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��ࡱ�>��	�������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������[�	��]}bjbj����	��ΐΐ�T�������44wwwww$�������P���D��J*+z�4������JJJJJJJ$�L��O<7JQw� ��� � 7Jww����J(((� �w�w�@
(� J(((%(��������[��U"�(�?�J0�J(�OQ$��O%(�Ow%(��"�(� ����7J7J/&�����J� � � � ���������������������������������������������������������������������O���������4	=:	Association between modern contraceptive use and socio-demographic factors among fecund young women in Bangladesh

Short title: Modern contraceptive use and socio-demographic factors

Ahmed Zohirul Islama

aDepartment of Population Science and Human Resource Development, University of Rajshahi, Bangladesh, Email:  HYPERLINK "mailto:zohirul.18@gmail.com" zohirul.18@gmail.com

Word count: Abstract- 221, Manuscript- 2,700














Abstract
Background The growth and size of Bangladesh�s population over the next few decades will largely depend on the reproductive habits of young people because half of the population of the country is aged below 25 years. However, a systematic study on the contraceptive behaviour of this sub-group of population is less evident. Therefore, this study aimed at exploring the determinants of using modern contraceptives among currently married fecund non-pregnant young women in Bangladesh. 
Methods This study utilized a cross-sectional data (n=3,744) extracted from the Bangladesh Demographic and Health Survey 2011. Differences in the use of modern contraceptives by socio-demographic characteristics were assessed by �2 analyses. Binary logistic regression was used to identify the determinants of modern contraceptive use among fecund young women. 
Results This study observed that six out of ten women used modern contraceptives. Getting FP methods from FP workers and husband-wife joint participation in decision making about healthcare issues and other familial activities increase the likelihood of using modern contraceptives. Regional variation is also another key factor that influences contraceptive use.
Conclusions Because husband-wife joint participation in decision making increases the likelihood of using contraceptives, government should focus on developing negotiation skills in young women by creating educational and employment opportunities. Reproductive and sex education should be introduced in schools to prepare the young for healthy and responsible living.

Keywords Contraception; modern contraceptive use; contraceptive demand; family planning, Bangladesh; BDHS

