Magnitude and correlates of modern contraceptive non-use among women of reproductive age in Eswatini: a secondary analysis of data from a population-based cross-sectional survey.

OBJECTIVES: We investigated the magnitude and correlates of modern contraceptive non-use among women of reproductive age (15-49 years) in Eswatini (formerly Swaziland). DESIGN: Secondary analysis of a cross-sectional, nationally representative, population-based, household survey SETTING: Eswatini PARTICIPANTS: Women of reproductive age in the Swaziland HIV Incidence Measurement Survey 3 2021 dataset PRIMARY OUTCOME MEASURE: The primary outcome was non-use of modern contraceptive methods. RESULTS: Of 3080 reproductive age women whose data were analysed in this study, 53% were aged 20-34 years, and the majority were from rural areas (66.8%). The weighted prevalence of non-use of modern contraceptives was 33%. The risk of non-use of modern contraceptives was lower among women: aged 20-34 (adjusted risk ratio (ARR)=0.85, 95% CI 0.75 to 0.97); from households of middle wealth quintile (ARR=0.82, 95% CI 0.68 to 0.97); who had given birth at least once (ARR=0.84, 95% CI 0.73 to 0.96); who were living with HIV (ARR=0.79, 95% CI 0.70 to 0.89); and among those who reported being sexually active in the past 12 months (ARR=0.54, 95% CI 0.48 to 0.61). On the other hand, adolescent girls aged 15-19 years (ARR=1.31, 95% CI 1.04 to 1.67) and women who lived in the Manzini (ARR=1.21, 95% CI 1.01 to 1.46) and Shiselweni regions (ARR=1.21, 95% CI 1.00 to 1.45) had a higher risk of not using modern contraceptives. CONCLUSION: Given that a third of women in Eswatini did not use modern contraceptive methods, there is a need to promote modern contraceptive methods in Eswatini, particularly long-acting methods. The Eswatini Sexual and Reproductive Health Program should strengthen initiatives aimed at promoting modern contraceptive use among adolescent girls and those living in the Manzini and Shiselweni regions, who showed a higher risk of not using modern contraceptives.