Long-Acting Reversible Contraceptive Use by Rural-Urban Residence among Women in Nigeria, 2016-2018

This study examined temporal trends in the association between rural-urban residence and the use of LARCs among women using a method of contraception. A secondary objective was to examine whether the association varied over time. This study was a secondary analysis of data collected by the Performance Monitoring for Action (PMA) project from Nigeria among women aged 15-49 in 2016 (N= 11,054), 2017 (N= 11,380), and 2018 (N = 11,106). Weighted multivariable logistic regression analyses examined the association between place of residence and the likelihood of LARC (overall and specific type) utilization. Using weighted multivariable logistic regression, we show that, of the 6488 women who were using a method of contraception, the rates of LARC utilization in urban areas were significantly lower than in rural areas (OR = 0.52, 95% CI 0.38-0.73), attributed mainly to the high utilization rates of implants. Women in urban areas were more likely to use intrauterine devices (IUDs) (OR = 1.90, 95% CI 1.09-3.30) compared to those in rural areas. Conversely, the use of implants was significantly lower among women in urban areas (OR = 0.39, 95% CI 0.28-0.54). Adjusting for all predictors, we observed a reduction, albeit not significantly different, in odds in overall LARC, IUD, and implant use in urban compared to rural areas. The use of LARCs increased between 2016 and 2018 and the association between LARC use and place of residence also differed by the PMA survey year. There is a need for programs and policies to close gaps in the disparities in overall and specific LARC utilization rates based on place of residence.