Spatial distribution and factors associated with unmet need for family planning among women of reproductive age in Zambia: Evidence from the 2024 Zambia Demographic and Health Survey
- 1University of Zambia - Ridgeway Campus
Abstract
Unmet need for family planning contributes to unintended pregnancies, unsafe abortions, and preventable maternal and child deaths, and remains high in sub-Saharan Africa. In Zambia, national estimates may conceal important geographic inequalities. We assessed the spatial distribution of, and factors associated with, unmet need for family planning among women of reproductive age in Zambia. We conducted a cross-sectional analysis of the 2024 Zambia Demographic and Health Survey (ZDHS), including 12,133 women aged 15-49 years. Survey-weighted logistic regression, accounting for the stratified two-stage cluster design, was used to estimate adjusted odds ratios (AOR) with 95% confidence intervals (CI). Global spatial autocorrelation was assessed with Morans I, local hotspots with the Getis-Ord Gi* statistic, and spatial clusters with a purely spatial Bernoulli scan statistic in SaTScan. The weighted prevalence of unmet need was 27.0% (95% CI: 25.7-28.3%), ranging from 23.8% in Central to 31.6% in North-Western Province. Unmet need was spatially clustered (Morans I = 0.142, p = 0.018), with hotspots mainly in Lusaka, Southern, North-Western, and Northern provinces; SaTScan detected a primary cluster in Lusaka (observed-to-expected ratio 1.42, p < 0.001). Women in union (AOR 2.33, 95% CI: 1.90-2.86) and never-married women (AOR 2.20, 95% CI: 1.69-2.86) had higher odds of unmet need than formerly married women, as did women with five or more children compared with none (AOR 3.05, 95% CI: 2.25-4.13). Lower odds were observed among women aged 35-49 years (AOR 0.65, 95% CI: 0.52-0.83), women in the richest wealth quintile (AOR 0.62, 95% CI: 0.45-0.86), employed women (AOR 0.73, 95% CI: 0.64-0.84) and urban residents (AOR 0.80, 95% CI: 0.68-0.95). Unmet need for family planning in Zambia is high, geographically clustered and socially patterned. Family planning programmes should prioritise hotspot areas, particularly Lusaka, Southern and North-Western provinces, while targeting younger, higher-parity and poorer women.
Related
- HIV serostatus disclosure to sexual partners and associated factors among reproductive-age women living with HIV in Lesotho: evidence from the 2023-2024 Lesotho Demographic and Health Survey.
- Spatial distribution and socioeconomic correlates of anaemia among women of reproductive age in Ghana: a hotspot analysis of the 2022 Demographic and Health Survey
- Predictors of modern contraceptive use among reproductive-aged women (15-49 years) in Mozambique: Evidence from Mozambique Demographic and Health Survey.
- Male Reproductive Disorders Associated with Antiseizure Medications: Evidence from Meta-Analysis and FAERS Pharmacovigilance Study
- Factors associated with the unmet need for spacing and limiting family planning: Evidence from a national survey
BibTeX
@misc{sibeso2026spatial,
title = {{Spatial distribution and factors associated with unmet need for family planning among women of reproductive age in Zambia: Evidence from the 2024 Zambia Demographic and Health Survey}},
author = {P. Sibeso and N. Tembo and C. Jacobs},
howpublished = {medRxiv},
year = {2026},
month = nov,
doi = {10.64898/2026.11.02.26367140},
url = {https://www.medrxiv.org/content/10.64898/2026.11.02.26367140v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Spatial distribution and factors associated with unmet need for family planning among women of reproductive age in Zambia: Evidence from the 2024 Zambia Demographic and Health Survey
AU - P. Sibeso
AU - N. Tembo
AU - C. Jacobs
PY - 2026
DA - 2026/11/02
PB - medRxiv
DO - 10.64898/2026.11.02.26367140
UR - https://www.medrxiv.org/content/10.64898/2026.11.02.26367140v1
AB - Unmet need for family planning contributes to unintended pregnancies, unsafe abortions, and preventable maternal and child deaths, and remains high in sub-Saharan Africa. In Zambia, national estimates may conceal important geographic inequalities. We assessed the spatial distribution of, and factors associated with, unmet need for family planning among women of reproductive age in Zambia. We conducted a cross-sectional analysis of the 2024 Zambia Demographic and Health Survey (ZDHS), including 12,133 women aged 15-49 years. Survey-weighted logistic regression, accounting for the stratified two-stage cluster design, was used to estimate adjusted odds ratios (AOR) with 95% confidence intervals (CI). Global spatial autocorrelation was assessed with Morans I, local hotspots with the Getis-Ord Gi* statistic, and spatial clusters with a purely spatial Bernoulli scan statistic in SaTScan. The weighted prevalence of unmet need was 27.0% (95% CI: 25.7-28.3%), ranging from 23.8% in Central to 31.6% in North-Western Province. Unmet need was spatially clustered (Morans I = 0.142, p = 0.018), with hotspots mainly in Lusaka, Southern, North-Western, and Northern provinces; SaTScan detected a primary cluster in Lusaka (observed-to-expected ratio 1.42, p < 0.001). Women in union (AOR 2.33, 95% CI: 1.90-2.86) and never-married women (AOR 2.20, 95% CI: 1.69-2.86) had higher odds of unmet need than formerly married women, as did women with five or more children compared with none (AOR 3.05, 95% CI: 2.25-4.13). Lower odds were observed among women aged 35-49 years (AOR 0.65, 95% CI: 0.52-0.83), women in the richest wealth quintile (AOR 0.62, 95% CI: 0.45-0.86), employed women (AOR 0.73, 95% CI: 0.64-0.84) and urban residents (AOR 0.80, 95% CI: 0.68-0.95). Unmet need for family planning in Zambia is high, geographically clustered and socially patterned. Family planning programmes should prioritise hotspot areas, particularly Lusaka, Southern and North-Western provinces, while targeting younger, higher-parity and poorer women.
ER -