The Role of Gender Inequality and Health Expenditure on the Coverage of Demand for Family Planning Satisfied by Modern Contraceptives : An Analysis of 14 LAC Countries

Background: Despite international efforts to improve reproductive health indicators, little attention is paid to the contributions of contextual factors to modern contraceptive coverage, especially in the Latin America and the Caribbean (LAC) region. This study aimed to identify the association between Gender Inequality and Health Expenditure with demand for family planning satisfied by modern contraceptive methods (DFPSm) in sexually active women from LAC countries.Methods: Our analyses included data from the most recent (post-2010) Demographic and Health Survey or Multiple Indicator Cluster Survey from 14 LAC countries. Descriptive analyses and multilevel logistic regressions were performed. Six individual-level factors were included. The effect of the contextual factors Gender Inequality Index (GII) and Current Health Expenditure on DFPSm was investigated.Findings: DFPSm ranged from 41·8% (95% CI: 40·2 - 43·5) in Haiti to 85·6% (95% CI: 84·9 - 86·3) in Colombia, with an overall median coverage of 77·8%. A direct association between the odds of DFPSm and woman’s education, wealth index, and the number of children was identified. Women from the third GII tertile were less likely (OR: 0·32, 95% CI: 0·13 - 0·76) to have DFPSm than those living in countries from the first tertile.Interpretation: Knowing the contribution of country-level factors to modern contraception may allow macro-level actions focused on the population's reproductive needs. In this sense, gender inequalities play an important role, as well as individual factors such as wealth and education.Funding Information: This work was supported by the Bill and Melinda Gates Foundation [OPP1199234] and [INV-010051]. The Associação Brasileira de Saúde Coletiva (ABRASCO) also acts as sponsor of the study.Declaration of Interests: The authors do not report any conflicting interests