Sage Journals: Discover world-class research

Abstract

In sub-Saharan Africa, there are different studies on contraceptive use and associated factors among people with disabilities. However, the findings are inconsistent and inconclusive. This study aimed to estimate the pooled prevalence of contraceptive use and associated factors among women with disabilities in sub-Saharan Africa. Comprehensive search was performed from different databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline was followed to report the results. The data were analyzed by using STATA software. Heterogeneity and publication bias was checked. The pooled odds ratio (POR) with a 95% confidence interval (CI) was used to report the measures of associations. The pooled prevalence of contraceptive use was 25.61% (95% CI: 20.68, 30.54). Being married (POR = 2.96; 95% CI: 1.31, 4.62), high income (POR = 2.20; 95% CI: 1.42, 2.97), having media access (POR = 1.74; 95% CI: 1.24, 2.23), being in the age group of 25–34 (POR = 2.52; 95% CI: 1.01, 3.94), vision impairment (POR = 3.82; 95% CI: 2.05, 5.59), good contraceptive knowledge (POR = 2.09; 95% CI: 1.27, 2.91), primary education (POR = 1.82; 95% CI: 1.25, 2.39), secondary education (POR = 2.31; 95% CI: 1.03, 3.59) and tertiary educational status (POR = 3.37; 95% CI: 1.28, 5.46) were factors associated with contraceptive use. Contraceptive use among women with disabilities is considerably low in sub-Saharan Africa. The use of contraceptives is primarily dependent on socio-demographic and economic status.

Keywords

Disability contraceptive utilization associated factors sub-Sahara Africa meta-analysis

Introduction

The definition of disabilities varies from country to country specifically in its meaning, scope, and severity.^1,2 World Health Organization (WHO) defines disabilities as; any impairment of a person’s body function or structure or mental functioning, activity limitation, and participation restriction (environmental factors).²

Worldwide, more than one billion (15%) of the world population are people with disabilities, of which 75%−80% are from developing countries.³ This population is the most discriminated against and marginalized group from contraceptive use in many countries, mainly in sub-Saharan African countries.^4
–6

Contraception is the intentional prevention of pregnancy by using different contraceptive methods like chemicals, drugs and surgical procedures.⁷ Although access and utilization of contraceptives is a reproductive right, its coverage remains undoubtedly low in people with disabilities. There is also considerable variation in the prevalence in which prevalence of contraceptive use in developing countries is significantly lower than the developed ones. This is corroborated by the following findings: the prevalence was 70.1%⁸ in the United States of America, 67.4%⁹ in Turkey, 17%¹⁰ in Ghana, 34%¹¹ to 51%¹² in Nigeria, 26.1%¹³ in Uganda, 16%¹⁴ in Kenya 26.9%¹⁵ in Sierra Leon, and 18%¹⁶ to 34%¹⁷ in Ethiopia.

Moreover, multitudes of factors associated with contraceptive use among people with disabilities were identified in sub-Saharan African countries (Sierra Leon, Uganda, Kenya, and Ethiopia). Among the factors; are access to media, marital status, working actively, income, age, ANC follow-up, types of disabilities, women’s attitude toward family planning methods, knowledge about family planning, the presence of nearby health facilities providing planning of family services, keeping confidentiality and privacy by the health facility, having good self-perception, educational and economic status were the most commonly identified factors.^14,16
–20

However, the findings of the primary studies are very inconsistent. Contraceptive use ranges from 10%²¹ in Nigeria to 45.4%²² in Ethiopia. Likewise, the identified associated factors vary from country to country. Thus, computing the pooled prevalence of contraceptive use and associated factors among people with disabilities is very crucial for the scientific community, policymakers, and program designers to develop strategies that could tackle contraceptive use barriers.

Therefore, this study aimed to estimate the pooled prevalence of contraceptive use and identify the factors associated with contraceptive use among people with disabilities in sub-Saharan Africa.

Significance for public health

To date the prevalence of contraceptive use and associated factors among people with disabilities in sub-Saharan Africa. And the findings of this study will be informative to take prompt measures.

