Multidimensional Socioeconomic Inequalities in Women's Current Non
Total Page:16
File Type:pdf, Size:1020Kb
Socioeconomic inequalities in use of contraception in Colombia: DHS 1986-2010 Catalina Gonzalez Uribe Thesis submitted for the degree of Doctor of Philosophy University College London 2012 2 I, Catalina Gonzalez Uribe confirm that the work presented in this thesis is my own. Where information has been derived from other sources, I confirm that this has been indicated in the thesis. Catalina Gonzalez Uribe 3 Abstract Background: In 2005 Colombia adopted the national Millennium Development Goal (MDG5) target of 75% modern contraceptive prevalence rate (CPR) by 2015. Important gains have been achieved with respect to living conditions, education and health indicators in recent decades but inequalities within the country remain to be addressed. Methods: The aim was to analyse socioeconomic inequalities in women’s ‘current non- use of contraception’ using the six Colombian Demographic and Health Surveys (DHS). A multidimensional approach to socioeconomic position was implemented. Absolute and relative socioeconomic inequalities were analysed using the Slope Index of Inequality (SII) and Relative Index of Inequality (RII). The interplay between level of education and Public capital with respect to contraceptive non-use was examined. Individual and contextual effects were investigated using a multilevel approach. Results: National prevalence in current non-use of contraception between 1986 and 2010 decreased from32.6% to 22.9%. Nationally, absolute inequalities narrowed but relative inequalities did not decline. Women with less than primary education had not met the CPR target in 2010 in urban (30.9%) and rural (41.4%) areas respectively. Absolute inequalities narrowed in urban areas but relative inequalities persisted in urban and rural areas. Gradients in contraceptive non-use with respect to household wealth were stronger among women in rural than in urban areas. The impact of level of education on contraceptive non-use was relatively weak among women in households and within communities with high Public capital compared to low Public capital. Municipality ethnic composition had an effect on women’s contraceptive non-use over and above individual and community characteristics. Conclusion: Colombia reached the national CPR target ahead of time. However, the persistent socioeconomic gradients in non-use of contraception by household wealth and education indicate the need to go beyond country averages and individual level determinants to monitor urban and rural socioeconomic inequalities and contextual effects on women’s contraceptive behaviour. 4 Abstract ............................................................................................................................ 3 Acknowledgements ........................................................................................................ 17 Introduction ................................................................................................................... 18 1. Background ............................................................................................................ 22 1.1. Colombia ................................................................................................................... 22 1.2. Summary and implications for this thesis ................................................................. 32 1.3. Measuring women’s socioeconomic position in low and middle income countries ............................................................................................................................... 33 1.4. Summary and implications for this thesis ................................................................. 38 1.5. Women and family planning: a rights-based framework .......................................... 39 1.6. Review of the literature ............................................................................................. 42 1.7. Summary and gaps in the literature ........................................................................... 46 2. Study Aims, objectives and hypotheses ............................................................... 49 3. Methodology .......................................................................................................... 54 3.1. Introduction ............................................................................................................... 54 3.2. The Datasets .............................................................................................................. 54 3.3. Study population and sampling procedure ................................................................ 55 3.4. Questionnaires ........................................................................................................... 56 3.5. Variables .................................................................................................................... 57 3.6. Analytical strategy ..................................................................................................... 69 3.7. Working with DHS data ............................................................................................ 85 4. Descriptive characteristics Colombian DHS 1986-2010 .................................... 89 4.1. Demographic characteristics for all women of reproductive age .............................. 89 4.2. Household characteristics for all women of reproductive age .................................. 93 4.3. Summary of main findings and discussion ................................................................ 97 4.4. Descriptive characteristics of the analytical sample .................................................. 99 4.5. Summary of main findings and discussion .............................................................. 109 4.6. Socioeconomic circumstances of women in the analytical sample ......................... 111 4.7. Summary of main findings and discussion .............................................................. 119 5 5. Multidimensional socioeconomic inequalities in current non-use of contraception 1986-2010 ............................................................................................. 122 5.1. Absolute inequalities of current non-use of contraception ...................................... 123 5.2. Summary of main findings and discussion .............................................................. 135 5.3. Relative inequalities of current non-use of contraception ....................................... 137 5.4. Summary of main findings and discussion .............................................................. 152 5.5. Trends in socioeconomic inequalities of current non-use of contraception ............ 154 5.6. Summary of main findings and discussion .............................................................. 159 6. The effect of women’s level of education on current non-use of contraception by household level of Public capital 1986-2010 ........................................................ 162 6.1. Absolute and relative education gradients by level of Public capital on women’s current non-use of contraception ........................................................................ 163 6.2. Predicted probabilities of the effect of education on women’s current non-use of contraception by level of Public capital ......................................................................... 172 6.3. Summary of main findings and discussion .............................................................. 176 7. Individual, community and municipality-level descriptive characteristics DHS 2005 and 2010 .............................................................................................................. 178 7.1. Individual-level characteristics ................................................................................ 178 7.2. Contextual community level characteristics ............................................................ 189 7.3. Contextual municipality level characteristics .......................................................... 193 7.4. Summary of main findings and discussion .............................................................. 201 8. Women’s contraceptive non-use: area differences and the effect of compositional and contextual characteristics ........................................................... 205 8.1. Women’s current non-use of contraception by individual characteristics .............. 205 8.2. The effect of individual characteristics on women’s current non-use of contraception ...................................................................................................................... 211 8.3. Summary of main findings and discussion .............................................................. 225 8.4. The effect of community characteristics on women’s current non-use of contraception ...................................................................................................................... 227 8.5. Summary of main findings and discussion .............................................................. 242 6 8.6. The effect of municipality characteristics on women’s current non-use of contraception ...................................................................................................................... 244 8.7. Summary of main findings and discussion .............................................................. 251 9. Compositional effect of women’s level of education on current non-use of contraception by community level of Public capital ...............................................