DEMOGRAPHIC

AND

HEALTH

SURVEYS

DHS WORKING PAPERS

2020 No. 165

Bienvenu Salim Camara

Sidikiba Sidibe

Nafissatou Dioubate

July 2020

This document was produced for review by the United States Agency for

International Development.

Non-use of Contraceptives among Married Women:

An Analysis of the 2018 Guinea

Demographic and Health Survey

DHS Working Paper No. 165 

Non-use of Contraceptives among Married Women: 

Analysis of the 2018 Guinea Demographic and 

Health Survey 

Bienvenu Salim Camara1

Sidikiba Sidibe1

Nafissatou Dioubate1 

ICF 

Rockville, Maryland, USA 

July 2020 

1

 CEA-PCMT–Department of Public Health, Gamal Abdel Nasser University of Conakry, Conakry, 

Guinea 

Corresponding author: Bienvenu Salim Camara, Yattayah, Commune of Ratoma, Conakry, Guinea; 

phone: +224 620830038; email: bienvenusalimcamara@gmail.com 
Acknowledgments: The authors wish to thank the United States Agency for International Development 

(USAID) for funding this research through the Demographic Health Survey (DHS) Fellows Program, which 

is implemented by ICF. We are also grateful to the DHS Fellows Program facilitators for improving our 

knowledge and skills in analyzing and scientifically reporting DHS data. We give thanks to the reviewers, 

editors, and formatters of this paper for improving its quality. Finally, we would like to say thank you to the 

Department of Public Health of the Gamal Abdel Nasser University of Conakry for supporting our 

application and local activities for this program. 

Editor: Diane Stoy 

Document Production: Joan Wardell 

This study was carried out with support provided by the United States Agency for International 

Development (USAID) through The DHS Program (#720-OAA-18C-00083). The views expressed are 

those of the authors and do not necessarily reflect the views of USAID or the United States Government. 

The DHS Program assists countries worldwide in the collection and use of data to monitor and evaluate 

population, health, and nutrition programs. For additional information about The DHS Program, contact: 

DHS Program, ICF, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; phone: +01 301-572-0950; 

fax: +01 301-572-0999; fax: +01 301-407-6501; email: reports@dhsprogram.com; internet: 

www.dhsprogram.com. 

Recommended citation: 

Camara, Bienvenu Salim, Sidikiba Sidibe, and Nafissatou Dioubate. 2020. Non-use of Contraceptives 

among Married Women: Analysis of the 2018 Guinea Demographic and Health Survey. DHS Working 

Paper No. 165. Rockville, Maryland, USA: ICF. 
iii 

CONTENTS 

TABLES .................................................................................................................................................. v

FIGURES .............................................................................................................................................. vii

ABSTRACT ........................................................................................................................................... ix

1 INTRODUCTION ........................................................................................................................ 1

1.1 Research Questions...................................................................................................... 2

1.2 Conceptual Framework ................................................................................................. 2

2 DATA AND METHODS ............................................................................................................. 3

2.1 Data ............................................................................................................................... 3

2.2 Variables ....................................................................................................................... 4

2.2.1 Outcome variable ............................................................................................. 4

2.2.2 Independent variables ...................................................................................... 4

2.3 Statistical Analysis ........................................................................................................ 4

3 RESULTS .................................................................................................................................. 5

Characteristics of the Study Sample .......................................................................................... 5 

Profile of Contraceptive Non-users ............................................................................................ 7 

Decision Making for Non-use, FP Need, and Intention for Future Contraceptive Use .............. 9 

Factors Associated with Non-use of Contraceptive Methods .................................................... 9

4 DISCUSSION ........................................................................................................................... 13 

5 CONCLUSIONS ....................................................................................................................... 15 

REFERENCES ...................................................................................................................................... 17 

v 

TABLES 

Table 1 Sociodemographic characteristics of married women age 15-49 who ever 

used a contraceptive method, GDHS 2018 ......................................................... 6 

Table 2 Profile of contraceptive ever users currently not using any method, GDHS 

2018 ..................................................................................................................... 8 

Table 3 Decision maker for non-use, FP need, and intention for future use among 

currently married women not currently using any method (n=436) ..................... 9 

Table 4 Bivariate analysis of factors associated with current non-use of contraceptive 

methods among women age 15-49 who have ever used contraceptive 

methods, GDHS 2018 ........................................................................................ 10 