Background
Family planning is the key strategy for impediment of unwanted pregnancies. Use of contraception decreases deaths of women by 44% and prevents 230 million births each year worldwide ADDIN EN.CITE <EndNote><Cite><Author>Ahmed</Author><Year>2012</Year><RecNum>3</RecNum><DisplayText>[1, 2]</DisplayText><record><rec-number>3</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1446527121">3</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ahmed, Saifuddin</author><author>Li, Qingfeng</author><author>Liu, Li</author><author>Tsui, Amy O</author></authors></contributors><titles><title>Maternal deaths averted by contraceptive use: an analysis of 172 countries</title><secondary-title>The Lancet</secondary-title></titles><periodical><full-title>The Lancet</full-title></periodical><pages>111-125</pages><volume>380</volume><number>9837</number><dates><year>2012</year></dates><isbn>0140-6736</isbn><urls></urls></record></Cite><Cite><Author>Liu</Author><Year>2008</Year><RecNum>180</RecNum><record><rec-number>180</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1470033385">180</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Liu, Li</author><author>Becker, Stan</author><author>Tsui, Amy</author><author>Ahmed, Saifuddin</author></authors></contributors><titles><title>Three methods of estimating births averted nationally by contraception</title><secondary-title>Population studies</secondary-title></titles><periodical><full-title>Population Studies</full-title></periodical><pages>191-210</pages><volume>62</volume><number>2</number><dates><year>2008</year></dates><isbn>0032-4728</isbn><urls></urls></record></Cite></EndNote>[1, 2]. Statistics shows that an increase of 15% to 17% of using contraceptives reduces population growth by one birth for one woman ADDIN EN.CITE <EndNote><Cite><Author>Cleland</Author><Year>2012</Year><RecNum>35</RecNum><DisplayText>[3]</DisplayText><record><rec-number>35</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1446533572">35</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cleland, John</author><author>Conde-Agudelo, Agustin</author><author>Peterson, Herbert</author><author>Ross, John</author><author>Tsui, Amy</author></authors></contributors><titles><title>Contraception and health</title><secondary-title>The Lancet</secondary-title></titles><periodical><full-title>The Lancet</full-title></periodical><pages>149-156</pages><volume>380</volume><number>9837</number><dates><year>2012</year></dates><isbn>0140-6736</isbn><urls></urls></record></Cite></EndNote>[3]. The population of the world became 7,336 million in 2015 where South Asia contributed 1,834 million people. Bangladesh, the third most populous country in South Asia comprises of 160.4 million people ADDIN EN.CITE <EndNote><Cite><Year>2015</Year><RecNum>153</RecNum><DisplayText>[4]</DisplayText><record><rec-number>153</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1466748662">153</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors></contributors><titles><title>Population Reference Bureau. World population data sheet</title><secondary-title>Population Reference Bureau Washington</secondary-title></titles><periodical><full-title>Population Reference Bureau Washington</full-title></periodical><dates><year>2015</year></dates><urls></urls></record></Cite></EndNote>[4], where half of the population is aged below 25 years ADDIN EN.CITE <EndNote><Cite><Year>2015</Year><RecNum>152</RecNum><DisplayText>[5]</DisplayText><record><rec-number>152</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1466748315">152</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors></contributors><titles><title>Central Intelligence Agency. Country Comparison to the World.</title><secondary-title>The World Factbook</secondary-title></titles><periodical><full-title>The World Factbook</full-title></periodical><dates><year>2015</year></dates><urls></urls></record></Cite></EndNote>[5]. As this large cohort of young people enter the reproductive life span, the growth and size of the population of Bangladesh over the next few decades will largely depend on their reproductive behaviour. A considerable number of young adults get married every year. Fulfillment of their contraceptive demand is crucial to the ongoing family planning (FP) programmes. Therefore, this study focuses on assessing the contraceptive use status of women under 25 years old. 
According to literature, socio economic and demographic factors such as residence ADDIN EN.CITE <EndNote><Cite><Author>Audu</Author><Year>2008</Year><RecNum>8</RecNum><DisplayText>[6]</DisplayText><record><rec-number>8</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1446527871">8</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Audu, Bala</author><author>Yahya, Shaibu</author><author>Geidam, Ado</author><author>Abdussalam, Hadiza</author><author>Takai, Idrisa</author><author>Kyari, Othman</author></authors></contributors><titles><title>Polygamy and the use of contraceptives</title><secondary-title>International Journal of Gynecology &amp; Obstetrics</secondary-title></titles><periodical><full-title>International Journal of Gynecology &amp; Obstetrics</full-title></periodical><pages>88-92</pages><volume>101</volume><number>1</number><dates><year>2008</year></dates><isbn>0020-7292</isbn><urls></urls></record></Cite></EndNote>[6], education ADDIN EN.CITE <EndNote><Cite><Author>Ekani-Besala</Author><Year>1998</Year><RecNum>150</RecNum><DisplayText>[7, 8]</DisplayText><record><rec-number>150</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1466745829">150</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ekani-Besala, M., Carre, N., Calvez, T., Thonneau P.</author></authors></contributors><titles><title>Prevalence and determinants of current contraceptive method use in a Palm Oil company in Cameroon</title><secondary-title>Contraception</secondary-title></titles><periodical><full-title>Contraception</full-title></periodical><pages>29�34</pages><volume>58</volume><dates><year>1998</year></dates><urls></urls></record></Cite><Cite><Author>Oye-Adeniran</Author><Year>2006</Year><RecNum>166</RecNum><record><rec-number>166</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1466836302">166</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Oye-Adeniran, Boniface A</author><author>Adewole, Isaac F</author><author>Umoh, Augustine V</author><author>Oladokun, Adesina</author><author>Gbadegesin, Abidoye</author><author>Ekanem, Ekanem E</author></authors></contributors><titles><title>Community-based study of contraceptive behaviour in Nigeria</title><secondary-title>African Journal of Reproductive Health</secondary-title></titles><periodical><full-title>African Journal of Reproductive Health</full-title></periodical><pages>90-104</pages><volume>10</volume><number>2</number><dates><year>2006</year></dates><isbn>1118-4841</isbn><urls></urls></record></Cite></EndNote>[7, 8], age ADDIN EN.CITE <EndNote><Cite><Author>Oye-Adeniran</Author><Year>2006</Year><RecNum>166</RecNum><DisplayText>[8]</DisplayText><record><rec-number>166</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1466836302">166</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Oye-Adeniran, Boniface A</author><author>Adewole, Isaac F</author><author>Umoh, Augustine V</author><author>Oladokun, Adesina</author><author>Gbadegesin, Abidoye</author><author>Ekanem, Ekanem E</author></authors></contributors><titles><title>Community-based study of contraceptive behaviour in Nigeria</title><secondary-title>African Journal of Reproductive Health</secondary-title></titles><periodical><full-title>African Journal of Reproductive 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<EndNote><Cite><Author>Rahman</Author><Year>2010</Year><RecNum>148</RecNum><DisplayText>[11, 12]</DisplayText><record><rec-number>148</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1458380552">148</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rahman, MM</author><author>Islam, AZ</author><author>Islam, MR</author></authors></contributors><titles><title>Rural-urban differentials of knowledge and practice of contraception in Bangladesh</title><secondary-title>Journal of Population and Social Studies</secondary-title></titles><periodical><full-title>Journal of Population and Social Studies</full-title></periodical><pages>87-110</pages><volume>18</volume><number>2</number><dates><year>2010</year></dates><urls></urls></record></Cite><Cite><Author>Islam</Author><Year>2016</Year><RecNum>186</RecNum><record><rec-number>186</rec-number><foreign-keys><key app="EN" 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name="Journal Article">17</ref-type><contributors><authors><author>Ekani-Besala, M., Carre, N., Calvez, T., Thonneau P.</author></authors></contributors><titles><title>Prevalence and determinants of current contraceptive method use in a Palm Oil company in Cameroon</title><secondary-title>Contraception</secondary-title></titles><periodical><full-title>Contraception</full-title></periodical><pages>29�34</pages><volume>58</volume><dates><year>1998</year></dates><urls></urls></record></Cite><Cite><Author>Rahman</Author><Year>2010</Year><RecNum>148</RecNum><record><rec-number>148</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1458380552">148</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rahman, MM</author><author>Islam, AZ</author><author>Islam, MR</author></authors></contributors><titles><title>Rural-urban differentials of knowledge and practice of contraception in Bangladesh</title><secondary-title>Journal of Population and Social Studies</secondary-title></titles><periodical><full-title>Journal of Population and Social Studies</full-title></periodical><pages>87-110</pages><volume>18</volume><number>2</number><dates><year>2010</year></dates><urls></urls></record></Cite></EndNote>[7, 11], autonomy ADDIN EN.CITE <EndNote><Cite><Author>Cleland</Author><Year>2006</Year><RecNum>34</RecNum><DisplayText>[14, 15]</DisplayText><record><rec-number>34</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1446533507">34</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cleland, John</author><author>Bernstein, Stan</author><author>Ezeh, Alex</author><author>Faundes, Anibal</author><author>Glasier, Anna</author><author>Innis, Jolene</author></authors></contributors><titles><title>Family planning: the unfinished agenda</title><secondary-title>The Lancet</secondary-title></titles><periodical><full-title>The Lancet</full-title></periodical><pages>1810-1827</pages><volume>368</volume><number>9549</number><dates><year>2006</year></dates><isbn>0140-6736</isbn><urls></urls></record></Cite><Cite><Author>Nagase</Author><Year>2003</Year><RecNum>119</RecNum><record><rec-number>119</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1454310531">119</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Nagase, T</author><author>Kunii, O</author><author>Wakai, S</author><author>Khaleel, A</author></authors></contributors><titles><title>Obstacles to modern contraceptive use among married women in southern urban Maldives</title><secondary-title>Contraception</secondary-title></titles><periodical><full-title>Contraception</full-title></periodical><pages>125-134</pages><volume>68</volume><number>2</number><dates><year>2003</year></dates><isbn>0010-7824</isbn><urls></urls></record></Cite></EndNote>[14, 15], desire for children ADDIN EN.CITE <EndNote><Cite><Author>Nagase</Author><Year>2003</Year><RecNum>119</RecNum><DisplayText>[15]</DisplayText><record><rec-number>119</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1454310531">119</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Nagase, T</author><author>Kunii, O</author><author>Wakai, S</author><author>Khaleel, A</author></authors></contributors><titles><title>Obstacles to modern contraceptive use among married women in southern urban Maldives</title><secondary-title>Contraception</secondary-title></titles><periodical><full-title>Contraception</full-title></periodical><pages>125-134</pages><volume>68</volume><number>2</number><dates><year>2003</year></dates><isbn>0010-7824</isbn><urls></urls></record></Cite></EndNote>[15], marital status ADDIN EN.CITE <EndNote><Cite><Author>Audu</Author><Year>2008</Year><RecNum>8</RecNum><DisplayText>[6]</DisplayText><record><rec-number>8</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1446527871">8</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Audu, Bala</author><author>Yahya, Shaibu</author><author>Geidam, Ado</author><author>Abdussalam, Hadiza</author><author>Takai, Idrisa</author><author>Kyari, Othman</author></authors></contributors><titles><title>Polygamy and the use of contraceptives</title><secondary-title>International Journal of Gynecology &amp; Obstetrics</secondary-title></titles><periodical><full-title>International Journal of Gynecology &amp; Obstetrics</full-title></periodical><pages>88-92</pages><volume>101</volume><number>1</number><dates><year>2008</year></dates><isbn>0020-7292</isbn><urls></urls></record></Cite></EndNote>[6] and partner communication ADDIN EN.CITE <EndNote><Cite><Author>Rahman</Author><Year>2010</Year><RecNum>148</RecNum><DisplayText>[11]</DisplayText><record><rec-number>148</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1458380552">148</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rahman, MM</author><author>Islam, AZ</author><author>Islam, MR</author></authors></contributors><titles><title>Rural-urban differentials of knowledge and practice of contraception in Bangladesh</title><secondary-title>Journal of Population and Social Studies</secondary-title></titles><periodical><full-title>Journal of Population and Social Studies</full-title></periodical><pages>87-110</pages><volume>18</volume><number>2</number><dates><year>2010</year></dates><urls></urls></record></Cite></EndNote>[11] have been associated with the use of modern contraceptives. However, most of these studies investigated the association between these socio-demographic covariates and modern contraceptive use (MCU) by focusing on all reproductive aged (15-49 years) women and failed to identify this relationship for women aged below 25 years. Additionally, earlier studies also failed to address fecund and non-pregnant women to investigate this relationship though these women are at actual risk of encountering unintended pregnancies. Since infecund women are physically unable to bear child and pregnant women are not currently in need of using contraceptives, including these women may bias the results. Therefore, this study attempted to explore the factors that affect the use of modern contraceptives (MC) among currently married, fecund and non-pregnant young women in Bangladesh. 

