase and questionnaire was administered to a sample of this target population.\u003c/p\u003e\n\u003cp\u003eData from quantitative phase was collected and analysed and those interesting relationships were further explored using focus-group discussions. These groups comprised of married community members, opinion, and religious leaders. Those community representatives in the focus group discussion were selected because they qualify for family planning utilization or were in the position to influence family planning uptake. They were selected in all 18 collines, however in case of collines with similar characteristics, representatives of two or three collines were invited to join one discussion group. This qualitative phase used an open-ended questionnaire that assessed different topics including family planning. Although questions had been preconceived, it was general, and the direction of discussions were driven by study participants. An experienced and trained moderator was appointed and ensured that all respondents were given equal opportunity to speak and their views were respected.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Area\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in rural districts of Bururi and Rumonge provinces located in South of Burundi, East Africa. Specifically, the study was conducted in 18 collines (districts) of the Vyanda and Rumonge commune (regions). While collines in the Vyanda commune were Mirango, Kabwayi, Migera, Mushishi, Kirungu, Kigutu, and Karirimvya, those in the Rumonge commune were Cabara, Mutambara, Karagara, Gitwe, Gatete, Gashasha, Kanenge, Mayengo, Nyakuguma and Busebwa.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome Variable \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe main outcome variable for investigation was current use of contraceptives which a binary variable (Yes/No). The definition of this variable was in line with that of the Burundian Demographic Health Survey [3]. To acquire information for this indicator, women in union were asked if they or their partners were doing something or using any method to avoid or delay pregnancy [13]. The population base used as a denominator was all women in union at the time of interview.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling Strategy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe quantitative phase included a two-stage sampling strategy which comprised of cluster and systematic sampling. During the first stage, all collines, their population were considered as a possible sampling frame. A probability proportion to size (PPS) was applied to select a desired cluster size of 30. The calculated sample size was divided by this number to determine the sampling interval. Enumerators upon arrival at every colline, received household list from the colline administrator. The sampling interval applied to derive the interval of households to be selected systematically. Given the study objectives, the following criteria were applied to ensure enumerators were interviewing the right households:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003eHousehold with women aged 15 and 49 also classified as those in reproductive age\u003c/li\u003e\n\u003cli\u003eHead of household and caregiver in the right state of mind to actively respond to questions\u003c/li\u003e\n\u003cli\u003eHouseholds whose head signed off the consent form\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion Criteria \u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003eHouseholds that did not meet the stated inclusion criteria\u003c/li\u003e\n\u003cli\u003eHouseholds whose women of reproductive age were currently pregnant\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size Calculation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size was calculated based on predetermined methodology of the Demographic Health Survey. Using this rigorous methodology, a sample size of 952 households were selected and distributed equally among the clusters. Details of the sample size calculation has been published elsewhere [3].\u003c/p\u003e\n\u003cp\u003eThe qualitative phase employed 11 focus groups with an average size of 12. Members of these groups were purposively selected to represent a mix of community representatives and members.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuantitative analysis was initially cleaned via quality check for completeness and consistency. \u003cbr /\u003e The analysis in this paper is based on knowledge of contraceptive methods and current use of contraceptive methods. Women who never had child or wanted another child within 2 years were excluded in the analysis regarding current use of contraceptive methods. These indicators were analysed quantitatively using IBM software-SPSS Statistic version 20 [13]. Chi-squares were used to assess relationships between outcomes and exposure variables. A logistic regression controlling for cofounders such as place of residence, wealth quintile and religion was used to predict the adjusted odds of a woman using contraceptives. Significance of statistical relationships was considered at 95%CI (two tailed). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor the qualitative analysis, focus group discussions were recorded, transcribed, and translated from Kirundi to French then to English. In ensuring consistency in translation, all transcripts were reviewed by two native Kirundi and French speakers with an advanced fluency in English. When there was a disagreement on translated word, a third advice was sought from a third person. After this, deductive mechanisms consisting of desired number of children, facilitators and barriers of family planning were employed to detect emerging themes and codes. The generated codes were applied to all transcripts for quotes which were in line to themes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA signed letter approval was granted for this study by the local health authorities in the Bururi and Rumonge province which is a representative body of the National Ethics committee at the province level. Study participants signed a consent form ahead of interview and careful steps were taken to ensure respondent\u0026rsquo;s rights and privacy were respected at all times.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSocio Demographics Characteristics\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 530 women in union at the time of data collection were interviewed from 930 households, accounting for a response rate of 95.4%. The mean age of the respondents was 30.76(\u0026plusmn; 6.872 SD) with a minimum age of 18 years (Table 1). More than half percent of women (51.7%) were between the age of 25 and 34 years. The mean age at the first pregnancy was 20.17(\u0026plusmn;3.53SD) years. More than a quarter (26.6%) of women in union has not attended formal education while only 12.3% of those who attended formal education had completed secondary education. The average number of children a woman had was 4.3(\u0026plusmn; 2.4 SD). 216 women (42%) had five or more children. Additionally, 37.7% of women spaced the last two children less than 24 months. 14% of the participants reported that they had ever lost a child less than 5 years old.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFamily Planning \u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, 94.3% of women, reported to know at least one type of contraception with 94.2% knowing at least a source of acquiring contraceptives. Only 22.6% of women who desired to space their next birth more than 2 years were using a contraception method at the time of interview. The most prevalent modern contraceptive method was the injectable accounting for 40%, followed by implants used by 24.6% of women. The male preservative, Intra Uterine Device (IUD), pills and sterilization represented 10.8%, 6.2%, 3.1% and 1.5% respectively. 13.8% of women who adhered to any form of contraception reported to be using natural contraceptive methods.\u0026nbsp; Among women not on any form of contraceptives, the following reasons were cited: side effects (51%), absence of menses since delivery which is considered as postpartum or postpartum amenorrhea in case it exceeds six weeks (18.8%), religious beliefs (12.9%), partner opposition (8.4%), partner absenteeism (6.4%) and lack of awareness about family planning services (2.5%). Among women on modern contraception, 68% reported that they were not informed about eventual side effects at the time they started utilization.\u003c/p\u003e\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;line-height:107%;\"\u003eTable 1: Socio-demographic and obstetric characteristics\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"width:515.45pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123.75pt;border: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003eCharacteristics\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115.9pt;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003eCategories\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.25pt;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003en (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88.95pt;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003e95% CI\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79.6pt;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003eP-value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 123.75pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eAge of mother\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e18-24\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e104 (19.6)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e18.3 \u0026ndash; 20.