Table 5 Logistic regression of factors associated with current non-use of contraceptive 

methods among women age 15-49 who have ever used contraceptive 

methods, GDHS 2018 ........................................................................................ 12 

vii 

FIGURES 

Figure 1 Conceptual framework of contraceptive non-use among ever users, GDHS 

2018 ..................................................................................................................... 2 

Figure 2 Flow chart for the study population selection and the definition of the outcome 

variable................................................................................................................. 3 

ix 

ABSTRACT 

In 2018, contraceptive prevalence in Guinea remained low at 11% (8% in the rural areas). This study aims 

to examine current contraceptive non-use among 1,076 married women in Guinea who have ever used any 

type of contraceptive method. The analyses included descriptive statistics, tests of association, a logistic 

regression, and a profile of women not currently using contraceptive methods among ever users. Of the 

sampled women, 454 (42%) were not using a contraceptive method. Three of five non-users made the 

decision about not using contraceptives. Reasons for non-use included infrequent sex (77%) and postamenorrhea/breastfeeding (10.6%). The unmet need for family planning was 48%. Half of the women 

(51%) reported that they intended to use a family planning method at a later time. Factors associated with 

contraceptive non-use included living in the administrative regions of Boké (AOR: 2.71; 95% CI: 1.4–5.26) 

and Mamou (AOR: 3.59; 95% CI: 1.39–9.29); being age 25-29 (AOR: 2.84; 95% CI: 1.24–6.49), 30-34 

(AOR: 3.09; 95% CI: 1.28–7.47), and 45-49 (AOR: 3.40; 95% CI: 1.18–9.77); having more than five living 

children (AOR: 0.44; 95% CI: 0.2–0.95); and the husband’s desire for more children (AOR: 1.73; 95% CI: 

1.1–2.71). Interventions that target ever users who are currently not using contraception could contribute to 

the resumption of contraceptive use among these women. Community family planning interventions such 

as male or couple sensitization or men’s involvement in reproductive health decisions can improve 

community perceptions about contraception and women’s rights for reproductive health. 

Key words: Contraceptive users, non-use, married women, Guinea, DHS 

1 

1 INTRODUCTION 

Unmet need for family planning (FP) is defined as the percentage of women who do not want to become 

pregnant but are not using contraception (The DHS Program 2012). In 2017, 24% of women of reproductive 

age in developing countries who wanted to avoid pregnancy did not use a modern contraceptive 

(Guttmacher 2017). The majority of women with an unmet need for FP live in sub-Saharan Africa (WHO 

2020). This challenge not only affects their reproductive rights (Starrs et al. 2018), but also increases their 

risk of disease and death. Use of modern contraceptive methods is a key contributor to reducing maternal 

and child deaths through the prevention of unintended pregnancy and induced, unsafe abortion. Methods 

such as condoms also help to prevent the transmission of HIV and other sexually transmitted infections 

(WHO 2020). The use of modern contraceptive methods has been prioritized by the Sustainable 

Development Goals (SDGs) that focus on universal access to sexual and reproductive health (Dockalova et 

al. 2016). 

Despite the repositioning efforts over recent years to increase modern contraceptive prevalence in Guinea, 

the contraceptive prevalence remains low in the country at 11%, and 8% in the rural areas (Institut National 

de la Statistique (INS) and ICF 2018). The repositioning efforts included strategies to improve the demand 

and provision of FP services. Strategies to increase demand have included information and sensitization 

campaigns on FP that used media and schools, and promotion of men’s involvement in raising women’s 

awareness of FP. Strategies that can improve the provision of services included integrating FP services into 

maternal health services (postpartum care, postabortion care, and vaccination services), training maternal 

health service providers, securing stocks of contraceptive methods in health facilities that include HIV 

management centers, and providing counseling services for adolescents (Ministère de la Santé Guinée 

2013). In 2012, 22% of women in Guinea faced unmet FP need (The DHS Program 2012), which 

demonstrates the need for addressing the unmet need of FP and improving contraceptive prevalence in 

Guinea. Women who are not using contraceptives while they want to avoid pregnancy are at risk of 

unwanted pregnancy (Faúndes 2012; WHO 2020). 

The 2018 Guinea DHS (GDHS) identified critical information about FP need that can guide actions to 

address unmet FP need in the country. Between 2012 and 2018 in Guinea, 66% of female contraceptive 

users discontinued contraception within the first 12 months of use. The major reason for discontinuation 

was the method’s side effects (27%) and was not related to the desire for a child (Institut National de la 

Statistique (INS) and ICF 2018). Contraceptive discontinuation has been called the “leaking bucket 

phenomenon” according to Jain (2014), who called for FP programs to prioritize this concern in developing 

countries. 