Methods
Data used
This study utilized a representative set of cross-sectional data extracted from the Bangladesh Demographic and Health Survey (BDHS) 2011. The survey was conducted under the authority of the National Institute of Population Research and Training (NIPORT) of the Ministry of Health and Family Welfare, Bangladesh. A nationally representative household based sample was created through a stratified, multistage cluster sampling strategy of which 600 primary sampling units were constructed (207 in urban areas and 393 in rural areas). The primary sampling units were derived from a sampling frame created for the 2011 Population and Housing Census, provided by Bangladesh Bureau of Statistics (BBS). Detailed information on survey design and sampling procedures has been reported elsewhere ADDIN EN.CITE <EndNote><Cite><Year>2013</Year><RecNum>157</RecNum><DisplayText>[16]</DisplayText><record><rec-number>157</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1466751269">157</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors></contributors><titles><title>National Institute of Population Research and Training (NIPORT). Bangladesh demographic and health survey 2011. Mitra and Associates, Dhaka, Bangladesh and ICF International, Calverton, Maryland, USA </title></titles><dates><year>2013</year></dates><urls></urls></record></Cite></EndNote>[16]. BDHS interviewed 17,842 women aged 15-49 years. After applying the definition of young people adopted by the United Nations ADDIN EN.CITE <EndNote><Cite><Year>2008</Year><RecNum>183</RecNum><DisplayText>[17]</DisplayText><record><rec-number>183</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1471417203">183</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors></contributors><titles><title>General Assembly Resolutions, A/RES/62/126 </title><secondary-title>United Nations</secondary-title></titles><periodical><full-title>United Nations</full-title></periodical><dates><year>2008</year></dates><urls></urls></record></Cite></EndNote>[17], a total of 3,744 currently married non-pregnant non-amenorrheic fecund women under 25 years old were selected for analyses (Figure 1).
 [Figure 1 about here]

