Mapping heterogeneity in family planning indicators in Burkina Faso, Kenya, and Nigeria, 2000–2020
Authors:   GBD Local and Small Area Estimation Family Planning Collaborators, Oh Doori , Cogen Rebecca M. , Mullany Erin C. , McLaughlin Susan , Abiodun Olumide , Adamu Lawan Hassan , Adepoju Abiola Victor , Adesina Miracle Ayomikun , Adeyinka Daniel Adedayo , Afolabi Aanuoluwapo Adeyimika , Ajumobi Olufemi , Amugsi Dickson A. , Angelino Olivia , Babalola Tesleem Kayode , Bocha Manaseh A. , Chukwu Isaac Sunday , Ekholuenetale Michael , Fagbamigbe Adeniyi Francis , Folayan Prof Morenike Oluwatoyin , Gadanya Prof Muktar A. , Gatotoh Augustine Mwangi , Haakenstad Annie , Hay Prof Simon I. , Ibitoye Segun Emmanuel , Ilesanmi Olayinka Stephen , Iregbu Kenneth Chukwuemeka , Joshua Charity Ehimwenma , Kayode Gbenga A. , Macharia Peter M. , Mohammed Shafiu , Mokaya Aggrey Gisiora , Murray Prof Christopher J. L. , Ngunjiri Josephine W. , Odhiambo Julius Nyerere , Odukoya Oluwakemi Ololade , Oghenetega Onome Bright , Ogunkoya Abiola , Okekunle Akinkunmi Paul , Okwute Patrick Godwin , Olagunju Andrew T. , Olakunde Babayemi Oluwaseun , Olufadewa Isaac Iyinoluwa , Olusanya Bolajoko Olubukunola , Olusanya Jacob Olusegun , Onwujekwe Prof Obinna E. , Owolabi Prof Mayowa O. , Sufiyan Mu’awiyyah Babale , Umar Shehu Salihu , Umeokonkwo Chukwuma David , Wado Yohannes Dibaba , Yusuf Hadiza , Dwyer-Lindgren Laura 
Published: February 2024

Abstract
Background
Family planning is fundamental to women’s reproductive health and is a basic human right. Global targets such as Sustainable Development Goal 3 (specifically, Target 3.7) have been established to promote universal access to sexual and reproductive healthcare services. Country-level estimates of contraceptive use and other family planning indicators are already available and are used for tracking progress towards these goals. However, there is likely heterogeneity in these indicators within countries, and more local estimates can provide crucial additional information about progress towards these goals in specific populations. In this analysis, we develop estimates of six family indicators at a local scale, and use these estimates to describe heterogeneity and spatial–temporal patterns in these indicators in Burkina Faso, Kenya, and Nigeria.

Methods
We used a Bayesian geostatistical modelling framework to analyse geo-located data on contraceptive use and family planning from 61 household surveys in Burkina Faso, Kenya, and Nigeria in order to generate subnational estimates of prevalence and associated uncertainty for six indicators from 2000 to 2020: contraceptive prevalence rate (CPR), modern contraceptive prevalence rate (mCPR), traditional contraceptive prevalence rate (tCPR), unmet need for modern methods of contraception, met need for family planning with modern methods, and intention to use contraception. For each country and indicator, we generated estimates at an approximately 5 × 5-km resolution and at the first and second administrative levels (regions and provinces in Burkina Faso; counties and sub-counties in Kenya; and states and local government areas in Nigeria).

Results
We found substantial variation among locations in Burkina Faso, Kenya, and Nigeria for each of the family planning indicators estimated. For example, estimated CPR in 2020 ranged from 13.2% (95% Uncertainty Interval, 8.0–20.0%) in Oudalan to 38.9% (30.1–48.6%) in Kadiogo among provinces in Burkina Faso; from 0.4% (0.0–1.9%) in Banissa to 76.3% (58.1–89.6%) in Makueni among sub-counties in Kenya; and from 0.9% (0.3–2.0%) in Yunusari to 31.8% (19.9–46.9%) in Somolu among local government areas in Nigeria. There were also considerable differences among locations in each country in the magnitude of change over time for any given indicator; however, in most cases, there was more consistency in the direction of that change: for example, CPR, mCPR, and met need for family planning with modern methods increased nationally in all three countries between 2000 and 2020, and similarly increased in all provinces of Burkina Faso, and in large majorities of sub-counties in Kenya and local government areas in Nigeria.

Conclusions
Despite substantial increases in contraceptive use, too many women still have an unmet need for modern methods of contraception. Moreover, country-level estimates of family planning indicators obscure important differences among locations within the same country. The modelling approach described here enables estimating family planning indicators at a subnational level and could be readily adapted to estimate subnational trends in family planning indicators in other countries. These estimates provide a tool for better understanding local needs and informing continued efforts to ensure universal access to sexual and reproductive healthcare services.