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Original research
Determinants of modern contraceptive use among married women of reproductive age: a cross-sectional study in rural Zambia
  1. Joseph Lasong1,
  2. Yuan Zhang1,
  3. Simon Afewerki Gebremedhin2,
  4. Sampson Opoku3,
  5. Chrissie Stansie Abaidoo4,
  6. Tamara Mkandawire2,
  7. Kai Zhao1,
  8. Huiping Zhang1
  1. 1Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
  2. 2Public Health School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
  3. 3Department of Social Health Management, School of Public Health, Huazhong University of Science and Technology, Tongji Medical College, Wuhan, Hubei, China
  4. 4Department of Anatomy, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
  1. Correspondence to Professor Huiping Zhang; zhpmed{at}


Objective Zambia is among the world’s top 10 countries with higher fertility rate (5.5 births/woman); unmet family planning need for births spacing (14%) and limiting births (7%). Women in rural Zambia (24%) are reported to have unmet need for family planning than those in urban areas (17%). This study was conducted to ascertain factors associated with modern contraceptive use among rural Zambian women.

Design Cross-sectional study.

Setting Rural Zambia.

Participants Secondary data of 4903 married or cohabiting rural women (15–49 years) after filtering out the pregnant, urban based and unmarried women from 2013 to 2014 Zambian Demographic and Health Survey (ZDHS) were analysed using SPSS V.22. Multiple logistic regression, Pearson’s χ2 and descriptive statistics were performed to examine factors associated with modern contraceptive use.

Results Factors that were positively associated with contraceptive use were respondent’s education (secondary adjusted ORs (AOR = 1.61, p≤0.002); higher (AOR = 2.39, p≤0.050)), wealth index (middle class, (AOR = 1.35, p≤0.005); rich (AOR = 2.04, p≤0.001) and richest (AOR = 1.95, p≤0.034)), high parity (1–2 (AOR = 5.31, p≤0.001); 3–4 (AOR = 7.06, p≤0.001); 5+ (AOR = 8.02, p≤0.001)), men older than women by <10 years (AOR = 1.50, p≤0.026) and women sensitised about family planning at health facility (AOR = 1.73, p≤0.001). However, old age (40–49 years (AOR = 0.49, p≤0.001)), other religions (Protestants, African traditionalists and Muslims) (AOR = 0.77, p≤0.007), ever had pregnancy miscarried, aborted or stillbirth (AOR = 0.78, p≤0.026) and women without knowledge of number of children husband desires (AOR = 0.71, p≤0.001) were negatively associated with contraceptive use.

Conclusion Modern contraceptive use in rural Zambia among currently married women of reproductive age group is relatively low (43%). We recommend that appropriate interventions are instituted to increase contraceptive access and use especially among uneducated older rural Zambian women.

  • Africa
  • women of reproductive age
  • rural
  • Zambia
  • modern contraceptive use

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  • Contributors Conceptualisation and drafting of the research was done by JL, ZH and ZK. ZY, SO, TM, CSA and SAG accomplished the statistical analysis, assisted in the interpretation of the results and drafted the manuscript. All authors contributed to the discussion of the paper, read and approved the final version.

  • Funding This work was supported by the National Natural Science Foundation of China (grant no. 8157060984, no. 81701539) and National Key Research and Development Plan (grant no. 2018YFC1004304).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study used secondary data of freely available data online. The authors accessed the 2013–2014 ZDHS data by receiving permission through DHS measure online ( The ZDHS received the ethical approval from Tropical Disease and Research Centre (TDRC) in Ndola, Zambia and the US Centre for Disease Control and Prevention (CDC) Atlanta’s Research ethics review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. Data are available in a public, open access repository. Zambian Demographic Health Survey (ZDHS, 2013/2014), accessible online