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" style=\"width:79.6pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:13.75pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e0.105\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 115.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e25-29\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e136 (25.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e21.4 \u0026ndash; 26.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 115.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 14.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e30-34\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 14.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e138 (26.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 14.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e22.3 \u0026ndash; 29.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 115.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 14.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e35-39\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 14.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e83 (15.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 14.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e12.7 \u0026ndash; 18.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 115.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 14.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e40-44\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 14.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e46 (8.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 14.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e7.2 \u0026ndash; 9.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 115.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 14.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e45+\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 14.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e23 (4.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 14.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e3.9 \u0026ndash; 5.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123.75pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79.6pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 123.75pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eEducational level of Women\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003eNo formal education\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e141 (26.6)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e23.5 \u0026ndash; 28.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" style=\"width:79.6pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:13.15pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e0.118\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 115.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003eUncompleted Primary education\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e197 (37.2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e32.3 \u0026ndash; 40.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 115.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003eCompleted primary education\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e49 (9.2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e7.2 \u0026ndash; 10.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 115.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003eUncompleted secondary education\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e91 (17.2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e14.3 \u0026ndash; 19.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 115.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003eCompleted Secondary School\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e48 (9.1)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e8.4 \u0026ndash; 10.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 115.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003eUniversity education\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e4 (0.8)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e0.2 \u0026ndash; 1.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123.75pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79.6pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 123.75pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eParity\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026le;4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e298 (58)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e56.6 - \u0026nbsp;60.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width:79.6pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:13.15pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e0.034*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 115.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e5-7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e162 (31.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e27.5 \u0026ndash; 33.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 115.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026ge;8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e54 (10.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e6.2 \u0026ndash; 14.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123.75pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eBirth interval between the last two children\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026lt;24 months\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e173 (37.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e37.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:79.6pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:13.15pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026lt;0.001*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123.75pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026ge;24months\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e286 (62.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e62.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;line-height:107%;\"\u003e*Chi-square relationship statistically significant\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\u003cBR\u003e\u003cp\u003eThere was a statistically significant negative association between last two children birth intervals and family planning utilisation (p-value \u0026lt;0.001). Those who had longer intervals between the two last births were less likely to adopt any family planning method as spacing had been considered as a natural family planning method.\u003c/p\u003e\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;line-height:107%;\"\u003eTable 2: Adjusted Odds Ratio (controlling for cofounders) predicting women\u0026rsquo;s use of family planning based on background characteristics\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162.85pt;border: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003eCharacteristic\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003eaOR (95%CI)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003eP-value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162.85pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eAge of Mother\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162.85pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e18-24\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e4.26 (1.88 \u0026ndash; 9.45)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e0.070\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162.85pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e25-29\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e5.04 (2.09 \u0026ndash; 10.27)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e0.038*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162.85pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e30-34\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e3.17 (2.68 \u0026ndash; 7.75)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e0.142\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162.85pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e35-39\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e2.15 (1.42 \u0026ndash; 9.83)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e0.354\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162.85pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e40-44\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e2.03 (1.37 \u0026ndash; 10.83)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e0.412\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162.85pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e45+\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162.85pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eEducational