No previous study has focused on ever users who are not currently using FP in order to better understand 

the low utilization of contraceptive methods in Guinea. The present study therefore aims to examine current 

non-use of contraceptive methods among ever users in Guinea.

 
2 

1.1 Research Questions

The research questions are: 

1. What is the profile of women age 15-49 who used contraception in the past but are not currently 

using contraceptive methods? 

2. What are the factors associated with non-use of contraceptive methods (any and modern methods) 

among women age 15-49 who have ever used a contraceptive method? 

1.2 Conceptual Framework

Analysis of factors associated with non-use of contraceptive among ever users in Guinea was guided by the 

conceptual framework below (Figure 1). The framework suggests that non-use of contraceptive methods 

among ever users in Guinea is influenced by primary factors such as ever users’ sociodemographic 

characteristics and intermediate factors such as a woman’s exposure to contraception messages through the 

media, her partner’s desire for children, and perceived reasons for non-use. The sociodemographic 

characteristics of the woman and her husband include living in rural or urban area, religion, age, education, 

wealth index, and number of living children. These characteristics can directly influence reasons for nonuse (intermediate factors) such as the husband’s opposition, as well as affordability or availability of 

methods. Sociodemographic characteristics can also influence other reasons for non-use through two other 

intermediate factors such as the woman’s exposure to contraceptive messages (which influences 

knowledge) and the partner’s desire for more children. A woman’s exposure to contraceptive messages can 

affect her ability to manage a method’s side effects, while a partner’s desire for more children can lead to 

his opposition to the woman’s use of a contraceptive method. 

Figure 1 Conceptual framework of contraceptive non-use among ever users, GDHS 2018 

 
3 

2 DATA AND METHODS 

2.1 Data 

We used the Guinea 2018 Demographic and Health Survey (GDHS) data, which were collected between 

March and June 2018. The GDHS is a cross-sectional, nationally representative household survey that used 

a multistage cluster strategy sampling (Institut National de la Statistique (INS) and ICF 2018). The GDHS 

includes questions on household and individual characteristics, and maternal and child health, as well as 

antenatal, delivery, and postpartum care. This study included 1,086 married women age 15-49 who were 

ever users of a contraceptive method. The study excluded pregnant women and those who intend to become 

pregnant. The flow chart for selection of the study population is shown in Figure 2. The data included 

sociodemographic characteristics and information on the contraceptive use such as exposure to FP 

messages, decision making for no contraceptive use, contraceptive need, and intention for future 

contraceptive use. 

Figure 2 Flow chart for the study population selection and the definition of the outcome variable
4 

2.2 Variables 

2.2.1 Outcome variable 

The outcome variable is non-use of contraceptive methods, among currently married women age 15-49, 

who have been exposed to pregnancy, have ever used a contraceptive method, and are not intending to 

become pregnant (Figure 2). 

2.2.2 Independent variables 

We identified the following explanatory variables of contraceptive non-use, based on their theoretical and 

empirical relevance: sociodemographic characteristics, residence (rural or urban), administrative region, 

ethnic group, religion, age, education, household wealth index group, husband/partner’s education level, 

woman’s exposure to FP messages through the media (if the woman heard about FP on the radio or 

television, if the woman read about FP in newspaper/magazine, or by test message on mobile phone), and 

the husband’s desire for more children. 

Additional descriptive variables were analyzed in the substudy population of ever users currently not using 

any contraceptive method: reasons for current non-use including who makes the decision for non-use and 

the intention for future contraceptive use. 

2.3 Statistical Analysis 

The study data were extracted from the 2018 GDHS dataset, cleaned, and analyzed with Stata 16 

(StataCorp, College Station, TX, US). The analysis adjusted for the multistage sample design of the survey. 

Descriptive data were presented as proportions with 95% confidence intervals or means ±standard 

deviation. To identify the factors associated with non-use of contraceptives, the Pearson chi square test was 

used to compare contraceptive non-use across study variables in the bivariate analysis. Based on the 

conceptual framework, all variables that we considered as theoretically or empirically influential on 

contraceptive use were included in the logistic regression model. Unadjusted and adjusted odds ratios were 

derived, and differences were considered statistically significant at p≤0.05. 
5 

3 RESULTS 

Characteristics of the Study Sample 

Table 1 shows the background characteristics of the study population. A total of 1,086 married women who 

ever used contraceptives were included in our analysis. This included 436 women (40%) who were not 

currently using any contraceptive method. Of the total sample, more than half (56%) lived in rural areas, 

with most women residing in Nzérekoré and Kankan (both at 22%). The majority of ever users were 

reported to be Muslims (80%). 

