Family planning practice in East Africa: A fact sheet
East Africa has 422,036,243 population, people below age 18 making up nearly half (50.2%) of it. This mainly because of the high fertility rate in the region and low contraceptive practice that could arise from the low status in family planning (FP) service delivery. The region has the highest maternal mortality.
This high young population has implication on health and development agenda as it puts an increasing burden on the working age population. One of the main areas of concern in East Africa is access to family planning and meeting the extent need. About 40% of women in East Africa practice contraceptives. This fact sheet presents the descriptive statistics on family planning practice among women in the five selected countries in East Africa. These are countries for which family planning related data is available from surveys conducted since 1989. The Demographic and Health Surveys (DHS) (1989-2014) cover and allow us to get data for women who are currently married or in a union.
Policy and legal context
Compare to the other regions of Africa, East African countries has a favorable policy and legal frameworks that promote couples to exercise for their sexual and reproductive health rights. These frameworks include: Ethiopia National Guide Line for family planning services, Kenya National Reproductive Health Strategy (2009-2015), Rwanda National Family Planning Policy and Its Five-Year Strategies (2006-2010), Tanzania National Family Planning Costed Implementation Program 2010-2015, and Uganda Family Planning Costed Implementation Plan, 2015–2020.
Family planning averts maternal deaths
Nearly on average, 40% maternal deaths averted in these countries as a result of family planning. The impact of family planning is highly observed in Kenya (51.5%) and Tanzania (43.3%) of the maternal deaths averted in 2012.
Contraceptive practice in the region, 1990-2014
In sub-Saharan Africa, the proportion of women aged 15-49 who use a modern contraceptive method has risen by only 10% between 1990 and 2014. The In Eastern Africa, the contraceptive prevalence rate is higher than the regional average, though over half of the women of reproductive age who are married or in a union are not using any contraception. In East Africa, 39.5% of women who are married or in-union aged 15 to 49 uses the modern contraceptive. But this average masks the wide variations in the sub-regions and the countries. The contraceptive practice among women increases in those countries with a different leap. Higher women in Kenya and Rwanda practice contraceptives than Ethiopia, Tanzania, and Uganda.
Source: ICF International, Demographic and Health Surveys.
In Ethiopia, for example, contraception is the lowest, with only 29% of women aged 15-49 using some form of contraception. Kenya, where 58% of women of childbearing age use contraception, is far better than those countries.
Fertility preferences, an important indicator for contraceptive practice
High numbers of women in the sub-region are currently expressing preferences for smaller numbers of children and for stopping childbearing altogether. Women who do not want any more children has increased only in Uganda from 41% to 43% between 2006 and 2011. The desire for more children is currently the lowest in Rwanda (49%) compared with the other countries. According to recent DHS data, the greatest demand for FP to limit childbearing is in Kenya and Uganda. Additionally, Ethiopia currently has the highest proportion of women who are undecided about their fertility preferences (Figure 3).
Family planning methods
Traditional birth control method contributes much less than 5% of family planning practices in the five countries. An overall increase in the use of modern contraceptives across the sub-region, there is a relatively stable proportion of women using traditional methods in Ethiopia, Rwanda, and Tanzania.
Long-term and short-term modern contraceptive practices
The use of short-term modern contraceptive methods is higher compared to long-term methods among women in all the five countries. We can assume that this is a reflection of the strong desire for spacing not limiting among women. The difference in contraceptive practice prevalence between countries shows also the status of family planning services in the countries. For example, merely 4.2% of married or in union women use long-acting contraceptives in Ethiopia, whereas it is 16.5% in Kenya practice it.
The contraceptive injectable: the most common method in the region
Availability of contraceptive methods in many African countries, banks heavily on short-term methods – the injectables, pill, and the male condom. Injectables are the most dominant method of contraception more than 30% of current users of the five selected countries. The least popular method contraceptive method is male sterilization due to minimal male participation in sexual and reproductive health issues, including family planning.
With little daily thought and its most effectiveness, long-acting contraceptives enable women to avoid unintended pregnancies. However, in those five countries use of long-acting contraceptives is as low as IUD (0.4%) and implants (1.9%) in Uganda.
Contraceptive use by mother’s education
Education gives women an opportunity to empower, get information and the ability to make choices about their sexual and reproductive health. The relationship between contraceptive use and schooling highlights the importance of education in women’s empowerment, knowledge of contraceptive methods, and autonomy in using family planning. In nearly all countries, contraceptive use is highest among mothers with secondary and higher education. In a few countries, such as Rwanda, mothers with primary level education are almost equal with secondary or higher education to experience contraception. Uneducated Rwandese women report more contraceptive practice compared to other country counterparts. The difference in contraceptive use is higher among women without education and with secondary education or higher in Kenya.
Contraceptive use by wealth status
The disparity in contraceptive practice fueled by the inequality in wealth quantile in those countries, suggesting that wealthier women, compared to their poorer counterparts, may find it easier to overcome barriers to getting access to family planning services. The largest gap in contraceptive use between the poorest and richest women is in Ethiopia, while the narrow gap is in Rwanda.