Methods

Searching strategies and data sources

We included articles published from 2011 to January 2022 and searched from different databases (PubMed (contains MEDLINE), Cochran Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO), WHO’s Institutional Repository for Information Sharing (IRIS), African Journals Online (AJOL)). Grey literature sources such as Google Scholar Google, Elsevier’s Scirus, science citation index and WorldCat were also explored to retrieve articles. The reference lists of included articles and previous reviews were cross-checked to identify additional articles. Articles were managed using EndNote X20 software. All retrieved articles were exported to this software and the removal of duplicated articles and reference citations was performed using this software. The Boolean search operators such as “AND,” and “OR” were used during the search process. Before the actual search, key terms were verified for appropriateness. The following search string was employed to search articles from PubMed:

((((((“prevalence”[Title] OR “magnitude”[Title] OR “coverage”[Title] OR “utilization”[Title] OR “determinants”[Title] OR “associated factors”[Title]) AND “Contracepti*” OR “family planning” AND “disab*”[Title] AND “Africa” OR “sub-Saharan Africa”[Title] OR “developing countries”[Title] OR “low income countries” AND (“humans”[MeSH Terms] AND “female”[MeSH Terms] AND 2011/01/01:3000/12/12[Date - Publication]))[Title])[Title])[Title])[Title]) AND ((humans [Filter]) AND (female [Filter]) AND (2011:3000/12/12[pdat]))

Finally, the Population (people with disabilities) and Outcome (Contraceptive use and associated factors) were followed in the search process.

Inclusion and exclusion criteria

The two authors (Zelalem Tenaw & Zebenay Workneh Bitew) selected the articles included in this study by exploring the title, abstract, study country, study population, and study design of the articles. In this study, observational studies (cross-sectional, case-control, cohort) reporting contraceptive use and factors were included. To compute the pooled odds ratio (POR), the crude odds ratio (COR) reported by the primary studies was used and studies using odds ratio (OR) to report the association were included. Studies not reporting the outcome of interests, systematic reviews and meta-analyses, non-human studies, qualitative studies, case reports, conference proceedings, case series, double publications using similar data, editorial comments, and studies conducted other than in the English language were excluded from the current study.

Data extraction procedure

The data were extracted from the included articles by using a standard tool prepared in Microsoft Excel 2013. The two investigators (ZT & ZWB), extracted the data independently. The data were cleaned and ready for the final analysis after extraction using the spreadsheet. The data extraction format included: the name of the author (s), publication year, study country, study design, calculated sample sizes, the prevalence of contraceptive use, and associated factors with contraceptive use with odds ratio.

Quality assessment

Quality appraisal was done by two authors (Zelalem Tenaw & Zebenay Workneh Bitew) independently using Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Observational Studies.²³ The checklists have: Yes, No, Unknown, and Not Applicable options. One is given for yes and zero for all other options. The scores were summed up and changed into percentages. Studies with a quality score of >50% were included in the current study (see S2 Table). Before the inclusion of articles, differences between the authors in the quality assessment process were solved through discussion.

Outcome measurement

In this study, identifying the associated factors with contraceptive use was the primary outcome. The other outcome was computing the pooled prevalence of contraceptive use among people with disabilities in sub-Saharan Africa. The associated factors with contraceptive use were identified using PORs with a 95% confidence interval. Variables with a pooled odds ratio (POR) not containing one in the 95% CI were taken as the independently associated factors.

Statistical methods and analysis

STATA Version 16 (STATA Corporation, College Station Texas) software was used to compute the pooled odds ratio. The effect sizes were the log odds ratios indicating the associated factors with contraceptive use among people with disabilities in sub-Saharan Africa. The log odds ratios were converted to an exponent of log odds (POR = e^lo^gOR) to report the associated factors. Pooled estimates were computed by using both random and fixed-effect models. However, a random-effect model was used to report the final pooled estimates due to high heterogeneity among the included studies. By using subgroup and univariate Meta-regression, the possible sources of heterogeneities among the included studies were checked. The pooled estimates were presented with their 95% CI. The results of this study were presented using texts, forest plots, and summary tables.

Publication bias and heterogeneity

The presence of publication bias was checked by looking at the symmetry of the funnel plot. If there is publication bias, the funnel plot is asymmetric and confirmed by Egger’s regression test at a p-value < 0.05.²⁴ Heterogeneity (I²) is the variation in study outcomes between studies.²⁵ To detect heterogeneity among studies, a forest plot test and the Cochrane Q statistics and I² were used.²⁶ The I² values of 25% was interpreted as low, 50% as medium, and 75% and above as high.²⁷

Ethical consideration: Not applicable

Results

Identification of articles

In the initial search of this systematic review and meta-analysis, 4388 articles were found from reputable databases and grey literature sources. Finally, 13 articles^{10,11,13,15
–22,28,29} were found eligible for this study. Of these articles, six articles were excluded from meta-analyses.^{10,11,21,22,28} To estimate the pooled prevalence of contraceptive use among people with disabilities in sub-Saharan Africa, all 13 articles were fitted (Figure 1).

