Abstract
Maternal mortality remains a significant global concern, particularly in sub-Saharan Africa, underscored by its inclusion in Sustainable Development Goal 3.1. Cameroon faces substantial challenges, with a maternal mortality rate of 438 per 100,000 live births as of 2023. Family planning is a crucial strategy for mitigating maternal and infant mortality. This study explored the association between husbands’ sociodemographic factors, household socioeconomic characteristics, and modern contraceptive use in Cameroon, contributing to a deeper understanding of contraceptive use. This cross-sectional study utilized data from the 2018–2019 Demographic and Health Surveys to examine modern contraceptive use among married or live-in partners women of reproductive age in Cameroon. The study excluded pregnant women, nonunion women, and individuals identified as sisters, granddaughters, mothers of household heads, or visitors. A quantitative analysis employing multiple logistic regression was conducted to assess the likelihood of modern contraceptive use. The study identified an 18.8% prevalence of modern contraceptive use among Cameroonian women of reproductive age. Sociodemographic and socioeconomic factors significantly influenced contraceptive use. A higher likelihood of modern contraceptive use was associated with husbands’ occupation (AOR: 4.53, 95% CI (2.55–8.04)), desire for fewer children (AOR: 1.57, 95% CI (1.28–1.93)), educational level (AOR: 2.36, 95% CI (1.80–3.12); AOR: 2.44, 95% CI (1.84–3.24); AOR: 3.9, 95% CI (2.78–5.47); AOR: 1.06, 95% CI (0.65–1.74)), household size (AOR: 1.25, 95% CI (1.06–1.49)), and wealth index (AOR: 2, 95% CI (1.60–2.50); AOR: 1.83, 95% CI (1.46–2.30); AOR: 2.21 95% CI (1.72–2.85); and AOR: 1.90, 95% CI (1.44–2.51)). Conversely, factors such as husbands living elsewhere (AOR 0.75, 95% CI (0.60–0.95)), women’s unawareness of their husbands’ desired number of children (AOR: 0.76, 95% CI (0.66–0.88)), living in households headed by older individuals (AOR: 0.64, 95% CI (0.50–0.83) and AOR: 0.50, 95% CI (0.36–0.68)), and having more than one ideal number of male children (AOR: 0.83, 95% CI (0.72–0.94) and AOR: 0.55, 95% CI (0.47–0.65)) were associated with a decreased likelihood of modern contraceptive use. These findings emphasize the complexity of family planning decisions and the need to consider diverse sociodemographic and socioeconomic factors in reproductive health initiatives. Key policy recommendations include comprehensive family planning education, gender equity promotion, engagement of elderly household heads, and cultural sensitivity in program implementation.
Keywords: Family, Structure, Prevalence, Modern contraceptives, Demographic and health surveys
Subject terms: Health care, Risk factors
Introduction
Maternal mortality remains a pressing global issue, particularly in sub-Saharan Africa, as emphasized by its inclusion in Sustainable Development Goal 3.1 by the United Nations1. Despite strides toward reducing maternal mortality, Cameroon faces significant challenges, including a maternal mortality ratio of 438 per 100,000 live births as of 2023 and an infant mortality rate of 54 per 1,000 live births, both higher than the African average2–4. Family planning emerges as a pivotal strategy to address these issues, offering avenues to mitigate maternal and infant mortality rates, as evidenced by various research findings5,6. It encompasses a spectrum of services and policies to empower individuals and couples to make informed decisions about their reproductive health7.
The World Health Organization underscores the importance of family planning as a cornerstone of family health, highlighting its role in achieving universal health coverage. Research indicates that investing in family planning yields significant developmental benefits, leading to higher income, increased wealth accumulation, and improved education opportunities6,8,7. Despite its recognized importance, access to modern contraceptives in Cameroon remains limited, with a projected 19% prevalence rate among women of reproductive age by 20239. Given the low percentage of contraceptive use, several researchers downplayed the issue, and the study’s angles were varied. The prevalence of usage of each technique of contraception as well as the sociodemographic characteristics related to the woman and community predictors that affect the use of a method of contraception were investigated. Women of childbearing age were also evaluated for their knowledge of and attitudes toward modern contraception. However, the marginal rise in prevalence over time suggests that there is a greater range of factors impacting the usage of contraceptives and that studies ought to hinge on certain issues.
