Understanding Risk Factors for Unmet Contraceptive Needs Among Married and Cohabiting Women in Sub-Saharan Africa: Evidence from 22 Countries

Abstract

Background
Unmet need for contraception remains a pressing challenge in sub-Saharan Africa (SSA), contributing to high rates of unintended pregnancies and adverse maternal outcomes despite interventions. This study assessed individual and contextual factors associated with unmet contraceptive needs among married and cohabiting women.
Methods
We analyzed Demographic and Health Survey data from 22 SSA countries collected between 2016 and 2023, comprising a weighted sample of 186,813 women aged 15–49 years. Multilevel logistic regression was applied to identify predictors of unmet need.
Results
The overall prevalence of unmet need was 21.8%, ranging from 12.5% in Rwanda to 33.9% in Liberia. Central Africa recorded the highest regional prevalence (23.5%), while Southern Africa reported the lowest (18.5%). Cohabiting women, younger women, and those with higher parity had increased odds of unmet need. In contrast, higher educational attainment, employment, and exposure to family planning messages through mass media reduced the odds. Unexpectedly, internet use and reported sexual autonomy were associated with slightly higher unmet need.
Conclusion
Policies should prioritize education, increase access to contraception, and strengthen community health outreach, with particular focus on cohabiting women and those with large family sizes.
Rwanda J Med Health Sci 2026;9(1):84-99