Community influences on modern contraceptive use among young women in low and middle-income countries: a cross-sectional multi-country analysis

BACKGROUND Despite investment in family planning programs and education, unmet need for family planning remains high among young women (aged 15-24) in low and middle-income countries, increasing the risk for unwanted pregnancies and adverse social and reproductive health outcomes. There is a dearth of cross-national research that identifies the differential impact of community level factors among youth in low and middle-income countries (LMICs), which is imperative for the design of structural level interventions aimed at increasing family planning use. METHODS Grounded in the socio-ecological framework, this paper utilizes Demographic and Health Survey (DHS) from 52 LMICs to examine the influence of community level reproductive, gender, fertility, literacy and economic indicators on modern contraceptive use among female youth. Analyses are conducted using multi-level logistic regressions with random community-level effects. RESULTS Our findings highlight the positive influence of community level education attainment and negative influence of gender and fertility related norms on young women's contraceptive use. Additionally, increased exposure to mass media did not positively influence young women's uptake of modern contraceptive methods. CONCLUSIONS Taken together, findings indicate that young women's contraceptive decision-making is greatly shaped by their social contexts. The commonalities and regional variations in community level influences provide support for both structural level interventions and tailored regional approaches to family planning interventions.