level of Women\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e1.31 (1.11 \u0026ndash; 1.49)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e0.183\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162.85pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003eNo formal education\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e1.21 (0.89 \u0026ndash; 5.53)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e0.621\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162.85pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003eUncompleted Primary education\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e1.32 (1.13 \u0026ndash; 2.31)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e0.319\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162.85pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003eCompleted primary education\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e2.91 (0.72 \u0026ndash; 4.12)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e0.213\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162.85pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003eUncompleted secondary education\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e3.11 (1.31 \u0026ndash; 5.40)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e0.081\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162.85pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003eCompleted Secondary School\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e1.94 (0.86 \u0026ndash; 5.28)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e0.003*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162.85pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003eUniversity education\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162.85pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eParity\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162.85pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026le;4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e1.72 (1.35 \u0026ndash; 2.01)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e0.002*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162.85pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e5-7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e1.03 (0.76 \u0026ndash; 3.82)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e0.172\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162.85pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026ge;8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003eRef\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162.85pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eBirth interval between the last two children\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162.85pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026lt;24 months\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e2.84 (1.92 \u0026ndash; 3.41)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026lt;0.001*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162.85pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026ge;24months\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;\"\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;line-height:107%;\"\u003e* Statistically significant associations at 95% CI (two tailed) from logistic regression\u003c/span\u003e\u003c/p\u003e\u003cBR\u003e\u003cp\u003eLogistic regression showed that women aged 25 to 29 were 5.04 times (95%CI 2.09 \u0026ndash; 10.27 \u003cem\u003ep=0.\u003c/em\u003e038) likely to use family planning methods compared to those aged above 45 years. Furthermore, completing secondary school was significantly associated with using family planning (aOR 1.94 95%CI 0.86 \u0026ndash; 5.28 \u003cem\u003ep=0.003\u003c/em\u003e). Women with four or less children were 1.72 times likely to use family planning in comparison to those with eight or more children (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFindings from Focus-Group Discussions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants of the focus group discussion were women of reproductive age (between 15 to 49 years old), men whose spouses\u0026rsquo; age was within 15 to 49 years, administrative and religious leaders. Each of the 18 collines was represented by an even number of women and men selected from the above group of people.\u003c/p\u003e\n\u003cp\u003eThe results of the quantitative phase showed low uptake of the family planning methods. The qualitative phase was undertaken to understand the reasons justifying the quantitative results. Large family size emerged as a key theme which resonated with most participants irrespective of the colline of residence.\u003c/p\u003e\n\u003cp\u003eConsidering the desired number of children expressed by each group, the discussion was directed towards the different barriers that hamper the achievement of the ideal family size as many families were having more children than they wished to have.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDesired number of children\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBoth men and women agreed that it was very hard to sustain a large family in the present socio-economic situation. Most participants suggested that at most four children was ideal to achieve a decent standard of living.\u003c/p\u003e\n\u003cp\u003eA female participant in a colline, Gatete described how she would have preferred to practice family planning earlier in her life:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026ldquo;\u003cem\u003eI have five children, but I wish I had three because life is very expensive nowadays\u003c/em\u003e.\u0026rdquo; (FGD woman, Gatete colline)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I think four children are enough to be brought up and educated properly\u003c/em\u003e\u0026rdquo;. (FGD man, Gitwe colline)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBarriers of Contraceptive use\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFear of side effects\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom the findings, fear of contraceptives\u0026rsquo; side effects was reported as the main reason for underutilisation and discontinuation modern contraceptive methods. Rumours regarding the side effects of family planning which included bleeding, cancer and infertility propagated by other community members had largely contributed to this communal fear.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eI know one lady who started using modern contraceptive after her second pregnancy. Later on she abandoned to get the third child but failed to conceive\u003c/em\u003e.\u0026rdquo; (FGD Woman, Migera colline)\u003c/p\u003e\n\u003cp\u003eThis climate of fear had been used as an avenue exploited by religious leaders and other anti-family planning people to make contraceptives unpopular:\u003c/p\u003e\n\u003cp\u003eA male participant said, \u0026ldquo;\u003cem\u003eChurch leaders often instruct the faithful\u003c/em\u003e\u003cem\u003e that \u003c/em\u003e\u003cem\u003ethe use of\u003c/em\u003e\u003cem\u003e modern \u003c/em\u003e\u003cem\u003econtraception is the cause of the increase of cancer cases that occur nowadays.\u003c/em\u003e\u0026rdquo; (FGD man, Gashasha colline)\u003c/p\u003e\n\u003cp\u003eIn addition, some participants had shared their personal experience with side effects and how this was conceived by their spouses and the community as a whole. Personal experiences had deeply shaped continuation of family planning and although there was wide community consensus on the adverse effects of family planning, side effects created preconception which encouraged family planning discontinuation as soon as side effects emerged:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026ldquo;\u003cem\u003eI have used injectable and I experienced continuous bleeding. I went back to the hospital and obtained some medicines and I have since abandoned the modern contraceptives method\u003c/em\u003e.\u0026rdquo; (FGD woman, Cabara colline)\u003c/p\u003e\n\u003cp\u003eIn addition, the issue of side effect management at the health system level was raised during the discussions.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026ldquo;\u003cem\u003eThere should be qualified personnel to deliver quality health care to follow those side effects cases closely and inform the people who are coming for family planning services about the side effects that may occur. If the health practitioner cannot give medicines to resolve the side effects issue, the patient will give up the use of family planning methods\u003c/em\u003e.\u0026rdquo; (FGD man, Mushishi colline)\u003c/p\u003e\n\u003cp\u003eFurther, participants were concerned about increased fees to treatment of side effects despite receiving the family planning for free. This concern had metamorphosed into a fear which served as a disincentive for not only initiating family planning but also, continuation for those that subscribed:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026ldquo;\u003cem\u003eI know a woman who have used an IUD but experienced side effects. This woman had to pay a lot of money for her treatment and then discouraged other women to consider any modern contraceptive methods\u003c/em\u003e.