title: Contraceptive use and distribution of high-risk births in Nigeria: a sub-national analysis.
abstract: BACKGROUND
  Family planning expansion has been identified as an impetus to harnessing Nigeria's demographic dividend. However, there is a need for data to address pockets of inequality and to better understand cultural and social factors affecting contraceptive use and health benefits. This paper contributes to addressing these needs by providing evidence on the trends and sub-national patterns of modern contraceptive prevalence in Nigeria and the association between contraceptive use and high-risk births in Nigeria.
  
  
  METHODS
  The study utilised women's data from the last three Demographic and Health Surveys (2003, 2008, and 2013) in Nigeria. The analysis involved descriptive, bivariate, and multivariate analyses. The multivariate analyses were performed to examine the relationship between high-risk births and contraceptive use. Associations were examined using Poisson regression.
  
  
  RESULTS
  Findings showed that respondents in avoidable high-risk birth categories were less likely to use contraceptives compared to those at no risk [rate ratio 0.82, confidence interval: 0.76-0.89, p<0.001]. Education and wealth index consistently predicted significant differences in contraceptive use across the models.
  
  
  CONCLUSIONS
  The results of this study suggest that women in the high-risk birth categories were significantly less likely to use a modern method of contraception relative to those categorised as having no risk. However, there are huge sub-national variations at regional and state levels in contraceptive prevalence and subsequent high-risk births. These results further strengthen evidence-based justification for increased investments in family planning programmes at the state and regional levels, particularly regions and states with high unmet needs for family planning.
authors.affiliation: Demography and Social Statistics Department, Obafemi Awolowo University, Ile Ife, Nigeria; akakanni@yahoo.ca.
authors.forename: Akanni
authors.initials: A
authors.lastname: Akinyemi
authors.affiliation: Demography and Social Statistics Department, Obafemi Awolowo University, Ile Ife, Nigeria.|Demography and Population Studies Programme, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Sunday
authors.initials: S
authors.lastname: Adedini
authors.affiliation: United Nations Population Fund, New York, NY, USA.
authors.forename: Sennen
authors.initials: S
authors.lastname: Hounton
authors.affiliation: Demography and Social Statistics Department, Obafemi Awolowo University, Ile Ife, Nigeria.|School of Research and Postgraduate Studies, Northwest University, Mafikeng, South Africa.
authors.forename: Ambrose
authors.initials: A
authors.lastname: Akinlo
authors.affiliation: United Nations Population Fund, Abuja, Nigeria.
authors.forename: Olanike
authors.initials: O
authors.lastname: Adedeji
authors.affiliation: United Nations Population Fund, Abuja, Nigeria.
authors.forename: Osarenti
authors.initials: O
authors.lastname: Adonri
authors.affiliation: United Nations Population Fund, New York, NY, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Friedman
authors.affiliation: School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Solomon
authors.initials: S
authors.lastname: Shiferaw
authors.affiliation: Institut Supérieur des Sciences de la Population, Ouagadougou University, Ouagadougou, Burkina Faso.
authors.forename: Abdoulaye
authors.initials: A
authors.lastname: Maïga
authors.affiliation: UNICEF, New York, NY, USA.
authors.forename: Agbessi
authors.initials: A
authors.lastname: Amouzou
authors.affiliation: International Center for Equity in Health, Federal University of Pelotas, Capão do Leão, Brazil.
authors.forename: Aluisio J D
authors.initials: AJ
authors.lastname: Barros
mesh_terms: D000293:Adolescent; D000328:Adult; D003267:Contraception; D003268:Contraception Behavior / Q000706:statistics & numerical data / Q000639:trends*; D003906:Developing Countries; D005193:Family Planning Services / Q000706:statistics & numerical data; D005260:Female; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D009549:Nigeria; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D055815:Young Adult
keywords: Nigeria; contraceptive use; estimates; high-risk births; sub-national