1. Need and Use of FP A secondary analysis of the 2008 Nigeria DHS

2. Nigerian Urban Reproductive Health Initiative Goal: In 5 years, increase the contraceptive prevalence rate (CPR) by 20 percentage points in six selected cities in Nigeria Three approaches for increasing CPR a.Increase the proportion of women that want to delay or limit childbearing b.Convert unmet need to met need for FP c.Reduce method discontinuation

3. Need for, and use of, FP among sexually active, non-menopausal women, 2008 NDHS

4. Conceptual Approach to Analysis DISTAL FACTORS 1.Poverty 2.Cultural norms PROXIMATE FACTORS 1.Desired family size 2.Female autonomy 3.Gender preference 4.Knowledge OUTCOMES 1.Need for FP 2.Use of FP 3.Duration of use of FP EDUCATION EXPOSURE TO FP MESSAGES QUALITY OF FP COUNSELING EDUCATION EXPOSURE TO FP MESSAGES QUALITY OF FP COUNSELING

5. Do proximate factors affect outcomes? DISTAL FACTORS 1.Poverty 2.Cultural norms PROXIMATE FACTORS 1.Desired family size 2.Female autonomy 3.Gender Preference 4.Knowledge OUTCOMES 1.Need for FP 2.Use of FP 3.Duration of use of FP EDUCATION EXPOSURE TO FP MESSAGES QUALITY OF FP COUNSELING EDUCATION EXPOSURE TO FP MESSAGES QUALITY OF FP COUNSELING

6. Percent of sexually active, non-menopausal urban women with a stated need for FP, by proximate factors % with need to space % with need to limit N IDEAL FAMILY SIZE 4 or fewer children 5 or more children 43.0*** 35.4 27.4*** 13.0 2,595 4,018 FEMALE AUTONOMY Participates in HH decisions Does not participate 48.8*** 33.5 18.4* 14.0 4,033 2,580 GENDER PREFERENCE Wants same # of sons, daughters Wants more children of one sex 41.7 42.9 17.3 19.0 6,373 3,733 KNOWLEDGE Knows at least 3 modern method Knows fewer than 3 method 42.1*** 34.1 19.2*** 11.5 4,651 1,962 Source: 2008 Nigeria DHS Adjusting for Age and Parity P-values: *p<0.05; **p<0.01; ***p<0.001

7. Percent of urban women with a need for FP currently using a modern FP method, by proximate factors % of using a modern FP method N IDEAL FAMILY SIZE 4 or fewer children 5 or more children 47.6*** 37.1 1,743 2,007 FEMALE AUTONOMY Participates in HH decisions Does not participate 41.1 43.3 2,142 1,608 GENDER PREFERENCE Wants same # of sons, daughters Wants more children of one sex 41.8 45.4 2,224 1,417 KNOWLEDGE Knows at least 3 modern method Knows fewer than 3 method 45.9*** 29.8 2,854 896 Source: 2008 Nigeria DHS Adjusting for Age and Parity P-values: *p<0.05; **p<0.01; ***p<0.001

8. Percent of urban women currently using a modern method for at least 2 years, by proximate factors % of users using for at least 2 years N IDEAL FAMILY SIZE 4 or fewer children 5 or more children 41.0 40.2 868 708 FEMALE AUTONOMY Participates in HH decisions Does not participate 34.6** 47.2 831 745 GENDER PREFERENCE Wants same # of sons, daughters Wants more children of one sex 40.9 41.3 623 919 KNOWLEDGE Knows at least 3 modern method Knows fewer than 3 method 39.9 44.1 1,303 273 Source: 2008 Nigeria DHS Adjusting for Age and Parity P-values: *p<0.05; **p<0.01; ***p<0.001

9. Summary These analyses suggest which factors you may consider when seeking to increase contraceptive use among urban women in general. Both ideal family size and FP knowledge are important for both need for, and use of, FP HH decision-making may affect need for FP but does not appear to effect use. These analyses do not support the role of gender preference in FP decisions.