\u0026rdquo; (FGD man, Mushishi colline)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eReligious beliefs\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn conservative communities, religion forms an integral section of the life and in the case of deciding the use and continuation of family planning, religion is a major determinant. From the focused group discussions, we learned that natural family planning which consists in identifying the signs and symptoms of fertility during a menstrual cycle and practising sexual abstinence during the fertile period to avoid pregnancy was the only method that most of the religions recommended. This influence from religious leaders and conceptualization of modern family planning as a sin served as a deterrent for most women:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026ldquo;\u003cem\u003eOur community health workers always sensitize about family planning but their teachings conflict with church teachings which say that modern family planning is a sin of killing. When it is known that a church follower has adhered to one of those methods, she will be suspended from the church services. That is the reason many individuals have given up the use of modern contraceptive methods\u003c/em\u003e.\u0026rdquo; (FGD man, Kabwayi colline)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCultural beliefs\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCulture as expected, was found as a determinant of family planning and this emerged as a theme from the focus group discussions. For some participants they cannot limit the family size when they have only girls on the other hand, they prefer many children because some of their offspring may eventually die and in that case, they hope that at least some will survive and support the family. Other women perceived increased family size of a man as a security to their marriage:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026ldquo;\u003cem\u003eIn Burundian culture we are afraid of having few children. For instance, if we go for vasectomy and death takes all the children, it will not be possible to reproduce again\u003c/em\u003e.\u0026rdquo; (FGD man, Kanenge colline)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026ldquo;\u003cem\u003eIn our community, women with many children think that their husband will not seek extra marital children and therefore do not adhere to family planning methods.\u003c/em\u003e\u0026rdquo; (FGD woman, Kanenge colline)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSpousal communication gap\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBoth men and women agreed that they do not openly discuss the optimal number of children and how family resources could support child upbringing.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eI could say that there is a lack of communication between husband and wife. Otherwise, if they were communicating effectively, they could convince each other and reach a common understanding on how to achieve family planning\u003c/em\u003e.\u0026rdquo; (FGD woman, Kabwayi colline)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eUnbalanced power and gender roles\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGroup discussions also reflected the fact that men do not participate in family planning sensitization and do not take any responsibility towards family planning, yet they have a predominant role in family decision-making including childbearing.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026ldquo;\u003cem\u003eWomen are victims of men who do not understand family planning policies. They spend most of the time in bars and when they come at home, they are drunk and force us into sexual intercourse while we are in our fertile period and we get unplanned pregnancies in that way.\u003c/em\u003e\u0026rdquo; (FGD woman, Karagara colline)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDiscouragement from family planning adherence\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e by health practitioners\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSome participants shared that in their health facility, they have encountered health practitioners who were religious and discouraged patients in adopting family planning methods. They advise them to consider only natural methods and emphasize the fact that modern contraceptive methods have many side effects.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026ldquo;\u003cem\u003eSome medical staff are against modern contraceptive methods because of their side effects. If the health practitioners doubt on those methods, we will be more doubtful about adopting any form of modern contraception methods\u003c/em\u003e.\u0026rdquo; (FGD man, Migera colline)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis mixed-methods study assessed the factors that hindered uptake of family planning methods among women of reproductive age (15 to 49 years) in rural collines of Vyanda and Rumonge districts of Burundi. The study found that knowledge on contraception methods was high with 94.3% of respondents able to cite at least one modern contraceptive method whereas utilization was low (22.6\u003cem\u003e%). \u003c/em\u003eThis confirms the BDHS finding which suggested that 97% of men and women know at least one contraceptive method but only 29% used any family planning method at the time of the survey [3].\u003c/p\u003e\n\u003cp\u003eTo understand the increased gap between the knowledge and the utilization of contraceptive methods, a qualitative study involving focus group discussions with men, women, community, and church leaders was conducted. Five recurring themes emerged from the qualitative analysis. Firstly, the fear of side effects from use of contraceptives and its management which is not handled appropriately by health workers. Second, religious beliefs and influence of religious actors which significantly impede uptake of modern contraceptives also emerged as a major determinant affecting uptake. Third, cultural norms and social constructs on childbearing was found to be another contributory factor. At the household level, lack of communication between spouses in having common understanding of how planning a family also served as a barrier. Also, low family planning methods uptake is explained by unbalanced power and gender roles which give men prerogatives to control woman\u0026rsquo;s procreative power while the men are less knowledgeable about reproductive health. Finally, some health practitioners discourage utilization of modern contraceptive methods, citing reasons of religion and/or side effects.\u003c/p\u003e\n\u003cp\u003eThis study highlights key lessons which should be considered for future program interventions. Fear of perceived side effects emerged as the first and most important factor affecting utilisation of family planning methods. After experiencing unpleasant side effects especially from using modern contraceptives, a significant fraction of women discontinue utilisation. These negative experiences are shared with social networks which, as a result, heighten the worries of side effects, serving as a deterrent for others to adopt these modern methods. Other studies in similar contexts in Africa have found consistent findings [14, 15]. In many instances, these side effects are also misconstrued especially by religious actors as \u0026lsquo;payment for the sin of using family planning\u0026rsquo; and discontinuing it would be the only way to relief and freedom. This belief is held in other African contexts and this has been captured by academic literature [16, 17].\u003c/p\u003e\n\u003cp\u003eSpousal miscommunication, unbalanced power and gender roles and non-involvement of male in family planning awareness program hinder the success of family planning interventions in such conservative communities. This is exacerbated by cultural norms in favour of large families and patriarchal society where family planning decisions must be approved by men who are considered as head of the family despite having limited knowledge in this area. Generally, patriarchy in rural communities especially in sub-Saharan Africa have always been a determinant of reproductive decisions inclusive of family planning. This has become a political issue which remains unattended even at national and international levels [18, 19]. In our communities, men who accepted family planning could not own up and defend their decision publicly as it was recognised as a sign of weakness and contravention to the cultural norms which strongly upheld increased household size as a wealth and power.\u003c/p\u003e\n\u003cp\u003eOur work suggests that family planning uptake can be increased in conservative rural communities via overall health systems strengthening including health workers\u0026rsquo; capacity to administer family planning methods with dignity and without blemish. \u0026nbsp;Communication of side effects at the onset of utilisation of family planning is key, as such, health staff especially those at primary healthcare should be well-trained to advise accordingly. Out-of-pocket payments associated with management of side effects are hindering factors, therefore implementing interventions to reduce the burden of payment could be critical and essential to uptake and continuation of modern contraceptives.