Figure 1.

PRISMA flow chart of study selection for a systematic review and meta-analysis of prevalence and associated factor with contraceptive use among people with disabilities in sub-Sahara Africa, 2022.

Description of articles

In this systematic review and meta-analysis, 13 articles were included. The pooled prevalence of contraceptive use was computed from 6434 study populations. The sample size of the original articles ranged from 174²² to 1880.¹⁰ Articles published from 2011 to 2021 were included in this study. The lowest prevalence(10%) of contraceptive use was reported in a study conducted among adolescents with learning disabilities in Nigeria,²¹ whereas the highest prevalence (45.4%) was reported in a study done in Ethiopia among youth with disabilities.²² Although the inclusion criteria considered all observational studies, all the studies included in this systematic review and meta-analysis were cross-sectional studies. Four studies were conducted among women with disabilities and three studies among reproductive-age women with disabilities. Likewise, a single study was conducted among each; blind and deaf women, an adolescent with learning disabilities, people with disability, youth with disability, reproductive age with a disability, adolescents with physical disabilities, and young people with disability. Of the total 13 articles, seven were conducted in Ethiopia, two in Nigeria, and others in conducted in Sierra Leon, Kenya, Uganda, and Ghana. Finally, by using the JBI checklist the qualities of articles were appraised. Accordingly, six articles were classified as high quality, whereas seven articles were classified as medium quality.

The pooled prevalence of contraceptive use

The pooled prevalence of contraceptive use was 25.61% (95% CI: 20.68, 30.54) in a random effect model with a remarkable heterogeneity among the included articles (I² = 99.99%, p < 0.001) (Figure 2). Both the funnel plot and egger’s test (p = 0.02) showed the presence of publication bias. Univariatemeta-regression was performed to check the possible effect of sample size on heterogeneity, and it was found to be a significant source of heterogeneity (p < 0.001).

Figure 2.

Forest plot for the pooled prevalence of contraceptive use among people with disabilities in sub-Sahara Africa, 2022.

Sub-group analysis of contraceptive use among people with disabilities in sub-Sahara Africa

The subgroup analysis was done based on the country and the study population. Based on the country analysis the highest prevalence was recognized in Ethiopia (28.98%, 95% CI: 24.36, 33.60) of people with disabilities were found to use contraceptives. Regarding the study population, the highest prevalence of contraceptive use was 45.40 (44.83, 45.97) among youth with disabilities (Table 1).

Table 1.

Sub-group analysis of contraceptive use among people with disabilities in sub-Sahara Africa, 2022.

Variables	Subgroup	No of studies	Contraceptive use (95% CI)	I², p-value
Country	Sierra Leon	01	26.90 (26.70, 27.10)	-
	Nigeria	02	22 (−1.52, 45.52)	(100%, <0.001)
	Ethiopia	07	28.98 (24.36, 33.60)	(100%, <0.001)
	Ghana	01	17 (16.94, 17.06)	-
	Kenya	01	16 (15.75, 16.25 )	-
	Uganda	01	26.10 (26.02, 26.18)	-
	Overall heterogeneity			(99.99%. <0.001)
Population	Women with disabilities	04	26.29 (26.19, 26.38)	(100%, <0.001)
	People with disability	01	26.90 (26.70, 27.10)	-
	Adolescents with learning disabilities	01	10 (9.73, 10.27)	-
	Youth with disability	01	45.40 (44.83, 45.97)	-
	Reproductive age people with disability	01	24.50 (24.28, 24.72)	-
	Reproductive age women with disabilities	03	26.73 (26.66, 26.80)	(99.9%, <0.001)
	Blind and deaf	01	31.10 (30.83, 31.37)	-
	Adolescents with physical disabilities	01	34 (33.57, 34.43)	-
	Young people with disabilities	01	17 (16.94, 17.06)	-
	Overall heterogeneity			(99.99%. <0.001)

Factors associated with contraceptive use among people with disabilities

Of the associated factors with contraceptive use, being married (POR = 2.96; 95% CI: 1.31, 4.62), high income (POR = 2.20; 95% CI: 1.42, 2.97) relative to poor, having media access (POR = 1.74; 95% CI: 1.24, 2.23), being in the age group of 25–34 (POR = 2.52; 95% CI: 1.01, 3.94), compared to age 15–24, vision impairment (POR = 3.82; 95% CI: 2.05, 5.59) relative to deaf, good contraceptive knowledge (POR = 2.09; 95% CI: 1.27, 2.91) compared with poor contraceptive knowledge, primary education (POR = 1.82; 95% CI: 1.25, 2.39), secondary education (POR = 2.31; 95% CI: 1.03, 3.59) and tertiary educational status (POR = 3.37; 95% CI: 1.28, 5.46) compared with no education were the significant associated factors with contraceptive use among people with disabilities in sub-Sahara Africa (See S1 Figures, Table 2).