To address this gap, Cameroon has implemented various health policies and programs to broaden access to family planning services. However, challenges persist, as reflected in the low contraceptive prevalence rate and the proportion of demand met by modern methods. Understanding the sociodemographic and socioeconomic factors influencing contraceptive use is crucial for tailoring effective interventions. In patriarchal societies like Cameroon, familial dynamics and cultural norms significantly influence contraceptive decision-making processes, highlighting the importance of considering household socioeconomic characteristics.
This study explored the association between husbands’ sociodemographic factors, household socioeconomic characteristics, and modern contraceptive use in Cameroon. By identifying these factors, this study seeks to provide policy recommendations to enhance couples’ decision-making processes regarding contraceptive use. The research questions and hypotheses outlined herein offer a structured framework for investigating these relationships, contributing to a deeper comprehension of modern contraceptive use in the Cameroonian context. Addressing maternal and infant mortality rates in Cameroon necessitates comprehensive strategies that prioritize access to family planning services. By examining the sociodemographic and socioeconomic factors influencing contraceptive use, this study aims to inform targeted interventions that promote reproductive health and empower individuals and families to make informed choices about their reproductive futures.
Data and methods
Study setting
Cameroon, located in Central Africa and bordered by Nigeria, Chad, and the Central African Republic, boasts diverse landscapes and cultures. From bustling urban centers, such as Yaoundé and Douala to rural communities, the country offers a rich tapestry of traditions and languages, with over 250 ethnic groups. The patriarchal social structure significantly influences family dynamics and gender roles, impacting decisions on reproductive health10.
Study design and sample size
This cross-sectional quantitative study explored the influence of family socioeconomic composition and husbands’ sociodemographic characteristics on contraceptive use among married or live-in partners women of reproductive age in Cameroon.
Data were obtained from the DHS database, which is renowned for its nationally representative household surveys covering a variety of health and population indicators. The data collection for this database was conducted from June 2018 to December 2018 and was made publicly available in 2019. This study focused on family planning, utilizing the Standard DHS, which includes detailed information on contraceptive knowledge, use, attitudes, and sources. These can be accessed at DHS Data11.
Although DHS typically employs a two-stage cluster design, this study utilized convenience sampling with specific inclusion and exclusion criteria. Included in the study were married women of reproductive age who were not currently pregnant, whereas unmarried women, pregnant women, and those under 15 or over 49 years old were excluded.
The initial sample comprised 33,988 women interviewed in households. Exclusions were made for pregnant respondents (n = 16,254) and those not currently in a union. Only women directly linked to the household head, including wives and daughters, were included. Those identified as mothers, granddaughters, or visitors were also excluded (n = 2,306). The final study population comprised of 13,986 women in unions who were not pregnant at the time of the survey (Fig. 1).
Fig. 1.
Final population of the study.
Variables
The dependent variable in this study was the current utilization of modern contraceptives, classified into two categories: users (women actively using modern contraceptives) and non-users (women not using any modern contraceptives, including those relying on traditional methods). The predictors examined included several factors related to the husbands, such as age, education, occupation, and desire for children. Additionally, household characteristics were considered, including household size, wealth index, sex of the household head, and the age of the household head. These Predictors were also used in several studies to determine the likelihood of using modern contraceptives12–17.