Response variable
The outcome variable of this study was modern contraceptive use, which is binary in nature (use or non-use). During the survey, sexually active women were asked if they were currently doing something or using any method to delay or avoid getting pregnant. Those that reported doing something or using any method to delay or avoid getting pregnant were further asked to indicate what they were doing or the method they were using. Modern contraceptive methods, such as pills, condoms, Intra-Uterine Devices (IUD), injections and implants/norplants, refer to safe and effective methods to prevent pregnancy. Those using modern contraceptives were coded as �1� and people who did not use modern contraceptives (either used traditional methods namely withdrawal, periodic abstinence, folkloric method or used nothing at all) were given the code �0�. 

Statistical analyses
This study begins with descriptive exploration of both response and explanatory variables. Differences in the use of modern contraceptives by socio-demographic characteristics were assessed by �2 analyses, with significance for all analyses set at p<0.05. Since the response variable of this study had two categories, the binary logistic regression was used to assess the net effect of selected socio-demographic variables. As stepwise logistic regression analysis is a technique for selecting influential variables in multiple regression models ADDIN EN.CITE <EndNote><Cite><Author>Chatterjee</Author><Year>2006</Year><RecNum>27</RecNum><DisplayText>[18]</DisplayText><record><rec-number>27</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1446533011">27</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chatterjee, Samprit</author><author>Hadi, Ali S</author></authors></contributors><titles><title>Simple linear regression</title><secondary-title>Regression Analysis by Example, Fourth Edition</secondary-title></titles><periodical><full-title>Regression Analysis by Example, Fourth Edition</full-title></periodical><pages>21-51</pages><dates><year>2006</year></dates><isbn>0470055464</isbn><urls></urls></record></Cite></EndNote>[18], this study used this technique of analysis (backward LR method). All the variables significant in chi-square tests were simultaneously included in the stepwise logistic regression model, and finally, the most influential predictors for modern contraceptive use were explored. Multicollinearity in the logistic regression analyses in this study was checked by examining the standard errors for the regression coefficients. A standard error larger than 2.0 indicates numerical problems, such as multicollinearity among the independent variables ADDIN EN.CITE <EndNote><Cite><Author>Chan</Author><Year>2004</Year><RecNum>25</RecNum><DisplayText>[19]</DisplayText><record><rec-number>25</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1446532675">25</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chan, YH</author></authors></contributors><titles><title>Biostatistics 202: logistic regression analysis</title><secondary-title>Singapore medical journal</secondary-title></titles><periodical><full-title>Singapore medical journal</full-title></periodical><pages>149-153</pages><volume>45</volume><number>4</number><dates><year>2004</year></dates><isbn>0037-5675</isbn><urls></urls></record></Cite></EndNote>[19]. In this study, all the independent variables in the fitted model had a standard error <0.70 indicate absence of multicollinearity. Data were analyzed using SPSS Release 21.0.