10. Do distal factors affect the outcomes through the proximate factors? DISTAL FACTORS 1.Poverty 2.Cultural norms PROXIMATE FACTORS 1.Desired family size 2.Female autonomy 3.Gender preference 4.Knowledge OUTCOMES 1.Need for FP 2.Use of FP 3.Duration of use of FP EDUCATION EXPOSURE TO FP MESSAGES QUALITY OF FP COUNSELING EDUCATION EXPOSURE TO FP MESSAGES QUALITY OF FP COUNSELING

11. Percent of urban women with favorable proximate factors, by wealth status Source: 2008 Nigeria DHS P-values: *p<0.05; **p<0.01; ***p<0.001

12. Percent of urban women with favorable proximate factors, by religion and region of residence Source: 2008 Nigeria DHS P-values: *p<0.05; **p<0.01; ***p<0.001

13. Direct and Indirect effects of Distal Factors on Need for FP Wealth StatusReligionRegion Total Effect-0.186*-0.237*-0.247* Direct Effect-0.116*-0.186*-0.195* Indirect Effect-0.070*-0.051*-0.052* Ideal Family Size-0.050*-0.042*-0.041* HH Decision-making0.016*0.021*0.024* Gender Preference0.002-0.005* Knowledge-0.038*-0.024*-0.030* Proportion of total effect mediated 0.3750.2150.266 Source: 2008 Nigeria DHS * Significantly different from 0

14. Direct and Indirect effects of Distal Factors on Current use of a modern method Wealth StatusReligionRegion Total Effect-0.168*-0.167*-0.156* Direct Effect-0.081*-0.105*-0.081* Indirect Effect-0.087*-0.062*-0.074* Ideal Family Size-0.028*-0.025*-0.023* HH Decision-making-0.010*-0.004-0.012* Gender Preference0.003*-0.006* Knowledge-0.052*-0.027*-0.034* Proportion of total effect mediated 0.5190.3690.478 Source: 2008 Nigeria DHS * Significantly different from 0

15. Direct and Indirect effects of Distal Factors on use of a modern method for 2 or more years Wealth StatusReligionRegion Total Effect-0.097*-0.089*-0.031 Direct Effect-0.100*-0.080*-0.025 Indirect Effect0.002-0.009-0.007 Ideal Family Size-0.005 HH Decision-making0.010*-0.006*-0.001 Gender Preference0.001 -0.001 Knowledge-0.0030.002-0.005 Proportion of total effect mediated 0.0300.1020.211 Source: 2008 Nigeria DHS * Significantly different from 0

16. Summary The analyses in this section suggest which factors you may consider when seeking to increase contraceptive use among wealth or cultural groupings. To increase need for FP among urban poor or muslim women in the North, focus on decreasing ideal family size To increase use of FP, among urban poor or muslim women in the North, focus on increasing knowledge of FP. However, many other factors exist that are unmeasured in these data. Wealth status and cultural norms do not have a strong effect on duration, once a woman adopts FP.

17. Does education and exposure moderate the effect of the distal factors on the proximate factors? DISTAL FACTORS 1.Poverty 2.Cultural norms PROXIMATE FACTORS 1.Desired family size 2.Female autonomy 3.Son preference 4.Knowledge EDUCATION EXPOSURE TO FP MESSAGES QUALITY OF FP COUNSELING EDUCATION EXPOSURE TO FP MESSAGES QUALITY OF FP COUNSELING

18. Percent of urban women with favorable proximate factors, by wealth status and exposure to FP messages Source: 2008 Nigeria DHS P-values: *p<0.05; **p<0.01; ***p<0.001

19. Percent of urban women with favorable proximate factors, by religion and exposure to FP messages Source: 2008 Nigeria DHS P-values: *p<0.05; **p<0.01; ***p<0.001

20. Percent of urban women with favorable proximate factors, by region and exposure to FP messages Source: 2008 Nigeria DHS P-values: *p<0.05; **p<0.01; ***p<0.001

21. Summary The analyses in this section suggest that exposure to FP messages can have an effect on FP knowledge and possibly household decision-making. Given the importance of fertility preferences in the preceding analyses, it is important to learn whether prior messages sought to decrease ideal family size (and failed) or did not target this factor.