Most (62%) of the sampled women were age 25-39. Adolescents (age 15-19) and young women (age 20-

24) represented 7.7% and 14.9%, respectively, among ever users. The majority of women (68.7%) and their 

husbands (64%) had no formal education. The married ever users had a high number of living children, 

with 27.7% of the women having five or more children and 34% having three or four children. While 40% 

of ever users did not know whether their husbands desired more children, 37% reported that their husbands 

desired more children. Less than half of women among ever users (54.5%) reported being exposed to FP 

messages through television, radio, newspapers, or mobile phone test messages within the few months 

before the survey. 
6 

Table 1 Sociodemographic characteristics of married women age 15-49 who ever used a 

contraceptive method, GDHS 2018 

Characteristics 

Contraceptive ever users 

n=1086 % 

95% CI 

Lower Upper 

Residence area Urban 473 43.6 36.5 51.0 

Rural 613 56.4 49.0 63.6 

Administrative region 

Boké 68 6.3 4.7 8.2 

Conakry 212 19.6 15.5 24.3 

Faranah 104 9.5 7.6 11.7 

Kankan 237 21.9 16.5 28.4 

Kindia 137 12.7 10.2 15.6 

Labé 51 4.6 3.6 6.0 

Mamou 40 3.7 2.8 4.8 

Nzérékoré 237 21.9 17.5 26.9 

Ethnic group Soussou 256 23.6 19.0 28.9 

Peulh 216 19.9 16.7 23.5 

Malinke 377 34.8 28.8 41.2 

Forestier 237 21.8 16.9 27.7 

Religion 

Muslim 867 79.8 73.9 84.7 

Christian and other 219 20.2 15.3 26.2 

Age group 15-19 84 7.7 5.7 10.3 

20-24 161 14.9 12.5 17.6 

25-29 235 21.7 19.1 24.5 

30-34 234 21.6 19.0 24.4 

35-39 203 18.7 16.2 21.6 

40-44 97 8.9 7.2 10.9 

45-49 71 6.5 5.0 8.4 

Education level 

No education 746 68.7 64.2 72.8 

Primary 113 10.4 8.3 13.0 

Secondary 181 16.6 13.9 19.7 

Higher 46 4.3 3.1 5.9 

Wealth index group Poorest 127 11.7 9.1 14.8 

Poorer 213 19.7 15.9 24.1 

Middle 191 17.6 14.5 21.2 

Richer 263 24.2 20.3 28.6 

Richest 292 26.9 22.6 31.6 

Number of living children 

0 86 8.0 5.8 10.9 

1 to 2 328 30.2 27.3 33.3 

3 to 4 371 34.1 31.1 37.3 

5 or more 301 27.7 24.7 30.9 

Expose to message Not exposed 598 55.1 49.6 60.4 

Exposed 488 44.9 39.6 50.4 

Husband/partner education level 

No education 674 63.7 59.6 67.6 

Primary 64 6.1 4.6 8.1 

Secondary 176 16.6 13.8 19.8 

Higher 144 13.7 11.0 16.8 

Husband desire for more children Both want same 225 20.9 17.6 24.6 

Husband wants 398 37.0 32.8 41.3 

Husband wants fewer 22 2.1 1.3 3.1 

Don’t know 433 40.1 36.5 43.9 
7 

Profile of Contraceptive Non-users 

Overall, 436 (40%) of ever users were not currently using any FP method. Of this group, 60% lived in rural 

areas (Table 2). These women were predominantly from the Malinke ethnic group (40%), Muslim (86%), 

and with no formal education (73%). The age groups 25-29 and 30-34 were the most represented with 24% 

each. The majority of women had three or more living children (65%). The husbands or partners of most 

women (67%) had no formal education. Almost half (45%) of the women reported being exposed to FP 

messages through media, and a similar proportion (45%) said that their husband wanted more children. 
8 

Table 2 Profile of contraceptive ever users currently not using any method, GDHS 2018 