Statistical analysis
Descriptive statistics and chi-square tests were employed to characterize the study population and explore associations between key variables and modern contraceptive use. Since our outcome variable—modern contraceptive use—is binary, logistic regression was the most straightforward and efficient method for analysis. To explore the predictors of modern contraceptive use, we included all relevant variables in a single binomial logistic regression model. This approach allowed us to estimate the likelihood of modern contraceptive use based on a range of sociodemographic factors, household characteristics, and other relevant variables. By employing these statistical techniques, we aimed to identify significant predictors of modern contraceptive use within the context of the study. All statistical analyses were conducted using Jamovi software, version 2.3.28 with a significance level of 0.05. The prevalence of modern contraceptive use was calculated as a fixed ratio: the number of women using modern contraceptives at the time of the survey divided by the total number of women included in the study.
Results
Table 1 displays the key sociodemographic characteristics of the respondents and their husbands. The majority of women (91%) were aged 25–49, with the remaining 9% being younger. Regarding education, 29.9% had no formal schooling, 37.3% had completed primary education, 29.8% had secondary education, and only 3% had higher education. Most women were employed (96.7%), and the study population was evenly distributed between urban (43.8%) and rural (56.2%) areas.
Table 1.
Sociodemographic characteristics of respondents and husbands.
| Variables | n | % |
|---|---|---|
| Respondent’s age | ||
| < 25 | 1261 | 9 |
| 25–49 | 12,725 | 91 |
| Respondent’s education level | ||
| Never studied | 4184 | 29.9 |
| Primary | 5222 | 37.3 |
| Secondary | 4162 | 29.8 |
| Higher | 418 | 3 |
| Respondent currently working | ||
| No | 3422 | 24.5 |
| Yes | 10,564 | 75.5 |
| Respondent’s place of living | ||
| Urban | 6121 | 43.8 |
| Rural | 7865 | 56.2 |
| Husband’ age | ||
| ≤ 30 | 1155 | 9.4 |
| 31–60 | 10,071 | 81.8 |
| > 60 | 1086 | 8.8 |
| Husband’s education level | ||
| Never studied | 2941 | 23.9 |
| Primary | 4337 | 35.2 |
| Secondary | 4043 | 32.8 |
| Higher | 734 | 6 |
| Unknown | 257 | 2.1 |
| Husband’ desire for children | ||
| Both want same | 4103 | 33.5 |
| Husband wants more | 4734 | 38.6 |
| Husband wants fewer | 610 | 5 |
| Unknown | 2812 | 22.9 |
| Husband’s place of living | ||
| Living with the wife | 11,321 | 92 |
| Staying elsewhere | 991 | 8 |
| Husband occupation | ||
| Not working | 351 | 2.9 |
| Working | 11,961 | 97.1 |
The husbands’ ages predominantly ranged from 31 to 60 years, with some aged under 31 years. Education levels varied as follows: 28.6% had no schooling, 42.1% had completed elementary education, 39.1% had secondary education, and 7.2% had higher education, with 2.5% being unsure. Regarding their desire for children, 37.7% wanted more children, 5.2% wanted fewer children, and 13.5% were unsure. The majority (92%) of women lived with their husbands, and most husbands were employed (97.1%).
Table 2 illustrates the key socioeconomic characteristics of the families included in this study. Among the 13,986 women, household sizes varied: 3,831 lived in smaller households (≤ 5 individuals), 7,387 in medium-sized households (6–10 individuals), 2,405 in larger households (11–20 individuals), and 363 in very large households (> 20 individuals). Nearly half (47.5%) of respondents lived in households with more than five children. Additionally, 73.6% resided in households with two or fewer children under five. However, 21.3% were in the poorest economic category, 23.3% were poorer, 22.9% were middle, 19.4% were richer, and 13.2% were richest.
Table 2.