\u003c/p\u003e\n\u003cp\u003eAccessibility to family planning in this setting is key and evidence from elsewhere has shown the importance of using community health workers in offering doorstep service especially in hard to reach places. One study in Uganda proved that in addition to pills and condoms, community health workers in Uganda could effectively provide injectable services and offer side effects counselling services effectively [21]. \u0026nbsp;Successful uptake of family planning in Ethiopia, Malawi and Rwanda all underscores the distinct contribution of health extension workers and overall health system strengthening strategy [22].\u003c/p\u003e\n\u003cp\u003eMen and religious leaders at the community level should be involved in family planning awareness initiatives.\u0026nbsp; An assessment of a male motivator project in Malawi provided evidence that men involvement in family planning program significantly increased spousal communication on family planning and effectively promote contraceptive uptake [20].\u0026nbsp; Moreover, religion plays a critical role in shaping people\u0026rsquo;s ideas, views and thoughts. Therefore, incorporating aspects of religion into family planning interventions could yield some positive impacts [23]. Adedini et al. [23] shared evidence of Nigerian urban Reproductive Health Initiative which suggests that there is a significant association between contraceptive uptake and exposure to family planning messages delivered by religious leaders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitation of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudies that employ responses from retrospective activities could result in recall bias. Recall bias could result in either overestimating or underestimating results presented here. To reduce the impact of recall bias, an exploratory approach in the form of focus group discussion was undertaken to validate and explain results from the quantitative research phase. Focus group discussions, if not moderated effectively could bring about differences in power dynamics among participants which, resulting in unequal contributions from study participants and skew results to only reflect the most powerful and vocal participants. This could have been our case, however, the employment of an experienced focus group facilitator for all the sessions, to a larger extent, averted all possibilities of this bias.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study emphasizes that the knowledge of contraceptive methods and the desire to limit the family size do not translate in contraceptive uptake. This information contributes to the existing body of knowledge on family planning in the context of Burundi and to a lesser extent, sub-Saharan Africa. Given that Burundi is among the countries with the least use of family planning methods, this study brings more clarity to the idiosyncratic factors affecting use especially among those living in conservative rural areas.\u003c/p\u003e\n\u003cp\u003eThe multifaceted impediments to increased contraceptive utilization must be considered by policy makers and program implementers in order to develop tailored interventions that are more integrated and likely to yield best results. To make strides towards universal access to family planning, government and partners should tackle the issue of side effect management and promote community-based family planning approach. The latter may include religious leaders\u0026rsquo; engagement to share scriptural messages in favour of family planning during mass campaign as it is anticipated that they can influence behaviour change of their followers. Capacity building and equipping community health workers to provide family planning counselling services, addressing community misbeliefs around family planning and door-step delivery of modern contraceptives could be an effective strategy worth the investment.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable width=\"566\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"206\"\u003e\n\u003cp\u003e\u003cstrong\u003eAcronym\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"361\"\u003e\n\u003cp\u003e\u003cstrong\u003eMeaning\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"206\"\u003e\n\u003cp\u003eDHS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"361\"\u003e\n\u003cp\u003eDemographic Health Survey\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"206\"\u003e\n\u003cp\u003eFGD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"361\"\u003e\n\u003cp\u003eFocus Group Discussion\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"206\"\u003e\n\u003cp\u003eFP\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"361\"\u003e\n\u003cp\u003eFamily Planning\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"206\"\u003e\n\u003cp\u003eIUD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"361\"\u003e\n\u003cp\u003eIntra Uterine Device\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"206\"\u003e\n\u003cp\u003ePPS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"361\"\u003e\n\u003cp\u003eProbability Proportion to size\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"206\"\u003e\n\u003cp\u003eSD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"361\"\u003e\n\u003cp\u003eStandard Deviation\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"206\"\u003e\n\u003cp\u003eSPSS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"361\"\u003e\n\u003cp\u003eStatistical\u0026nbsp;Product and Service Solutions\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA signed approval was obtained for this study from the local ethics committee and health authorities in the Bururi and Rumonge province after presentation of a study protocol and questionnaires. The study was also internally commissioned and approved by senior management of the organisation after review of the study protocol and questionnaires. Study participants also signed a consent form ahead of interview and child anthropometric measurements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used for analysis in this manuscript are available from the Research, Monitoring and Evaluation Department of VHW. Data is restricted but available from the authors upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSH and ENO conceptualised the study. SH supervised data collection, analysed both qualitative and quantitative and wrote first draft of the manuscript. ENO reviewed the first draft, provided technical comments, and made edits when necessary. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to all field assistants and measurers who spent an extended time in the community collecting these data.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Bank, 2020.\u0026nbsp;\u003cem\u003eBurundi | Data\u003c/em\u003e. [online] Data.worldbank.org. Available at: \u0026lt;https://data.worldbank.org/country/burundi?view=chart; accessed on 30/07/2019.\u0026gt; [Accessed 12 April 2020].\u003c/li\u003e\n\u003cli\u003eWorld Bank, 2020.\u0026nbsp;\u003cem\u003eRural Population (% Of Total Population) | Data\u003c/em\u003e. [online] Data.worldbank.org. Available at: \u0026lt;https://data.worldbank.org/indicator/SP.RUR.TOTL.ZS?locations=BI; accessed on 31/07/2019\u0026gt; [Accessed 12 April 2020].\u003c/li\u003e\n\u003cli\u003eMinist\u0026egrave;re \u0026agrave; la Pr\u0026eacute;sidence charg\u0026eacute; de la Bonne Gouvernance et du Plan [Burundi] (MPBGP), Minist\u0026egrave;re de la Sant\u0026eacute;Publique et de la Lutte contre le Sida [Burundi] (MSPLS), Institut de Statistiques et d\u0026rsquo;\u0026Eacute;tudes \u0026Eacute;conomiques duBurundi (ISTEEBU), et ICF. 2017. Troisi\u0026egrave;me Enqu\u0026ecirc;te D\u0026eacute;mographique et de Sant\u0026eacute;. Bujumbura, Burundi :ISTEEBU, MSPLS, et ICF\u003c/li\u003e\n\u003cli\u003eAlsammani, M.A. and Ahmed, S.R., 2015. Grand multiparity: risk factors and outcome in a tertiary hospital: a comparative study.\u0026nbsp;\u003cem\u003eMateria socio-medica\u003c/em\u003e,\u0026nbsp;\u003cem\u003e27\u003c/em\u003e(4), p.244.\u003c/li\u003e\n\u003cli\u003eDe Jonge, H.C., Azad, K., Seward, N., Kuddus, A., Shaha, S., Beard, J., Costello, A., Houweling, T.A. and Fottrell, E., 2014. Determinants and consequences of short birth interval in rural Bangladesh: a cross-sectional study.\u0026nbsp;\u003cem\u003eBMC pregnancy and childbirth\u003c/em\u003e,\u0026nbsp;\u003cem\u003e14\u003c/em\u003e(1), p.427.\u003c/li\u003e\n\u003cli\u003eStover, J. and Ross, J., 2010. How increased contraceptive use has reduced maternal mortality.\u0026nbsp;\u003cem\u003eMaternal and child health journal\u003c/em\u003e,\u0026nbsp;\u003cem\u003e14\u003c/em\u003e(5), pp.687-695.\u003c/li\u003e\n\u003cli\u003eAhmed, S., Li, Q., Liu, L. and Tsui, A.O., 2012. Maternal deaths averted by contraceptive use: an analysis of 172 countries.\u0026nbsp;\u003cem\u003eThe Lancet\u003c/em\u003e,\u0026nbsp;\u003cem\u003e380\u003c/em\u003e(9837), pp.111-125.