Results
Contraceptive use status 
Contraceptive use status of young women is presented in Table 1. It was observed that 64% women used modern contraceptive methods where the most commonly used contraceptive method was pills (42%), followed by injections (13%), and condoms (8%). 
[Table 1 about here]
It can be seen from Table 2 that 55% of the women who did not use contraceptives wanted children within the next two years but the rest of the women were not expecting to be pregnant and hence had risks of unplanned pregnancy. Evidently, 29% women were at risk of having mistimed pregnancy as they wanted a child after two years but were not using contraceptives and 11% women were at risk of encountering unwanted pregnancy as they want no child at all but were not using contraceptives.
[Table 2 about here]

Modern contraceptive use by socio-demographic profiles 
Table 3 described the percentage distribution of MCU by socio-demographic characteristics of the women. This study explored factors that might be associated with modern contraceptive use at a bivariate level of analysis, using the chi-square test and hence, provided p-values for the heterogeneity of the groups within each independent variable with regard to the proportions of using versus not using MC.
[Table 3 about here]
Use of MC was found highest among young women aged 23-24 years, those who lived in Barisal division, those who resided in the urban area, those who got married before 15 years of age, those who had two or more living children, those whose husbands were professional workers, those who desired no more children or desired child after two years, those who were given FP methods by FP workers and whose husbands wanted fewer children. Moreover, husband-wife joint participation in decision making regarding respondents� healthcare, child healthcare, large household purchases and visiting family members or relatives were found to be the biggest users of MC. 