Socioeconomic characteristics of families.
| Variables | n | % |
|---|---|---|
| Household members | ||
| ≤ 5 | 3 831 | 27.4 |
| 6–10 | 7 387 | 52.8 |
| 11–20 | 2 405 | 17.2 |
| > 20 | 363 | 2.6 |
| Number of children | ||
| ≤ 3 | 3 341 | 23.9 |
| 4–5 | 4 005 | 28.6 |
| > 5 | 6 640 | 47.5 |
| Number of children under 5 | ||
| ≤ 2 | 10 295 | 73.6 |
| 3–4 | 2 888 | 20.6 |
| > 4 | 803 | 5.7 |
| Number of wives | ||
| 1 | 9 139 | 88.4 |
| > 1 | 1 200 | 11.6 |
| The ideal number of boys | ||
| ≤ 1 | 2 535 | 18.1 |
| 2–3 | 6 185 | 44.2 |
| > 3 | 5 266 | 37.7 |
| Sex of the head of the HH | ||
| Male | 11 278 | 80.6 |
| Female | 2 708 | 19.4 |
| Age of the head of the HH | ||
| ≤ 30 | 1 059 | 7.6 |
| 31–60 | 10 961 | 78.4 |
| > 60 | 1 966 | 14.1 |
| Wealth index | ||
| Poorest | 2 980 | 21.3 |
| Poorer | 3 253 | 23.3 |
| Middle | 3 200 | 22.9 |
| Richer | 2 713 | 19.4 |
| Richest | 1 840 | 13.2 |
Table 3 presents the logistic regression results for factors associated with modern contraceptive use. Women aged 25–49 were 34% less likely to use modern contraception compared to those younger than 25 years, corresponding to an odds ratio of 0.66. Education played a significant role; those with primary, secondary, and higher education were 3.81, 4.1, and 4.3 times more likely to use modern contraceptives, respectively. Additionally, employed women were 1.15 times more likely to use modern contraceptives. Women whose husbands lived elsewhere had 0.75 times lower odds of utilizing modern contraception. The husband’s education level also influenced the usage, with those having primary, secondary, or higher education being 2.36, 2.44, and 3.9 times more likely to utilize modern contraception, respectively. Moreover, women whose husbands were employed had 4.53 times higher odds of using modern contraception than those whose husbands were not employed.
Table 3.
Sociodemographic characteristics of husbands as predictors of modern contraceptive use.
| Variables | Use of modern contraceptives | |||
|---|---|---|---|---|
| UOR (95% CI) | AOR (95% CI) | |||
| Respondent’s age | ||||
| < 25 | ||||
| 25–49 | 0.7 | (0.60–0.80)** | 0.66 | (0.54–0.81)** |
| Respondent’s education level | ||||
| Never studied | ||||
| Primary | 7.27 | (6.1–8.62)** | 3.81 | (2.98–4.88)** |
| Secondary | 9.54 | (8.03–11.24)** | 4.1 | (3.15–5.33)** |
| Higher | 14.67 | (11.40–18.91)** | 4.3 | (3.02–6.27)** |
| Respondent currently working | ||||
| No | ||||
| Yes | 1.4 | (1.25–1.54)** | 1.15 | (1.01–1.30)* |
| Respondent’s place of living | ||||
| Urban | ||||
| Rural | 0.57 | (0.52–0.62)** | 0.88 | (0.77–1.02) |
| Husband ‘age | ||||
| ≤ 30 | ||||
| 31–60 | 0.74 | (0.64–0.85)** | 1.1 | (0.85–1.42) |
| > 60 | 0.35 | (0.27–0.43)** | 0.64 | (0.41–1.01) |
| Husband’s education level | ||||
| Never studied | ||||
| Primary | 6.6 | (5.4–8.10)** | 2.36 | (1.80–3.12)** |
| Secondary | 7.87 | (6.46–9.58)** | 2.44 | (1.84–3.24)** |
| Higher | 14.2 | (11.21–17.99)** | 3.9 | (2.78–5.47)** |
| Unknown | 3.61 | (2.41–5.41)** | 1.06 | (0.65–1.74) |
| Husband’ desire for children | ||||
| Both want same | ||||
| Husband wants more | 0.72 | (0.65–0.80)** | 0.94 | (0.84–1.07) |
| Husband wants fewer | 1.47 | (1.22–1.77)** | 1.57 | (1.28–1.93)** |
| Unknown | 0.56 | (0.50–0.64)** | 0.76 | (0.66–0.88)** |
| Husband’s place of living | ||||
| Living with the wife | ||||
| Staying elsewhere | 0.77 | (0.65–0.92)* | 0.75 | (0.60–0.95)* |
| Husband occupation | ||||
| Not working | ||||
| Working | 2.94 | (1.98–4.37)** | 4.53 | (2.55–8.04)** |
P-value < 0.05*; P-value < .001**. UOR: unadjusted odd ratio; AOR: adjusted odd ratio; CI: confidence interval.