\u003c/li\u003e\n\u003cli\u003eNdayizigiye, M., Fawzi, M.S., Lively, C.T. and Ware, N.C., 2017. Understanding low uptake of contraceptives in resource-limited settings: a mixed-methods study in rural Burundi.\u0026nbsp;\u003cem\u003eBMC health services research\u003c/em\u003e,\u0026nbsp;\u003cem\u003e17\u003c/em\u003e(1), p.209.\u003c/li\u003e\n\u003cli\u003eWorld Health Organisation, 2020.\u0026nbsp;\u003cem\u003eFamily Planning/Contraception\u003c/em\u003e. [online] Who.int. Available at: \u0026lt;https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception\u0026gt; [Accessed 12 April 2020].\u003c/li\u003e\n\u003cli\u003eG\u0026uuml;ney, T., 2017. POPULATION GROWTH AND SUSTAINABLE DEVELOPMENT IN DEVELOPED-DEVELOPING COUNTRIES: AN IV (2SLS) APPROACH GELİŞMİŞ-GELİŞMEKTE OLAN \u0026Uuml;LKELERDE N\u0026Uuml;FUS ARTIŞI VE S\u0026Uuml;RD\u0026Uuml;R\u0026Uuml;LEBİLİR KALKINMA: BİR IV (2SLS) YAKLAŞIMI.\u0026nbsp;\u003cem\u003ePopulation\u003c/em\u003e,\u0026nbsp;\u003cem\u003e22\u003c/em\u003e(4), pp.1255-1277.\u003c/li\u003e\n\u003cli\u003eThobani R, Jessani S, Azam I, Reza S, Sami N, Rozi S, et al. (2019) Factors associated with the discontinuation of modern methods of contraception in the low income areas of Sukh Initiative Karachi: A community-based case control study. PLoS ONE 14(7): e0218952. \u003ca href=\"https://doi.org/10.1371/journal.pone.0218952\"\u003ehttps://doi.org/10.1371/journal.pone.0218952\u003c/a\u003e\u003c/li\u003e\n\u003cli\u003eBekele T, Gebremariam A, Tura P (2015) Factors Associated with Contraceptive Discontinuation in Agarfa District, Bale Zone, South East Ethiopia. Epidemiology (sunnyvale) 5: 179. doi :10.4172/2161-1165.1000179\u003c/li\u003e\n\u003cli\u003eVerma, J.P., 2012.\u0026nbsp;\u003cem\u003eData analysis in management with SPSS software\u003c/em\u003e. Springer Science \u0026amp; Business Media\u003c/li\u003e\n\u003cli\u003eGonie A, Wudneh A, Nigatu D, Dendir Z. Determinants of family planning use among married women in bale eco-region, Southeast Ethiopia: a community based study. BMC Womens Health. 2018;18(1):50. Published 2018 Mar 12. doi:10.1186/s12905-018-0539-7\u0026nbsp;\u003c/li\u003e\n\u003cli\u003eChebet JJ, et al. \u0026ldquo;Every method seems to have its problems\u0026rdquo;-perspectives on side effects of hormonal contraceptives in Morogoro region, Tanzania. BMC Womens Health. 2015;15(1):1\u003c/li\u003e\n\u003cli\u003eBelda SS, et al. Modern contraceptive utilization and associated factors among married pastoralist women in Bale eco-region. BMC Health Serv Res. 2017;17:194\u003c/li\u003e\n\u003cli\u003eAbdalla AAA, Ahmmed EH (2017) Evaluate Use and Barriers to Accessing Family Planning Services among Reproductive Age Women in the White Nile, Rural Districts, Sudan. Health Sci J. Vol. 11 No. 6: 531.\u003c/li\u003e\n\u003cli\u003eMbadu Fid\u0026egrave;le Muanda, Gahungu Parfait Ndongo, Lauren J. Messina \u0026amp; Jane Bertrand (2017) Barriers to modern contraceptive use in rural areas in DRC, Culture, Health \u0026amp; Sexuality, 19:9, 1011-1023, DOI: 10.1080/13691058.2017.1286690\u003c/li\u003e\n\u003cli\u003eVouking MZ, Evina CD, Tadenfok CN. Male involvement in family planning decision making in sub-Saharan Africa- what the evidence suggests.\u0026nbsp;\u003cem\u003ePan Afr Med J\u003c/em\u003e. 2014;19:349. Published 2014 Dec 3. doi:10.11604/pamj.2014.19.349.5090\u003c/li\u003e\n\u003cli\u003eShattuck D, Kerner B, Gilles K, Hartmann M, Ng'ombe T, Guest G. Encouraging contraceptive uptake by motivating men to communicate about family planning: the Malawi Male Motivator project.\u0026nbsp;\u003cem\u003eAm J Public Health\u003c/em\u003e. 2011;101(6):1089\u0026ndash;1095. doi:10.2105/AJPH.2010.300091\u003c/li\u003e\n\u003cli\u003eGuttmacher Institute, 2020.\u0026nbsp;\u003cem\u003eMale Motivator Project, Malawi\u003c/em\u003e. [online] Guttmacher Institute. Available at: \u0026lt;https://www.guttmacher.org/\u0026gt; [Accessed 12 April 2020].\u003c/li\u003e\n\u003cli\u003eFamily Health International 360, 2020 [online] Fhi360.org. Available at: \u0026lt;https://www.fhi360.org/sites/default/files/media/documents/africa-bureau-case-study-report.pdf\u0026gt; [Accessed 12 April 2020]\u003c/li\u003e\n\u003cli\u003eAdedini, S.A., Babalola, S. Ibeawuchi, C., Omotoso, O., Akiode, A. and Odeku, M., 2018. Role of religious leaders in promoting contraceptive use in Nigeria: evidence from the Nigerian Urban Reproductive Health Initiative.\u0026nbsp;\u003cem\u003eGlobal Health: Science and Practice\u003c/em\u003e,\u0026nbsp;\u003cem\u003e6\u003c/em\u003e(3), pp.500-514\u003c/li\u003e\n\u003cli\u003eWorld Bank, 2020.\u0026nbsp;\u003cem\u003eFertility rate, total (births per woman) | Data\u003c/em\u003e. [online] Data.worldbank.org. Available at: \u003cbr /\u003e \u0026lt; \u003ca href=\"https://data.worldbank.org/indicator/SP.DYN.TFRT.IN?locations=BI\"\u003ehttps://data.worldbank.org/indicator/SP.DYN.TFRT.IN?locations=BI\u003c/a\u003e\u0026gt; [Accessed 19 August 2020].\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"reproductive-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"reph","sideBox":"Learn more about [Reproductive Health](http://reproductive-health-journal.biomedcentral.com)","snPcode":"12978","submissionUrl":"https://submission.nature.com/new-submission/12978/3","title":"Reproductive Health","twitterHandle":"@Reprod_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Family Planning, Contraception, barriers, perceptions, rural Burundi, sub-Saharan Africa","lastPublishedDoi":"10.21203/rs.3.rs-24210/v4","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-24210/v4","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground \u003c/strong\u003eWith a fertility rate of 5.4 children per woman, Burundi ranked as seventh country with the highest fertility rate in the world. Family planning is an effective way of achieving desirable family size, appropriate birth spacing and significant reduction in unintended pregnancies. Furthermore, family planning has been linked to improvements in maternal health outcomes. Yet, in spite of the overwhelming evidence on the benefits of family planning and despite high knowledge and free services, utilisation is low especially in rural communities with conservative people. Employing a mixed methods approach, this study first quantifies contraceptive prevalence and second, explores the contextual multilevel factors associated with low family planning utilisation among community members.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eAn explanatory sequential mixed study was conducted. Five hundred and thirty women in union were interviewed using structured and pre-tested questionnaire. Next, 11 focus group discussions were held with community members composed of married men and women, administrative and religious leaders \u0026nbsp;(n=132). The study was conducted in eighteen collines of two health districts of Vyanda and Rumonge in Bururi and Rumonge provinces in Burundi. Quantitative data was analysed with SPSS and qualitative data was coded and deductive thematic methods were applied to find themes and codes.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eThe overall contraceptive prevalence was 22.6%. From logistic modelling analysis, it was found that women aged 25 to 29 (aOR 5.04 (95% CI 2.09 – 10.27 p=0.038)), those that have completed secondary school and having four or less children \u0026nbsp;were significantly associated with use of family planning (aOR 1.72 (95%1.35 – 2.01) p=0.002). Among factors why family planning was unused included experience with side effects and costs associated with its management in the health system. Religious conceptualisation and ancestral negative beliefs of family planning had also shaped how people perceived it. Furthermore, at the household level, gender imbalances between spouses had resulted in break in communication, also serving as a factor for non-use of family planning. \u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion \u003c/strong\u003eGiven that use of family planning is rooted in negative beliefs emanating mainly from religious and cultural practices, engaging local religious leaders and community actors may trigger positive behaviours change needed to increase its use.