title: Trends and patterns of modern contraceptive use and relationships with high-risk births and child mortality in Burkina Faso.
abstract: BACKGROUND
  In sub-Saharan Africa, few studies have stressed the importance of spatial heterogeneity analysis in modern contraceptive use and the relationships with high-risk births.
  
  
  OBJECTIVE
  This paper aims to analyse the association between modern contraceptive use, distribution of birth risk, and under-five child mortality at both national and regional levels in Burkina Faso.
  
  
  METHODS
  The last three Demographic and Health Surveys - conducted in Burkina Faso in 1998, 2003, and 2010 - enabled descriptions of differentials, trends, and associations between modern contraceptive use, total fertility rates (TFR), and factors associated with high-risk births and under-five child mortality. Multivariate models, adjusted by covariates of cultural and socio-economic background and contact with health system, were used to investigate the relationship between birth risk factors and modern contraceptive prevalence rates (mCPR).
  
  
  RESULTS
  Overall, Burkina Faso's modern contraception level remains low (15.4% in 2010), despite significant increases during the last decade. However, there are substantial variations in mCPR by region, and health facility contact was positively associated with mCPR increase. Women's fertility history and cultural and socio-economic background were also significant factors in predicting use of modern contraception. Low modern contraceptive use is associated with higher birth risks and increased child mortality. This association is stronger in the Sahel, Est, and Sud-Ouest regions. Even though all factors in high-risk births were associated with under-five mortality, it should be stressed that short birth spacing ranked as the highest risk in relation to mortality of children.
  
  
  CONCLUSIONS
  Programmes that target sub-national differentials and leverage women's health system contacts to inform women about family planning opportunities may be effective in improving coverage, quality, and equity of modern contraceptive use. Improving the demand satisfied for modern contraception may result in a reduction in the percentage of women experiencing high-risk births and may also reduce child mortality.
authors.affiliation: Centre for Demographic Research, Université Catholique de Louvain, Louvain-la-Neuve, Belgium.|Institut Supérieur des Sciences de la Population, Ouagadougou University, Ouagadougou, Burkina Faso; mailayebf@yahoo.fr.
authors.forename: Abdoulaye
authors.initials: A
authors.lastname: Maïga
authors.affiliation: United Nations Population Fund, New York, NY, USA.
authors.forename: Sennen
authors.initials: S
authors.lastname: Hounton
authors.affiliation: United Nations Children's Fund, New York, NY, USA.
authors.forename: Agbessi
authors.initials: A
authors.lastname: Amouzou
authors.affiliation: Demographic and Social Statistics Department, Obafemi Awolowo University, Ife, Nigeria.
authors.forename: Akanni
authors.initials: A
authors.lastname: Akinyemi
authors.affiliation: School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Solomon
authors.initials: S
authors.lastname: Shiferaw
authors.affiliation: Institut National de la Statistique et de la Démographie, Ouagadougou, Burkina Faso.
authors.forename: Banza
authors.initials: B
authors.lastname: Baya
authors.affiliation: United Nations Population Fund, Ouagadougou, Burkina Faso.
authors.forename: Dalomi
authors.initials: D
authors.lastname: Bahan
authors.affiliation: International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.
authors.forename: Aluisio J D
authors.initials: AJ
authors.lastname: Barros
authors.affiliation: Institute for International Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Neff
authors.initials: N
authors.lastname: Walker
authors.affiliation: United Nations Population Fund, New York, NY, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Friedman
mesh_terms: D000328:Adult; D001721:Birth Intervals; D001723:Birth Rate; D002050:Burkina Faso / Q000453:epidemiology; D002648:Child; D046688:Child Mortality / Q000639:trends*; D003267:Contraception / Q000706:statistics & numerical data* / Q000639:trends; D003268:Contraception Behavior / Q000639:trends*; D003906:Developing Countries; D005193:Family Planning Services; D005260:Female; D006306:Health Surveys; D006801:Humans; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D012424:Rural Population; D012959:Socioeconomic Factors
keywords: Burkina Faso; fertility; high-risk births; modern contraceptive use; under-five child mortality