Table 4 displays logistic regression results for factors influencing modern contraceptive use. Women in households with 6–10 members and those with over 20 members were 1.33 and 2.37 times more likely to use modern contraception, respectively, compared to those in smaller households. Similarly, women in households with more than 5 children had 1.25 times higher odds of utilizing modern contraceptives. However, those desiring more male children had lower odds of contraceptive use, with odds ranging from 0.83 to 0.55. The age of household head was inversely associated with contraceptive use, with those aged 31–60 and older having lower odds. Economic status also played a role, with households in wealthier subgroups having higher odds of modern contraceptive use compared to the poorest subgroup.
Table 4.
Socioeconomic characteristics of families as predictors of modern contraceptive use.
| Variables | Use of modern contraceptives | |||
|---|---|---|---|---|
| UOR (95% CI) | AOR (95% CI) | |||
| Household members | ||||
| ≤ 5 | ||||
| 6–10 | 1.06 | (0.96–1.17) | 1.33 | (1.15–1.53)** |
| 11–20 | 0.75 | (0.65–0.86)** | 1.16 | (0.93–1.45) |
| > 20 | 0.77 | (0.57–1.-4) | 2.37 | (1.48–3.82)** |
| Number of children | ||||
| ≤ 3 | ||||
| 4–5 | 1.01 | (0.90–1.35) | 1.16 | (0.99–1.35) |
| > 5 | 0.66 | (0.60–0.74)** | 1.25 | (1.06–1.48)* |
| Number of children under 5 | ||||
| ≤ 2 | ||||
| 3–4 | 0.92 | (0.82–1.02) | 1 | (0.87–1.15) |
| > 4 | 0.81 | (0.66–0.98)* | 0.88 | (0.61–1.270 |
| Number of wives | ||||
| 1 | ||||
| > 1 | 0.64 | (0.54–0.76)** | 1.04 | (0.85–1.27) |
| The ideal number of boys | ||||
| ≤ 1 | ||||
| 2–3 | 0.89 | (0.80–0.99)* | 0.83 | (0.72–0.94)* |
| > 3 | 0.35 | (0.31–0.39)** | 0.55 | (0.47–0.65)** |
| Sex of the head of the HH | ||||
| Male | ||||
| Female | 0.8 | (0.72–0.90) | 1 | (0.82–1.22) |
| Age of the head of the HH | ||||
| ≤ 30 | ||||
| 31–60 | 0.74 | (0.63–0.85)** | 0.64 | (0.50–0.83)** |
| > 60 | 0.59 | (0.49–0.72)** | 0.5 | (0.36–0.68)** |
| Wealth index | ||||
| Poorest | ||||
| Poorer | 3.22 | (2.70–3.83)** | 2 | (1.6–2.50)** |
| Middle | 3.79 | (3.19–4.50)** | 1.83 | (1.46–2.30)** |
| Richer | 5.22 | (4.39–6.20)** | 2.21 | (1.72–2.85)** |
| Richest | 6.37 | (5.32–7.63)** | 1.9 | (1.44–2.51)** |
P-value < 0.05*; P-value < .001**. UOR: unadjusted odd; ratio; AOR: adjusted odd ratio; CI: confidence interval.
Discussion
This study examined the relationship between husbands’ sociodemographic factors, household socioeconomic characteristics, and modern contraceptive use in Cameroon, offering valuable insights into contraceptive utilization.
