title: The effect of joint contraceptive decisions on the use of Injectables, Long-Acting and Permanent Methods (ILAPMs) among married female (15-49) contraceptive users in Zambia: a cross-sectional study.
abstract: BACKGROUND
  Zambia's fertility rate and unmet need for family planning are still high. This is in spite of the progress reported from 1992 to 2007 of the increase in contraceptive prevalence rate from 15% to 41% and use of modern methods of family planning from 9% to 33%. However, partner disapproval of family planning has been cited by many women in many countries including Zambia. Given the effectiveness of long-acting and permanent methods of family planning (ILAPMs) in fertility regulation, this paper sought to examine the relationship between contraceptive decision-making and use of ILAPMs among married women in Zambia.
  
  
  METHODS
  This paper uses data from the 2007 Zambia Demographic and Health Survey. The analysis is based on married women (15-49) who reported using a method of family planning at the time of the survey. Out of the 7,146 women interviewed, only 1,630 women were valid for this analysis. Cross-tabulations and binary logistic regressions with Chi-square were used to analyse associations and the predictors of use of ILAPMs of contraception, respectively. A confidence interval of .95 was used in determining relationships between independent and dependent variables.
  
  
  RESULTS
  Two thirds of women made joint decisions regarding contraception and 29% of the women were using ILAPMs. Women who made joint contraceptive decisions are significantly more likely to use ILAPMs than women who did not involve their husband in contraceptive decisions. However, the most significant predictor is the wealth index. Women from rich households are more likely to use ILAPMs than women from medium rich and poor households. Results also show that women of North Western ethnicities and those from Region 3 had higher odds of using ILAPMs than Tonga women and women from Region 2, respectively.
  
  
  CONCLUSIONS
  Joint contraceptive decision-making between spouses is key to use of ILAPMs in Zambia. Our findings have also shown that the wealth index is actually the strongest factor determining use of these methods. As such, family planning programmes directed at increasing use of LAPMs ought to not only encourage spousal communication but should also consider rolling out interventions that incorporate economic empowerment.
authors.affiliation: Population Dynamics and Reproductive Health Research Program, African Population & Health Research Center, Manga Close, Off Kirawa Road, P,O, Box 10787-00100, Nairobi, Kenya. nmutombo@aphrc.org.
authors.forename: Namuunda
authors.initials: N
authors.lastname: Mutombo
authors.forename: Pauline
authors.initials: P
authors.lastname: Bakibinga
mesh_terms: D000293:Adolescent; D000328:Adult; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003270:Contraceptive Agents; D003273:Contraceptive Devices; D003430:Cross-Sectional Studies; D003657:Decision Making; D005193:Family Planning Services / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D018454:Spouses; D014930:Women; D055815:Young Adult; D015024:Zambia
chemical_list: D003270:Contraceptive Agents