Table 2.

Factors associated with contraceptive use among people with disabilities in sub-Sahara Africa, 2022.

Factors	Number of articles	POR	Heterogeneity (I², p-value & model)	Reference category
Married	07	2.96 (1.31, 4.62)*	(84.39%, p < 0.001, REM)	Unmarried
Primary education	04	1.82 (1.25, 2.39)*	(0.00%, p < 0.001, REM)	No education
Secondary education	04	2.31 (1.03, 3.59)*	(64.66%, p = 0.01, REM)	No education
Tertiary education	04	3.37 (1.28, 5.46)*	(60.22%, p = 0.01, REM)	No education
Actively working	02	0.69 (0.06, 1.33)	(0.00%, p = 0.09, REM)	Not working
Age 25–35	02	3.04 (0.09, 5.99)	(52.37, p = 0.02, REM)	Age 15–24
High income	03	1.31 (0.53, 2.07)*	(53.53%, p < 0.001, REM)	Poor
Middle income	04	1.31 (0.53, 2.07)	(53.53%, p = 0.02, REM)	Poor
Media access	02	1.74 (1.24, 2.23)*	(0.00%, p < 0.001, REM)	No access
Health facility access without difficulty	02	4.64 (−0.89, 10.17)	(75.12%, p < 0.001, REM)	No access
Age 25–34	02	2.52 (1.01, 3.94)*	(5.51%, p < 0.001, REM)	Age 15–24
Vision impairment	02	3.82 (2.05, 5.59)*	(0.00%, p < 0.001, REM)	Deaf
Good contraceptive knowledge	03	2.09 (1.27, 2.91)*	(0.00%, p < 0.001, REM)	Poor knowledge

POR: pooled odds ratio; REM: random effect model.

Significant at p < 0.05.

Discussion

The pooled prevalence of contraceptive use among people with disabilities in sub-Saharan Africa was 25.61%%. Marital status, educational level and status, income, media access, age group, types of impairment, and contraceptive knowledge are the identified associated factors with contraceptive use among people with disabilities in sub-Saharan Africa. Country, types of disability, and sample size are found to be the source of the heterogeneity.

This pooled prevalence (25.61%) is lower than the findings of studies conducted in the United States of America 70.1%.⁸ The possible explanation for the discrepancies might be associated with the difference in the sample size (744 in the USA and 6434 in this study)⁸ and maybe the socio-cultural differences in the study population. People with disabilities in developing countries are considered sexually inactive and marginalized in the use of contraceptives.^30
–32 The sub-group analysis showed that there is a significant difference in contraceptive use among sub-Saharan African countries and types of people with disabilities. The highest contraceptive use was found in Ethiopia 28.98%, but the lowest contraceptive use 10% was reported in Kenya. The pooled prevalence revealed that there is a noticeable difference between youth with disability (45.4%) and adolescents with learning disability (10%) in contraceptive use. The possible reason for this difference might be the poor understanding and communication ability of adolescents with learning disabilities about the importance and use of contraceptive.²¹

In this study, married people with disabilities have a higher chance of contraceptive use than unmarried people with disabilities. The disparity could be that people with disabilities have a higher desire to prevent pregnancy,³³ and husbands’ involvement and encouragement might increase the use of contraceptives.¹⁷ The other significantly associated factors with contraceptive use among people with disabilities are educational level. People with disabilities who attended primary, secondary and tertiary education have a greater chance of contraceptive use compared to their counterparts with no education. This could be because education is the key to seeking information and eradicating traditional thoughts about bad rumors about the side effects and safety of using contraceptives.^16,34 Good contraceptive knowledge is the other associated factor with contraceptive use when compared with those having poor contraceptive knowledge. The reason seems justifiable since knowledge has a positive influence on the use of contraceptives.³⁵ The other associated factor is media access, the chance of contraceptive use increased with media access. Since media access is used to have information about different issues like the advantage of using contraceptives.¹⁶ High income is the other associated factor with contraceptive use when compared with low income. The possible reason might be the increments in contraceptive provision by private health sectors and the uncontrolled payment for the services.^36,37 Being in the age group of 25 to 34 increased the chance of contraceptive use when compared with the 15 to 24 age group. The possible justification might be the increased chance of marriage and having unprotected sexual intercourse will increase. Due to the higher desire to prevent pregnancy³³ among people with disabilities the chance of using contraceptives will increase. People with visual impairment have a better chance of using contraceptives compared with people with hearing impairment. The possible reason might be that people with visual impairment had better information access from different channels like radio channels than people with hearing impairment.¹⁶ Radio is the most available and important channel to access different information that is used to change the behavior of individuals to use contraceptives in developing countries.