This study revealed a low prevalence of modern contraceptive use at 18.8%. This figure is comparable to findings in Ethiopia18 and a pooled analysis of sub-Saharan African nations16. However, the methodologies employed in these studies differed in several aspects, including the modeling techniques used and the adjustments made for covariates. In contrast, it is higher than the prevalence observed in Myanmar19 but lower than the overall prevalence in sub-Saharan Africa20. Despite this context, the prevalence remains relatively low, highlighting the need for further investigation into the influencing factors that can maximize the benefits of contraception.
Furthermore, this study identified that women living away from their spouses were less likely to use modern contraception, which aligns with findings from similar studies in sub-Saharan Africa21,22. Additionally, the education level of husbands plays a crucial role; higher education levels are associated with increased contraceptive use, a trend supported by studies across various countries17,21,22. Moreover, husbands’ desire for children significantly influences contraceptive use, emphasizing the importance of considering male perspectives in family planning initiatives. Interestingly, women whose husbands were employed were also more likely to utilize modern contraception, underscoring the significance of economic factors in contraceptive decision-making as presented in a study in Nigeria23.
In addition, household size emerged as a significant factor, with larger households being associated with higher contraceptive use. This finding contrasts with results from Nigeria, suggesting important contextual variations23. Furthermore, the desire for male children was inversely related to contraceptive use, consistent with studies conducted in South Asia and Nigeria24,25. Initially, polygamous households exhibited lower contraceptive use; however, this association diminished after adjusting for other variables. Moreover, the number of children was positively associated with contraceptive use, which aligns with the findings of other studies in Senegal17. Additionally, the age of the household head and economic status influenced contraceptive prevalence, with younger household heads and higher economic quintiles being linked to increased contraceptive use.
These findings underscore the multifaceted nature of contraceptive use, influenced by socioeconomic factors, household dynamics, and cultural norms. Further research is warranted to elucidate intrafamilial power dynamics and enhance family planning interventions.
Limitations
Although this cross-sectional study utilized secondary data from the DHS to investigate modern contraception utilization and household factors among Cameroonian women, several limitations should be acknowledged as follows.
Data recency: This study utilized the DHS dataset from 2018 to 2019, the most recently available for Cameroon, potentially limiting the representation of current trends.
Incomplete responses: Some respondents did not answer certain questions, leading to unknown data points that could affect the accuracy of the measured variables.
Potential bias: The study was susceptible to biases inherent to the data collection process, including recall bias, which could have inadvertently influenced the study outcomes.
These limitations underscore the need for caution when interpreting the study’s findings and highlight areas for improvement in future research.
Conclusion and recommendations
The findings of this study underscore the multifaceted nature of modern contraceptive use, emphasizing the significant influence of sociodemographic and socioeconomic factors, particularly husbands’ characteristics and family economic status. In light of these results, we recommend that governments and healthcare providers prioritize comprehensive family planning education, promote gender equity by involving men in family planning discussions, and implement community-based awareness programs. Tailoring family planning initiatives to align with cultural norms will further enhance the acceptance and adoption of modern contraceptives. Effective policies must consider both women’s attributes and husbands’ roles to create an environment conducive to informed family planning decisions, ultimately improving reproductive health outcomes.
Acknowledgements
This manuscript is part of the Master’s thesis of the Yonsei University KOICA Health Program. I express my deepest gratitude to my advisors and professors at Yonsei University for their invaluable guidance and support throughout this research. Special thanks go to the Korea International Cooperation Agency (KOICA) for providing this unique opportunity and their continuous encouragement. I am grateful to my family and friends for their support and patience during this period. Finally, I thank all the participants and colleagues who contributed to this study in various ways.
Abbreviations
- AOR
Adjusted odd ratio
- CI
Confidence Interval
- DHS
Demographic and health survey
- UOR
Unadjusted odd ratio
Author contributions
S.A., M.L., J.L., S.K., and S.K. contributed equally to the research.
Funding
Declaration.
The Authors received no financial support for this article’s research, authorship, and publication.
Data availability
The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.
Declarations
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Contributor Information
Samira Amadou, Email: amadsamishams@yahoo.com.
Sunjoo Kang, Email: ksj5139@yuhs.ac.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.