Determinants of modern contraceptive use 
Stepwise logistic regression analyses were performed to determine the most influential factors that might affect the use of MC. It was observed from Table 4 that modern contraceptive use is positively associated with desire for a child either after two years go by or wanted no child at all, receiving FP methods from FP workers, number of living children, husband doing professional job and husband-wife joint participation in decision making about women�s healthcare, child�s healthcare, and visiting family members or relatives and negatively associated with residing in Sylhet, Chittagong and Dhaka divisions, not knowing about husbands� desires for children and living in the rural area.
This study showed that women who wanted to have a child after two years were more likely (OR: 9.788, p<0.0001) to use MC and who wanted no child at all were also more likely (OR: 8.767, p<0.0001) to use MC than who wanted a child within two years of the survey. Besides, women who were undecided about having child and who wanted a child but were unsure about timing were also more likely to use MC compared to who wanted a child within two years of the survey. Women who were given family planning method by the FP workers were 4.523 times likely to use MC than their counterparts who only talked with the FP workers. The likelihood of using MC was significantly increased when husband and wife jointly took decision on respondent�s own health care, child health care, and on visiting family members or relatives than those who decided alone about these issues.
This study also explained that number of living children played a significant role in contraceptive use since the likelihood of using MC was increased (OR: 1.841, p<0.0001) with increasing number of child. The likelihood of using MC increased (OR: 1.575, p<0.0001) among women whose husbands were professional (non-manual) workers compared to their counterparts whose husbands were manual workers. 
The likelihood of using MC was decreased with increasing age and increased with increasing age at marriage. The likelihood of using MC was decreased among women who did not know about their husbands� desires for having children than those women who desired equal number of children with their husbands� desire. Women who resided in the rural areas were less likely to use (OR: 0.643, p<0.0001) MC than who lived in the urban areas. Women residing in Sylhet, Chittagong, Dhaka, and Rangpur division were 0.329, 0.363, 0.563, and 0.685 times likely to use MC than who lived in Barisal division, respectively.
[Table 4 about here]
Discussion
This study assessed modern contraceptive prevalence and explored the socio-demographic factors associated with the utilization of MC among currently married, fecund and non-pregnant women under 25 years old in Bangladesh using Demographic and Health Survey data of 2011. 
This study observed that modern contraceptive prevalence was 64% among women aged below 25 years. Although this proportion is higher than  the national level (52%) ADDIN EN.CITE <EndNote><Cite><Year>2013</Year><RecNum>157</RecNum><DisplayText>[16]</DisplayText><record><rec-number>157</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1466751269">157</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors></contributors><titles><title>National Institute of Population Research and Training (NIPORT). Bangladesh demographic and health survey 2011. Mitra and Associates, Dhaka, Bangladesh and ICF International, Calverton, Maryland, USA </title></titles><dates><year>2013</year></dates><urls></urls></record></Cite></EndNote>[16], findings of this study demonstrates that remarkable proportions of young women were at risk of encountering unplanned pregnancies because they wanted to either postpone or delay pregnancies but did not use any contraceptive. 
The study shows that the most likely group of women who are prone to using MC are young women who wanted a child after two years go by or women who did not want any child at all, followed by women who received FP methods from FP workers, who took decision together with their husbands about women�s healthcare, child�s healthcare and visiting family members or relatives, who had increasing number of living children and whose husbands were non-manual/professional workers. On the other hand, women who resided in the Sylhet division were least likely to use MC followed by those who lived in Chittagong and Dhaka division; those who did not know about their husbands� desires for children and who lived in the rural areas of the country. Several researchers showed that child spacing was the most important reason for married couples using MC and the desire of having several children was the prime reason for married couples for not using MC ADDIN EN.CITE <EndNote><Cite><Author>Mohammed</Author><Year>2014</Year><RecNum>114</RecNum><DisplayText>[20]</DisplayText><record><rec-number>114</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1447132367">114</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mohammed, Abdurahman</author><author>Woldeyohannes, Desalegn</author><author>Feleke, Amsalu</author><author>Megabiaw, Berihun</author></authors></contributors><titles><title>Determinants of modern contraceptive utilization among married women of reproductive age group in North Shoa Zone, Amhara Region, Ethiopia</title><secondary-title>Reprod Health</secondary-title></titles><periodical><full-title>Reprod Health</full-title></periodical><pages>13</pages><volume>11</volume><number>1</number><dates><year>2014</year></dates><urls></urls></record></Cite></EndNote>[20]. 
Present study revealed that women who wanted to have children after two years go by or wanted no child at all were more likely to use MC compared to those who wanted to have a child within two years. This finding is similar to previous studies conducted in Bangladesh and Uganda ADDIN EN.CITE <EndNote><Cite><Author>Asiimwe</Author><Year>2014</Year><RecNum>7</RecNum><DisplayText>[21, 22]</DisplayText><record><rec-number>7</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1446527821">7</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Asiimwe, John Bosco</author><author>Ndugga, Patricia</author><author>Mushomi, John</author><author>Ntozi, James Patrick Manyenye</author></authors></contributors><titles><title>Factors associated with modern contraceptive use among young and older women in Uganda; a comparative analysis</title><secondary-title>BMC public health</secondary-title></titles><periodical><full-title>BMC Public Health</full-title></periodical><pages>926</pages><volume>14</volume><number>1</number><dates><year>2014</year></dates><isbn>1471-2458</isbn><urls></urls></record></Cite><Cite><Author>Islam</Author><Year>2017</Year><RecNum>190</RecNum><record><rec-number>190</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1495903828">190</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Islam, Ahmed Zohirul</author><author>Rahman, Mosiur</author><author>Mostofa, Md Golam</author></authors></contributors><titles><title>Association between contraceptive use and socio-demographic factors of young fecund women in Bangladesh</title><secondary-title>Sexual &amp; Reproductive Healthcare</secondary-title></titles><periodical><full-title>Sexual &amp; Reproductive Healthcare</full-title></periodical><dates><year>2017</year></dates><isbn>1877-5756</isbn><urls></urls></record></Cite></EndNote>[21, 22]. Studies suggest that costs of higher education, costs of living, and goals and desires of career progression and development increase the likelihood of women conceiving later than they would have had these factors been absent ADDIN EN.CITE <EndNote><Cite><Author>OsayiOsemwenkha</Author><Year>2004</Year><RecNum>140</RecNum><DisplayText>[23]</DisplayText><record><rec-number>140</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1456992740">140</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>OsayiOsemwenkha, Sylvia</author></authors></contributors><titles><title>Gender issues in contraceptive use among educated women in Edo state, Nigeria</title><secondary-title>African health sciences</secondary-title></titles><periodical><full-title>African health sciences</full-title></periodical><pages>40-49</pages><volume>4</volume><number>1</number><dates><year>2004</year></dates><isbn>1680-6905</isbn><urls></urls></record></Cite></EndNote>[23]. Young women express their desires of not conceiving at an early age due to the sacrifices that come with being a mother, like giving up education, and being too young to take care of a toddler and raise a child ADDIN EN.CITE <EndNote><Cite><Year>2012</Year><RecNum>160</RecNum><DisplayText>[24]</DisplayText><record><rec-number>160</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1466762713">160</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors></contributors><titles><title>United Nations. Goal 5: Improving maternal health</title></titles><dates><year>2012</year></dates><urls></urls></record></Cite></EndNote>[24]. 
