Disparities in contraceptive preferences among Bangladeshi women: a multilevel logistic regression study

Understanding the contraceptive preferences of currently married women who are not using any method but intend to do so in the future is critical for addressing unmet need and informing targeted family planning strategies. In Bangladesh, despite progress in contraceptive uptake, disparities persist across socio-demographic groups and geographic regions. This study examines the determinants of preferred future contraceptive methods among non-using but intending women in Bangladesh using a multilevel analytic framework.

We used data from the 2014 Bangladesh Demographic and Health Survey (BDHS), focusing on 3,662 currently married women aged 15-49 who were not using any contraceptive method but intended to adopt one in the future. The outcome variable, preferred future contraceptive method, was categorized into three groups: Pill (reference), Injection, and Other methods (e.g., condom, sterilization, Norplant). A two-level multinomial logistic regression model was applied, with women (level 1) nested within administrative divisions (level 2), using a Bayesian estimation approach.

The Pill was the most preferred method overall (49%), followed by Other methods (30%) and Injection (21%). Preference patterns varied by age, education, parity, wealth, and place of residence. Women with higher education had significantly greater odds of preferring other methods over pills (OR = 1.68, 95% CI: 1.14-2.51), while those with more children were more likely to prefer injections. Urban women were more inclined to prefer other methods compared to rural women (OR = 1.38, 95% CI: 1.14-1.71). The analysis revealed significant variation across divisions, highlighting contextual influences on contraceptive preferences.

Contraceptive preferences among non-using but intending women in Bangladesh are shaped by a complex interplay of individual and regional factors. Programs aiming to reduce unmet need and method discontinuation should adopt tailored strategies that consider age, education, parity, and regional disparities. Enhancing method choice, promoting female education, and improving service delivery in underserved regions are essential for achieving reproductive health equity and advancing national and global family planning goals.