Characteristics 

Ever users currently not using any 

contraceptive 

n=436 % 

95% CI 

Lower Upper 

Residence area Urban 174 40.0 32.8 47.6 

Rural 262 60.0 52.4 67.2 

Administrative region 

Boké 37 8.6 6.5 11.4 

Conakry 73 16.9 13.1 21.4 

Faranah 57 13.1 10.7 16.1 

Kankan 102 23.3 18.8 28.5 

Kindia 40 9.2 7.3 11.4 

Labé 27 6.2 4.7 8.1 

Mamou 26 5.9 4.6 7.5 

Nzérékoré 74 17.0 13.8 20.7 

Ethnic group Soussou 88 20.3 16.3 25.0 

Peulh 104 23.8 20.0 28.1 

Malinke 175 40.2 34.4 46.2 

Forestier 69 15.7 11.6 21.0 

Religion 

Muslim 377 86.4 81.1 90.4 

Christian and other 59 13.6 9.7 18.9 

Age group 15-19 18 4.1 2.2 7.6 

20-24 59 13.5 10.5 17.1 

25-29 106 24.2 20.4 28.5 

30-34 103 23.8 19.8 28.4 

35-39 80 18.3 14.9 22.3 

40-44 37 8.5 6.3 11.5 

45-49 33 7.6 5.1 11.0 

Education level 

No education 317 72.6 67.3 77.3 

Primary 41 9.3 6.7 12.8 

Secondary 59 13.6 10.2 18.0 

Higher 19 4.5 2.9 6.8 

Wealth index group Poorest 64 14.6 11.2 18.9 

Poorer 89 20.5 15.9 26.0 

Middle 81 18.7 14.5 23.8 

Richer 91 20.8 16.6 25.6 

Richest 111 25.4 20.3 31.4 

Number of living children 

0 31 7.1 4.6 10.8 

1 to 2 122 28.0 23.9 32.5 

3 to 4 163 37.4 32.6 42.4 

5 or more 120 27.5 23.1 32.4 

Expose to message Not exposed 242 55.5 49.3 61.5 

Exposed 194 44.5 38.5 50.7 

Husband/partner education level 

No education 282 67.0 61.2 72.2 

Primary 26 6.1 3.6 10.2 

Secondary 58 13.9 10.6 18.0 

Higher 55 13.0 9.2 17.9 

Husband desire for more children Both want same 69 15.8 12.3 20.0 

Husband wants 198 45.4 39.4 51.5 

Husband wants fewer 8 1.8 0.9 3.4 

Don’t know 161 37.1 31.7 42.7 
9 

Decision Making for Non-use, FP Need, and Intention for Future 

Contraceptive Use 

An estimated 60% of the non-users made the decision for not using contraceptives (Table 3); 21% said that 

the decision was primarily their husband/partner’s decision, while 17% reported that the decision to not use 

a contraceptive was made jointly with their husband/partner. 

The most common reason reported for not using a contraceptive method was infrequent sex (77%), followed 

by postpartum amenorrhea or breastfeeding (11%). Only 10 women (2%) reported side effects or 

inconvenience as the reason for non-use. 

Unmet need for FP among married women ever users who are not currently using any contraceptive was 

estimated at 48%. With intention for future contraceptive use, approximately half (51%) of non-users 

reported that they intend to use a contraceptive method in the future, while 39% did not intend to do so. 

Table 3 Decision maker for non-use, FP need, and intention for future use among currently 

married women not currently using any method (n=436) 

Number 

% 

95% CI 

Characteristics n=436 Lower Upper 

Decision making for not using Mainly woman 262 60.0 54.5 65.4 

Mainly husband, partner 91 21.0 16.8 25.8 

Joint decision 75 17.1 13.5 21.5 

Other 8 1.9 0.9 3.9 

Reason 

No/infrequent sex 336 77.1 72.5 81.2 

Postamenorrhea/breastfeeding 46 10.6 7.9 14.2 

Fatalistic/religion 14 3.3 1.8 5.9 

Opposition respondent/partner 24 5.5 3.7 8.1 

Knows no source 1 0.2 0.0 1.7 

Side effect/inconvenient/body 10 2.3 1.1 4.7 

Access/cost 5 1.0 0.4 2.7 

Need for contraception No unmet need 225 51.7 46.4 56.9 

Unmet need 211 48.3 43.1 53.4 

Intention to use 

Use later 221 50.7 44.9 56.4 

Unsure about use 47 10.8 8.0 14.5 

Does not intend to use 168 38.5 33.4 43.9 

Factors Associated with Non-use of Contraceptive Methods

The bivariate analysis showed that factors associated with the non-use of contraceptive methods among 