This study indicates that getting FP methods from FP workers have significant effects on MCU because the likelihood of using MC increased among women who were given FP methods by the FP workers. Consistently, other studies undertaken in Bangladesh and Cambodia show that  activities undertaken by FP workers and married women�s access to FP related information are significantly associated with increased use of modern contraceptives ADDIN EN.CITE <EndNote><Cite><Author>Rahman</Author><Year>2010</Year><RecNum>148</RecNum><DisplayText>[11, 25]</DisplayText><record><rec-number>148</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1458380552">148</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rahman, MM</author><author>Islam, AZ</author><author>Islam, MR</author></authors></contributors><titles><title>Rural-urban differentials of knowledge and practice of contraception in Bangladesh</title><secondary-title>Journal of Population and Social Studies</secondary-title></titles><periodical><full-title>Journal of Population and Social Studies</full-title></periodical><pages>87-110</pages><volume>18</volume><number>2</number><dates><year>2010</year></dates><urls></urls></record></Cite><Cite><Author>Thou</Author><Year>2008</Year><RecNum>170</RecNum><record><rec-number>170</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1466837566">170</key></foreign-keys><ref-type name="Thesis">32</ref-type><contributors><authors><author>Thou, Chourn</author></authors></contributors><titles><title>Factors influencing modern contraceptive use among currently married women in Cambodia</title></titles><dates><year>2008</year></dates><publisher>MAHIDOL UNIVERSITY</publisher><urls></urls></record></Cite></EndNote>[11, 25].
Women who were under collective decision-making with their husbands on their own health care, child health care as well as on visiting family members or relatives were more likely to use MC than those who took decision alone about these issues. Studies suggest that gender equality is likely to boost women�s independence and is likely to increase the usage of MC. This is because increased women freedom is likely to increase women participation in decision making ADDIN EN.CITE <EndNote><Cite><Author>Hakim</Author><Year>2003</Year><RecNum>63</RecNum><DisplayText>[26]</DisplayText><record><rec-number>63</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1446610598">63</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hakim, Abdul</author><author>Salway, Sarah</author><author>Mumtaz, Zubia</author></authors></contributors><titles><title>Womens autonomy and uptake of contraception in Pakistan</title><secondary-title>Asia-Pacific Population Journal</secondary-title></titles><periodical><full-title>Asia-Pacific Population Journal</full-title></periodical><pages>63-82</pages><volume>18</volume><number>1</number><dates><year>2003</year></dates><urls></urls></record></Cite></EndNote>[26]. Besides, male involvement in sharing the responsibility of practicing and supporting family planning is identified as a vital strategy in growing the contraceptive prevalence rate. Asian countries, in particular, have reproductive health services and family planning services designed primarily for women ADDIN EN.CITE <EndNote><Cite><Author>Manaf</Author><Year>2010</Year><RecNum>165</RecNum><DisplayText>[27]</DisplayText><record><rec-number>165</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1466766412">165</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Manaf, AR</author><author>Manaf, M</author></authors></contributors><titles><title>Male participation and sharing of responsibility in strengthening family planning activities in Malaysia </title><secondary-title>Malaysian Journal of Public Health Medicine</secondary-title></titles><periodical><full-title>Malaysian Journal of Public Health Medicine</full-title></periodical><pages>23-27</pages><volume>10</volume><number>1</number><dates><year>2010</year></dates><urls></urls></record></Cite></EndNote>[27]. Therefore, involving men in FP programmes needs widespread approach from policy to infrastructure and service delivery ADDIN EN.CITE <EndNote><Cite><Author>Manaf</Author><Year>2010</Year><RecNum>165</RecNum><DisplayText>[27]</DisplayText><record><rec-number>165</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1466766412">165</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Manaf, AR</author><author>Manaf, M</author></authors></contributors><titles><title>Male participation and sharing of responsibility in strengthening family planning activities in Malaysia </title><secondary-title>Malaysian Journal of Public Health Medicine</secondary-title></titles><periodical><full-title>Malaysian Journal of Public Health Medicine</full-title></periodical><pages>23-27</pages><volume>10</volume><number>1</number><dates><year>2010</year></dates><urls></urls></record></Cite></EndNote>[27].
Present study demonstrates that women in Sylhet, Chittagong, Dhaka and Rangpur division were less likely to use modern contraceptives compared to women in Barisal division. Rural residents are less likely to use contraceptives in comparison to urban residents. Studies suggest that cultural beliefs like value attached to child, the quality of reproductive health care services ADDIN EN.CITE <EndNote><Cite><Author>Tsui</Author><Year>1992</Year><RecNum>173</RecNum><DisplayText>[28]</DisplayText><record><rec-number>173</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1466838954">173</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Amy Ong Tsui</author><author>Luis Hernando Ochoa</author></authors></contributors><titles><title>The Role of Family Planning Programs as a Fertility Determinant. In Service Proximity as a Determinant of Contraceptive Behavior : Evidence from Cross-National Studies of Survey Data. Edited by J.P. J.Ross. London: Oxford University Press</title></titles><dates><year>1992</year></dates><urls></urls></record></Cite></EndNote>[28], the physical characteristics of the area, and the presence of transport routes ADDIN EN.CITE <EndNote><Cite><Author>Nielsen</Author><Year>2012</Year><RecNum>89</RecNum><DisplayText>[29, 30]</DisplayText><record><rec-number>89</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1447130049">89</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Nielsen, Karoline Kragelund</author><author>Nielsen, Siff Malue</author><author>Butler, Robb</author><author>Lazarus, Jeffrey V</author></authors></contributors><titles><title>Key barriers to the use of modern contraceptives among women in Albania: a qualitative study</title><secondary-title>Reproductive health matters</secondary-title></titles><periodical><full-title>Reproductive health matters</full-title></periodical><pages>158-165</pages><volume>20</volume><number>40</number><dates><year>2012</year></dates><isbn>0968-8080</isbn><urls></urls></record></Cite><Cite><Author>Stephenson</Author><Year>2007</Year><RecNum>174</RecNum><record><rec-number>174</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1466839120">174</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Stephenson, Rob</author><author>Baschieri, Angela</author><author>Clements, Steve</author><author>Hennink, Monique</author><author>Madise, Nyovani</author></authors></contributors><titles><title>Contextual influences on modern contraceptive use in sub-Saharan Africa</title><secondary-title>American journal of public health</secondary-title></titles><periodical><full-title>American journal of public health</full-title></periodical><pages>1233-1240</pages><volume>97</volume><number>7</number><dates><year>2007</year></dates><isbn>0090-0036</isbn><urls></urls></record></Cite></EndNote>[29, 30] are some of the factors that influence the use of contraceptives in different cultures and regions.
The likelihood of using MC decreased among women who did not know about their husbands� desires for having children in comparison to women who shared the same feelings regarding parenthood as their husbands. Women whose husbands did professional jobs were more likely to use MC compared to women whose husbands were manual workers. 
This study revealed that number of living children played a significant role in contraceptive use since the likelihood of using modern contraceptive was increased with increasing the number of children. This finding is in line with previous reports from Bangladesh and Tanzania ADDIN EN.CITE <EndNote><Cite><Author>Lwelamira</Author><Year>2012</Year><RecNum>175</RecNum><DisplayText>[22, 31]</DisplayText><record><rec-number>175</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1466839306">175</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lwelamira, J</author><author>Mnyamagola, G</author><author>Msaki, MM</author></authors></contributors><titles><title>Knowledge, Attitude and Practice (KAP) towards modern contraceptives among married women of reproductive age in Mpwapwa District, Central Tanzania</title><secondary-title>Current Research Journal of Social Sciences</secondary-title></titles><periodical><full-title>Current Research Journal of Social Sciences</full-title></periodical><pages>235-245</pages><volume>4</volume><number>3</number><dates><year>2012</year></dates><isbn>2041-3246</isbn><urls></urls></record></Cite><Cite><Author>Islam</Author><Year>2017</Year><RecNum>190</RecNum><record><rec-number>190</rec-number><foreign-keys><key app="EN" db-id="fes2twdwrwfv2ke2at7v5ztla2e5pvt0d9v0" timestamp="1495903828">190</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Islam, Ahmed Zohirul</author><author>Rahman, Mosiur</author><author>Mostofa, Md Golam</author></authors></contributors><titles><title>Association between contraceptive use and socio-demographic factors of young fecund women in Bangladesh</title><secondary-title>Sexual &amp; Reproductive Healthcare</secondary-title></titles><periodical><full-title>Sexual &amp; Reproductive Healthcare</full-title></periodical><dates><year>2017</year></dates><isbn>1877-5756</isbn><urls></urls></record></Cite></EndNote>[22, 31]. Our study also described that the likelihood of using MC decreased with increasing age and increased with increasing age at marriage. Therefore, this study suggests that establishing youth-friendly service centers in suitable places and giving necessary materials would encourage young people to use reproductive health services. 

