Community influences on modern contraceptive use among young women in low and middle-income countries: a cross-sectional multi-country analysis
Outcomes: Gender‑Based Violence, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Norms related to ideal family size, early marriage, and gender roles—particularly those that limit women’s autonomy—act as major barriers to contraceptive use. Changing these norms through community-wide interventions, education, and women’s empowerment is essential for increasing contraceptive access and supporting young women’s reproductive agency.
Objectives This study examined how community-level characteristics shape modern contraceptive use among young women aged 15–24 in low- and middle-income countries (LMICs). It aimed to identify both global patterns and regional differences in the influence of education, fertility norms, gender dynamics, and media exposure on contraceptive behavior.
Methods Using Demographic and Health Survey (DHS) data from 52 LMICs (2008–2016), the study analyzed responses from over 305,000 young women. Community-level variables—such as education attainment, fertility and gender norms, decision-making autonomy, and mass media exposure—were created by aggregating individual data within primary sampling units. Multilevel logistic regression models assessed associations with modern contraceptive use, adjusting for individual and household characteristics. Regional models were also used to examine variation in influences by context.
Results Modern contraceptive use among young women varied widely across countries, with a global average of 17.8%. Young women were more likely to use modern contraception if they lived in communities with higher average education levels, later age at first marriage, and greater decision-making autonomy for women. However, use was lower in communities with earlier sexual debut, earlier first birth, larger ideal family size, and more accepting attitudes toward intimate partner violence. Surprisingly, greater exposure to mass media was not consistently associated with increased contraceptive use and was negatively associated in some regions.
Conclusions Contraceptive use among young women is deeply influenced by their broader community environments—not just individual choices. Community education levels, fertility expectations, and gender norms all shape whether and how young women access and use contraception. Effective programs must address these structural influences to close the gap in unmet need.
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