\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Beyond knowledge acquisition: factors influencing family planning utilization among women in conservative communities in Rural Burundi.","msid":"","msnumber":"","nonDraftVersions":[{"code":"","date":"2021-04-09 00:00:00","doi":"","editorialEvents":[{"type":"editorAssigned","content":"","date":"2021-03-24T00:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2021-03-23T23:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2021-03-23T23:00:00+00:00","index":"","fulltext":""},{"type":"notPreprinted","content":""}],"status":"timeline","journal":{"display":true,"email":"[email protected]","identity":"reproductive-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"reph","sideBox":"Learn more about [Reproductive Health](http://reproductive-health-journal.biomedcentral.com)","snPcode":"12978","submissionUrl":"https://submission.nature.com/new-submission/12978/3","title":"Reproductive Health","twitterHandle":"@Reprod_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":4,"date":"2021-02-08 17:48:06","doi":"10.21203/rs.3.rs-24210/v4","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Minor revision","date":"2021-02-24T00:00:00+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2021-02-09T00:00:00+00:00","index":1,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2021-02-04T00:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2021-01-25T00:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2021-01-24T23:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2021-01-24T23:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"reproductive-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"reph","sideBox":"Learn more about [Reproductive Health](http://reproductive-health-journal.biomedcentral.com)","snPcode":"12978","submissionUrl":"https://submission.nature.com/new-submission/12978/3","title":"Reproductive Health","twitterHandle":"@Reprod_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":3,"date":"2021-01-18 17:27:20","doi":"10.21203/rs.3.rs-24210/v3","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Minor revision","date":"2021-01-18T00:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-01-17T00:00:00+00:00","index":1,"fulltext":"Recommendation: Minor Revision\nForm responses:\n---\n\nComments to Author:\n---\nThere are a a few grammatical errors mainly in the abstract, viz: line 11, in line 13,multiparity should be one word and community should be communities. In line 15, explore should be explores, line 2 should read --those that have completed secondary education---, lines 26 and 27 should be were significantly ---. In line 40 what do the authors mean by community actors?* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. 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I understand that my name will be included on my report to the authors and, if the manuscript is accepted for publication, my named report including any attachments I upload will be posted on the website along with the authors' responses. I agree for my report to be made available under an Open Access Creative Commons CC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any comments which I do not wish to be included in my named report can be included as confidential comments to the editors, which will not be published.: **\nI agree to the open peer review policy of the journal**\n"},{"type":"reviewerAgreed","content":"","date":"2021-01-13T00:00:00+00:00","index":2,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-01-13T00:00:00+00:00","index":2,"fulltext":"Recommendation: Accept\nForm responses:\n---\n\nComments to Author:\n---\nThe paper has been adequately improved.\n\nI suggest that the abstract and plain summary also be reviewed for grammatical errors.\n\nalso, the first point under the exclusion criteria section should be removed. Exclusion is not the opposite of inclusion.* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. 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Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Level of interest: **An article of importance in its field**\n* Quality of written English: **Needs some language corrections before being published**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* I agree to the open peer review policy of the journal. I understand that my name will be included on my report to the authors and, if the manuscript is accepted for publication, my named report including any attachments I upload will be posted on the website along with the authors' responses. I agree for my report to be made available under an Open Access Creative Commons CC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any comments which I do not wish to be included in my named report can be included as confidential comments to the editors, which will not be published.: **\nI agree to the open peer review policy of the journal**\n"},{"type":"editorAssigned","content":"","date":"2021-01-06T00:00:00+00:00","index":"","fulltext":""},{"type":"reviewersInvited","content":"","date":"2021-01-06T00:00:00+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2021-01-06T00:00:00+00:00","index":1,"fulltext":""},{"type":"checksComplete","content":"","date":"2021-01-05T23:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2021-01-05T23:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"reproductive-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"reph","sideBox":"Learn more about [Reproductive Health](http://reproductive-health-journal.biomedcentral.com)","snPcode":"12978","submissionUrl":"https://submission.nature.com/new-submission/12978/3","title":"Reproductive Health","twitterHandle":"@Reprod_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":2,"date":"2020-09-04 14:47:39","doi":"10.21203/rs.3.rs-24210/v2","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Minor revision","date":"2020-12-12T00:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-10-13T12:00:00+00:00","index":1,"fulltext":"Recommendation: Minor Revision\nForm responses:\n---\n\nComments to Author:\n---\nThere are several grammatical errors that need to be corrected throughout the text. Under results. post-partum amenorrhoea should be substituted for delayed post-partum.* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **No**\n* Level of interest: **An article of importance in its field**\n* Quality of written English: **Needs some language corrections before being published**\n* Declaration of competing interests: **i declare i have no competing interest**\n* I agree to the open peer review policy of the journal. I understand that my name will be included on my report to the authors and, if the manuscript is accepted for publication, my named report including any attachments I upload will be posted on the website along with the authors' responses. I agree for my report to be made available under an Open Access Creative Commons CC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any comments which I do not wish to be included in my named report can be included as confidential comments to the editors, which will not be published.: **\nI agree to the open peer review policy of the journal**\n"},{"type":"editorInvitedReview","content":"","date":"2020-10-02T12:00:00+00:00","index":2,"fulltext":"Recommendation: Minor Revision\nForm responses:\n---\n\nComments to Author:\n---\nThank you for the revised document.\n\nWhile the author has made substantial improvements to the paper, the study is primarily focused on married women of reproductive age, rather than all women of reproductive age. This therefore causes some differences in the presentation of the introduction and the flow of the findings. I suggest the author focuses the introduction and discuss results on findings/studies that have focused on married women's family planning rather than being general.* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Level of interest: **An article of importance in its field**\n* Quality of written English: **Acceptable**\n* Declaration of competing interests: **I declare that I have no competing interests.**\n* I agree to the open peer review policy of the journal. I understand that my name will be included on my report to the authors and, if the manuscript is accepted for publication, my named report including any attachments I upload will be posted on the website along with the authors' responses. I agree for my report to be made available under an Open Access Creative Commons CC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any comments which I do not wish to be included in my named report can be included as confidential comments to the editors, which will not be published.: **\nI agree to the open peer review policy of the journal**\n"},{"type":"reviewerAgreed","content":"","date":"2020-09-24T12:00:00+00:00","index":2,"fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-09-20T12:00:00+00:00","index":1,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-09-18T12:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-09-03T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-09-02T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-09-02T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"reproductive-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"reph","sideBox":"Learn more about [Reproductive Health](http://reproductive-health-journal.biomedcentral.com)","snPcode":"12978","submissionUrl":"https://submission.nature.com/new-submission/12978/3","title":"Reproductive Health","twitterHandle":"@Reprod_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2020-04-28 19:28:21","doi":"10.21203/rs.3.rs-24210/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2020-08-18T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-08-15T12:00:00+00:00","index":1,"fulltext":"Recommendation: Minor Revision\nForm responses:\n---\n\nComments to Author:\n---\nMETHODS: When was the study conducted and where and when in the various communities were the focus group discussions held? It is not clear when and were the questionnaires were administered and to whom? Type of questionnaire and content.\nRESULTS: In line 49-what do the authors mean by delayed postpartum?* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Level of interest: **An article of importance in its field**\n* Quality of written English: **Acceptable**\n* Declaration of competing interests: **I declare i have no competing interest**\n* I agree to the open peer review policy of the journal. I understand that my name will be included on my report to the authors and, if the manuscript is accepted for publication, my named report including any attachments I upload will be posted on the website along with the authors' responses. I agree for my report to be made available under an Open Access Creative Commons CC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any comments which I do not wish to be included in my named report can be included as confidential comments to the editors, which will not be published.: **\nI agree to the open peer review policy of the journal**\n"},{"type":"editorInvitedReview","content":"","date":"2020-08-05T12:00:00+00:00","index":2,"fulltext":"Recommendation: Major Revision\nForm responses:\n---\n\nComments to Author:\n---\nGeneral Comments\n\n1. It was not very easy to refer to sections of the paper due to the lack of line or page numbers.\n2. Overall, the study is critical but the author needed to do a couple of reviews before submission. Some of the results are not presented adequately and appropriately, and some of the interpretations are not firmly founded in the results of this particular study.\n3. It is not clear what the author is referring to as 'multilevel\nSpecific Comments\nAbstract\n1. As of 2018, Burundi's TRF was at 5.4, and it was 7th in the region. Kindly check this and correct accordingly.\n2. The focus of the study is married women and contraceptive use. This only becomes clear in the methods, more effort to introduce the reader to the focus on married women can be appreciated.\n3. A mixed-methods approach was employed. It would be nice to report triangulated results, particularly in the abstract, as some of the findings are repeated. For example, side effects and religious beliefs seem to be dominant\n4. In conclusion, a reference to 'deeply rooted negative beliefs' seems to pop up for the first time. These can be referred to in the results section.\nBackground\n5. Crosscheck Burundi's TFR as at 2018 or later.\n6. The study aim needs to be checked; a word might be missing\nMethods\n7. The qualitative sample needs to be mentioned in the abstract as it seems as though only women were included in the discussions.\n8. Why were men excluded since you were investigating the contraceptive prevalence rate?\n9. What were the criteria for selecting community representatives? Were these selected from all 18 collines or selected from specific collines? How were these selected?\n10. Were the transcripts from the FGDs back-translated, considering all three translations? How sure are you that the meanings were not were distorted?\n11. It is advisable to name the IRB and the approval number if possible.\nResults\n12. What was the response rate? What were some of the reasons households were left out? This can be addressed in the methodology section under the data collection.\n13. It is interesting to note that there were no barrier methods used primarily for people so concerned about the side effects of hormonal methods.\n14. The author has not indicated the results for the statistical tests. It would be nice if the table included the results of the descriptive results and statistical tests. As it is, the results are minimal and not very informative.\n15. The descriptive table is also limited. \"N\" means the real population. \"n\" denoted the sample. The figures reported under \"N\" in the table represent proportions of \"n\". Overall, the presentation of findings is incomplete. The reporting is also minimal; it would be nice to see statistics reported with their 95% CIs and the pvalue. See other papers on how this is done.\n16. It would be nice if the qualitative finding had an introductory statement preparing the reader on what the main themes were and how they will be presented. Moreover, since this was a mixed-methods design, this section would benefit from a recap of the qualitative streak's objective.\n17. The qualitative findings had aims, and these must be presented first. It will also impact the presentation of results. It seems as though people want to limit their children, so why is it being reported as a barrier? It seemed as though the qualitative study aimed to find out reasons why the CPR was low.\n18. The first qualitative theme seems to be reporting reasons for limiting the number of children. They desire more, but they cannot because of the economic situation.\n19. The qualitative results lack any description of participants and the composition of the focus groups. How were they constituted? Was gender a factor? Whom were they representing? Which regions did they come from? Were they all from one region or a participant per region? Were they disaggregated by age?\n20. The theme on side effects says \"This climate of fear had been used as an avenue exploited by religious leaders and anti-family planning propagandists to make contraceptives unpopular\". This statement needs to be backed by a quote. As it is not precisely represented by the quotes below.\n21. A quote to illustrate one theme that is being reported is sufficient.\n22. The theme of religious beliefs seems to suggest all forms of FP are wrong, yet the quote seems to pick which methods are sinful. Modern vs natural methods. What did the participants consider as natural?\n23. Reference to 'culture' is too broad in the context of this study. Marital norms or practices or parity and culture are not synonymous. If we insist on using culture, then 'beliefs' rather than 'barriers' may be used.\n24. The last theme reports health worker perspectives though no health workers were interviewed in the study. The perspective of this theme needs to be more explicit. Refusal is also not the same as discouragement.\n25. The theme on spousal communication seems to be reporting both communication and lack of decision making power on the number of children experienced by the women and the lack of responsibility of the men when it came to limiting or spacing children. This could be a theme on its' own, as gender and power.\nDiscussion and Conclusion\n26. The discussion section needs to open with a summary of the findings before seeing what other literature has found in comparison with this mixed-methods study.\n27. Why is the study reporting an ideal number of children first? This was not the aim of the study. What were the key findings? These findings need to be the main focus of the discussion before other findings, such as several children. The readers would expect the author to open with FP usage rates and then the factor that influences the utilization of FP.\n28. The findings do not support the point on \"propaganda\" by religious leaders. How did the author arrive at this conclusion? These are beliefs, and the community members share in these beliefs. Do they feel like the religious leaders are not truthful with them? How did the author conclude that religious teachings were propaganda? Did the participants state this as a barrier?\n\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. 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I understand that my name will be included on my report to the authors and, if the manuscript is accepted for publication, my named report including any attachments I upload will be posted on the website along with the authors' responses. I agree for my report to be made available under an Open Access Creative Commons CC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any comments which I do not wish to be included in my named report can be included as confidential comments to the editors, which will not be published.: **\nI agree to the open peer review policy of the journal**\n"},{"type":"reviewerAgreed","content":"","date":"2020-07-14T12:00:00+00:00","index":2,"fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-07-05T12:00:00+00:00","index":1,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-07-04T12:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-04-28T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-04-27T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-04-23T12:00:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"","date":"2020-04-22T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"reproductive-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"reph","sideBox":"Learn more about [Reproductive Health](http://reproductive-health-journal.biomedcentral.com)","snPcode":"12978","submissionUrl":"https://submission.nature.com/new-submission/12978/3","title":"Reproductive Health","twitterHandle":"@Reprod_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ca4349a2-fa88-44ff-8747-43b66de06c8f","owner":[],"postedDate":"February 8th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":1950651,"name":"Sexual \u0026 Reproductive Medicine"}],"tags":[],"updatedAt":"2021-05-29T16:03:14+00:00","versionOfRecord":[],"versionCreatedAt":"2021-02-08 17:48:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v4","identity":"rs-24210","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-24210","identity":"rs-24210","version":["v4"]},"buildId":"369fNeqWncA4NS6XSWjrt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}