Limitations
There may be possibility of threats to internal validity. Firstly, major portions of the observations were dropped (approximately 79%) during data cleaning because this study considered only currently married, non-pregnant and fecund young women. Therefore, this study would suffer from the selection bias. Secondly, personal opinions of interviewers would have biased the information. However, according to the BDHS, interviewers were provided sincere training for implementing the survey based on a training manual especially developed to enable the field staff to collect data in a friendly, secure, and ethical manner.

Finally, there may be a possibility of threat to external validity, although nationally representative data set was employed, this study cannot be generalized to all women in Bangladesh because it focused on only currently married and fecund young women. However, this study has its strengths also. Since a nationally representative dataset is used in this study, findings could be a true representation of the situation of this sub-group of women. Moreover, international comparisons of results are possible as DHS surveys take up similar instruments across the countries.

Conclusions
Desire for a child after two years go by or want no child at all contributed the most to increasing MCU, followed by getting FP methods from FP workers. Women who have an equal say in decision making matters regarding their own healthcare, child�s healthcare and visiting family members or relatives are the next group of women most likely to use MC. Since a noticeable portion of currently married fecund non-pregnant young women want to either postpone or delay pregnancies but does not use contraceptives, this study suggests a qualitative study to investigate in depth why this sub-group of women do not use contraceptives. This study also suggests that family planning interventions should be tailored introducing reproductive and sex education in schools to prepare the young for healthy and responsible living. Besides, policy makers should focus on developing negotiation skills in young people by creating educational and employment opportunities since husband-wife joint decision making power increases contraceptive use. Comparison between young and adult women about contraceptive discontinuation and switching of methods would be our future research.

Abbreviations
MCU, modern contraceptive use; MC, modern contraceptives; FP, family planning; BDHS, Bangladesh demographic and health survey; CI, confidence interval; OR, odds ratio

Acknowledgements
I would like to acknowledge Dr. Md. Golam Mostofa, Department of Population Science and Human Resource Development, University of Rajshahi, Bangladesh, Dr. Serap Emil, Middle East Technical University, Turkey and Shahidul Islam, Bangor Business School, Bangor University, United Kingdom for their valuable suggestions in preparing the manuscript.

Funding
None

Availability of data and materials
The dataset is available to registered users in  HYPERLINK "http://dhsprogram.com/data/available-datasets.cfm" http://dhsprogram.com/data/available-datasets.cfm

Authors� contributions
Not applicable

Competing interests
The author declares that he has no competing interests.

Consent for publication
Not applicable

Ethics approval and consent to participate
The BDHS data collection procedures were approved by the ORC Macro Institutional Review Board (Calverton, MD, USA). The protocol of the survey was reviewed and approved by the National Ethics Review Committee of the Bangladesh Ministry of Health and Family Welfare. Informed consent was obtained from each of the participants before the interview.

Author details
aAssistant Professor, Department of Population Science and Human Resource Development
University of Rajshahi, Rajshahi-6205, Bangladesh.

References

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