married women (age 15-49) who have ever used any contraceptive method included the administrative 

region, ethnic group, religious affiliation, age, and husband’s desire for more children (Table 4). Variables 

such as education levels, wealth index, number of living children, or exposure to FP messages were not 

associated with FP non-use. 
10 

Table 4 Bivariate analysis of factors associated with current non-use of contraceptive methods 

among women age 15-49 who have ever used contraceptive methods, GDHS 2018 

Ever users not currently using any 

contraceptive method 

 % 95% CI 

Characteristics n=1,086 Lower Upper p-value 

Type of residence area 0.140 

Urban 36.8 31.1 43.0 

Rural 42.7 37.9 47.7 

Administrative region <0.001*** 

Boké 55.2 45.4 64.7 

Conakry 34.6 25.4 45.2 

Faranah 55.4 45.0 65.3 

Kankan 42.8 37.3 48.5 

Kindia 29.1 19.5 40.9 

Labé 53.3 35.6 70.3 

Mamou 64.1 45.0 79.5 

Nzérékoré 31.2 24.0 39.3 

Ethnic group <0.001*** 

Soussou 34.6 27.3 42.7 

Peulh 48.0 40.2 56.0 

Malinke 46.4 41.2 51.8 

Forestier 29.0 22.4 36.7 

Religion <0.001*** 

Muslim 43.5 39.4 47.6 

Christian and other 27.1 20.4 35.1 

Age group at time of survey 15-19 21.6 12.1 35.5 0.028* 

20-24 36.4 29.0 44.5 

25-29 44.9 37.9 52.2 

30-34 44.3 37.4 51.4 

35-39 39.2 32.3 46.6 

40-44 38.3 28.4 49.3 

45-49 46.5 33.2 60.3 

Education level 0.146 

No education 42.5 37.9 47.1 

Primary 35.9 27.0 46.9 

Secondary 32.9 25.7 41.1 

Higher 41.8 27.7 57.3 

Education husband level 0.433 

No education 41.8 37.0 46.8 

Primary 40.0 26.0 55.9 

Secondary 33.3 25.7 42.0 

Higher 37.9 28.2 48.7 

Wealth index 0.099 

Poorest 50.5 41.4 59.5 

Poorer 41.9 34.6 49.6 

Middle 42.7 34.3 51.6 

Richer 34.4 28.1 41.2 

Richest 37.9 30.9 45.6 

Number of living children 0.348 

0 35.9 24.7 49.0 

1 to 2 37.2 31.6 43.2 

3 to 4 44.0 38.3 49.8 

5 or more 39.9 33.8 46.3 

Husband’s desire <0.001*** 

Both want same 30.5 23.2 38.9 

Husband wants more 49.7 43.9 55.6 

Husband wants fewer 34.7 18.4 55.7 

Don’t know 37.4 32.1 43.0 

Expose to message 0.869 

Not exposed 39.8 34.4 45.5 

Exposed 40.5 35.4 45.7 

*p<0.05; **p<0.01; ***p<0.001 
11 

In the multivariate logistic regression (Table 5), we found that living in the administrative regions of Boké 

and Mamou; being age 25-29, 30-34, or 45-49; having five or more living children; and the husband’s desire 

for more children were associated with non-use of any contraceptive method among ever users. 

Women who lived in Boké and Mamou had 2.7 and 3.6 times the odds, respectively, of not using 

contraceptive methods compared to those living in Conakry. 

Compared with adolescents (age 15-19), women age 25-29, 30-34, and 45-49 had 2.8 times, 3.1 times, and 

3.4 times the odds, respectively, of not using any contraceptive method. Women whose husbands desired 

more children had 1.7 times the odds of not using a contraceptive method compared to women who had the 

same desire as their husband. Women with five or more children had 56% lower odds of not using a 

contraceptive method compared to those with no living children. 
12 

Table 5 Logistic regression of factors associated with current non-use of contraceptive 

methods among women age 15-49 who have ever used contraceptive methods, GDHS 

2018 

Ever users not currently using any 

contraceptive method 

 

AOR 

95% CI 

Characteristics Lower Upper p-value 

Type of residence area Urban 1 Ref Rural 0.78 0.42 1.43 0.422 

Administrative region 

Conakry 1 Ref 

Boke 2.71 1.40 5.26 0.003* 

Faranah 1.99 0.97 4.09 0.060 

Kankan 1.14 0.59 2.21 0.693 

Kindia 0.89 0.45 1.76 0.737 

Labé 2.61 0.99 7.14 0.053 

Mamou 3.59 1.38 9.29 0.009* 

Nzérékoré 1.09 0.51 2.31 0.828 

Ethnic group Soussou 1 Ref Peulh 1.04 0.60 1.81 0.876 

Malinke 1.61 0.96 2.70 0.068 

Forestier 1.58 0.54 4.65 0.406 

Religion 

Muslim 1 

Christian and Other 0.41 0.13 1.25 0.116 

Age group at time of survey 15-19 1 Ref 20-24 1.77 0.73 4.23 0.205 

25-29 2.84 1.24 6.49 0.013* 

30-34 3.09 1.28 7.47 0.012* 

35-39 2.45 0.94 6.43 0.067 

40-44 2.39 0.89 6.48 0.085 

45-49 3.40 1.18 9.77 0.023* 

Education level 

No education 0.94 0.45 1.97 0.860 

Primary 0.82 0.37 1.84 0.635 

Secondary 0.70 0.33 1.47 0.345 

Higher 1 

Education husband level No education 1 Ref Primary 1.09 0.51 2.34 0.812 

Secondary 0.91 0.55 1.51 0.714 

Higher 1.22 0.70 2.15 0.478 

Wealth index 

Poorest 1.56 0.69 3.52 0.286 

Poorer 1.51 0.69 3.29 0.302 

Middle 1.31 0.68 2.52 0.423 

Richer 0.80 0.50 1.29 0.356 

Richest 1 Ref 

Living children 0 1 Ref 1-2 0.60 0.31 1.16 0.127 

3-4 0.57 0.28 1.17 0.125 

5+ 0.44 0.20 0.95 0.037* 

Husband’s desire 

Both want same 1 Ref 

Husband wants more 1.73 1.10 2.71 0.017* 

Husband wants fewer 0.96 0.37 2.48 0.937 

Don’t know 1.10 0.71 1.71 0.660 

Exposure to message Not exposed 1 Ref Exposed 1.16 0.81 1.65 0.418 

*p<0.05; **p<0.01; ***p<0.001 

 
13 

4 DISCUSSION 

This study is the first to examine non-use of contraceptives among ever-users in Guinea. The results show 

that 40% of women who ever used contraception are currently not using any contraceptive method. The 

majority of these women made the decision themselves not to use contraception. The primary reason 

reported for not using contraception was infrequent sex. However, nearly half of the sample of non-users 

reported having an unmet need for FP, and half said that they intend to use a contraceptive method in the 

future. Factors associated with non-use of contraceptive methods among Guinean married women ever 

users of a contraceptive method included living in the administrative regions of Boké and Mamou; being 

age 24-29, 30-34, or 45-49; having more than five living children; and the husband’s desire for more 

children. These findings have important health policy and practice implications in Guinea for contraceptive 

coverage of women who are in need of FP. 

First, a high proportion of married women ever users of contraceptives are not currently using any 

contraceptive method. This suggests that contraceptive coverage has not increased in Guinea, despite efforts 

from the health system such as sensitization campaigns on FP that use media and schools, integration of FP 

services into maternal health services (postpartum and postabortion care, vaccination services), training of 

maternal health services providers, and securing stocks of different contraceptive methods in health 

facilities. There may be an increase in the number of new contraceptive users in response to the efforts of 

the health system (Ministère de la Santé Guinée 2013). However, overall contraceptive use will not increase 

if ever users of contraceptives stop using contraceptives. This phenomenon in FP has been called the 

“leaking bucket phenomenon” by Jain, who reported that actions that target contraceptive ever users who 

are not currently using any contraceptive method would contribute to increased contraceptive prevalence 

(Jain 2014). 

We found in our study that 48% of such women have FP unmet need, while 51% have the intention to use 

contraceptive in the future. In 2018, Camara et al. reported that 36% to 48% of women had unmet FP need 

in the rural district of Forécariah in Guinea (Camara et al. 2018). The same study reported that 54% of 

postpartum women intended to use a contraceptive nine months after giving birth. The findings from this 

study suggest that addressing unmet FP need is crucial to increasing the use of contraceptive methods 

among specific groups of women exposed to the risk of pregnancy. While a recent study in 78 countries 

showed that gender equality and education increase access to modern contraceptive methods (Slaymaker et 

al. 2020), it is important to note that adapted and targeted strategies according to specific categories of 

women could yield a more sustainable increase in the demand for contraceptives. 

Second, we had hypothesized that the husband’s desire for more children and a woman’s exposure to FP 

messages through the media were predictors of contraceptive non-use among ever users in Guinea. We 

expected ever users whose husbands desire more children to be more likely not to use contraceptives, and 

that women exposed to FP messages through media were less likely not to use contraceptive methods. We 

found that a husband’s desire for more children was positively associated with current non-use of 

contraceptive among ever users. However, exposure to FP messages through the media had no statistical 

influence on current non-use of contraceptives among ever users. A husband’s influence on women’s 

contraceptive use has been documented. Many studies have reported the desire for more children or the 

husband’s opposition as reasons for unmet FP need in Africa (Adebowale and Palamuleni 2014; Camara et 
14 

al. 2018). In Africa, men are culturally viewed as the head of the family and control the decision for healthseeking behaviors that include choices about reproductive health (Barry 2017). Community-level FP 

interventions, such as male or couple sensitization or men’s involvement in reproductive health, can 

improve perceptions in the community about contraception and women’s rights for reproductive health. In 

addition, further research on why exposure to FP messages through the media appears to have no influence 

on current non-use of contraceptives among ever users is needed. It is possible that the way that messages 

are conveyed to sensitize women do not give women the opportunity to express their concerns or ask 

questions for better information on FP (Ministère de la Santé Guinée 2013). 

We found that contraceptive ever users currently not using any method reported the reasons of non-use as 

infrequent sex, postpartum amenorrhea, breastfeeding, and partner's opposition. This was similar to findings 

from DHS surveys in 52 countries between 2005 and 2014 that reported that the most common reasons 

cited by married women for not using contraception included contraceptive side effects/health risks, having 

sex infrequently or not at all (24%), and breastfeeding and/or haven’t resumed menstruation after a birth 

(20%) (Institut National de la Statistique (INS) and ICF 2018). Qualitative studies that further explore 

women’s reasons for non-use of contraceptives would be helpful and could guide interventions and 

priorities to improve demand for and the supply of contraceptives. 

In our findings, compared to adolescent married ever users age 15-19, married women age 25-29, 30-34 

and 45-49 who were ever users had greater odds of not currently using a modern FP method. This finding 

corroborates the data from the Population Reference Bureau that found reasons for not using a FP method 

among married women varied according to age. Thus, fear of side effects and, to a lesser extent, opposition 

to use are generally greater concerns among women age 25 and over, while postpartum breastfeeding is 

often cited by women under age 25 as a reason for not using FP method (Population Reference Bureau 

2019). Another reason for non-use of contraceptive methods in younger women is that more young couples 

want to have children as compared to older couples. 

Our study has some limitations. First, the cross-sectional design does not allow for assessment of causal 

relationships between non-use of contraceptive and other factors. We analyzed the GDHS data, which is 

purely quantitative. It was not possible to conduct qualitative analysis to better understand the factors that 

influence non-use of contraceptives among ever users. However, this study has the potential for guiding 

policies and practices on contraceptive use since it is the first of its kind in Guinea, is representative of the 

whole country, and has statistical power from the large sample size. 
15 

5 CONCLUSIONS 

This research showed that two women of every five ever users of contraceptives in Guinea are currently 

not using any contraceptive method. The majority of these women made a personal decision to not use a 

contraceptive method. The primary reason reported for not using contraceptives was infrequent sex. 

However, nearly 48% of the women reported an unmet need for family planning, and half said they intend 

to use a contraceptive method in the future. Factors associated with non-use of contraceptive methods 

among Guinean married women who were ever users of a contraceptive method included living in the 

administrative regions of Boké and Mamou, being age 20-24, 30-34, 35-39 or 45-49, having more than five 

living children, and the husband’s desire for more children. 

This study recommends interventions that focus on contraceptive ever users who are currently not using 

any contraceptive method and could aid in the resumption of contraceptive use among these women. 

Community-level FP interventions such as male or couple sensitization or men’s involvement in 

reproductive health could improve community perceptions about contraception and women’s rights for 

reproductive health. Further qualitative research is needed to better explore reasons for non-use of 

contraceptives among married women who were ever users of contraceptives in Guinea. 

 

17 

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