These findings may be used by policymakers, program planners, and researchers. On the other hand, multiple sources were explored to identify research articles. However, articles included in this study assessed different study populations (people with disability, women with disability, adolescents with disability, youth with disability, reproductive-age people with disability, reproductive-age women with disability, blind and deaf women, adolescents with physical disabilities, and young people with disability) to estimate contraceptive use. This is one of the limitations of this study because the higher heterogeneity in the pooled estimates originated from this problem. And also, the study period interval from 2011 to 2021 is too long and seems unreasonable to pool the prevalence of contraceptive use, but due to the attention given and the accessibility of contraceptive to people with disabilities are not shown a great difference between the study periods. Therefore, the pooling of the prevalence could be reasonable and useful.³⁸

Conclusion

Contraceptive use among people with disabilities is considerably low in sub-Saharan Africa. Being married, having good contraceptive knowledge, having a high income, having media access, being in the age group of 25–34, having vision impairment, and attending primary, secondary and tertiary education levels increased the use of contraceptives among people with disabilities. Therefore, policy makers have to encourage education for people with disabilities, design appropriate media access for people with disabilities, involve people with disabilities in income-generating activities to enhance contraceptive use in sub-Saharan Africa.

Supplemental Material

sj-docx-1-phj-10.1177_22799036231204330 – Supplemental material for Contraceptive use among people with disabilities in sub-Sahara Africa: A systematic review and meta-analysis

Supplemental material, sj-docx-1-phj-10.1177_22799036231204330 for Contraceptive use among people with disabilities in sub-Sahara Africa: A systematic review and meta-analysis by Zelalem Tenaw, Taye Gari, Zebenay Workneh Bitew and Achamyelesh Gebretsadik in Journal of Public Health Research

Supplemental Material

sj-docx-2-phj-10.1177_22799036231204330 – Supplemental material for Contraceptive use among people with disabilities in sub-Sahara Africa: A systematic review and meta-analysis

Supplemental material, sj-docx-2-phj-10.1177_22799036231204330 for Contraceptive use among people with disabilities in sub-Sahara Africa: A systematic review and meta-analysis by Zelalem Tenaw, Taye Gari, Zebenay Workneh Bitew and Achamyelesh Gebretsadik in Journal of Public Health Research

Footnotes

Acknowledgements

We authors thank the primary authors who published the articles included in this study.

Authors’ contributions

ZT, AG, TG and ZWB designed the review. ZT and ZWB conduct a comprehensive search and extract data. ZT analyze and writes the manuscript. AG, TG and ZWB comment on and edited the manuscript.

Data availability

All the data are included in the manuscript (tables and graphs) and with the Supplemental Files

Disclaimer

The view expressed in the submitted article is the author’s own.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Supplemental material

Supplemental material for this article is available online.

References

United Nations. Disability and Development Report New York: Department of economic and social affairs; 2018.

World Health Organization. Towards a common language for functioning, disability, and health: ICF. Geneve: World Health Organization, 2002.

Zziwa

Babikako

Kwesiga

, et al. Prevalence and factors associated with utilization of rehabilitation services among people with physical disabilities in Kampala, Uganda. A descriptive cross sectional study. BMC Public Health 2019; 19(1): 1742–1811.

MacKay

The United Nations Convention on the rights of persons with disabilities. J Int Law Commer 2006; 34: 323.

Hosseinpoor

Stewart Williams

Gautam

, et al. Socioeconomic inequality in disability among adults: a multicountry study using the World Health Survey. Am J Public Health 2013; 103(7): 1278–1286.

Girma Garo

Garoma Abe

Dugasa Girsha

, et al. Unmet need for family planning and associated factors among currently married women of reproductive age in Bishoftu town, Eastern Ethiopia. PLoS One 2021; 16(12): e0260972–NaN16.

Jain

Muralidhar

Contraceptive methods: needs, options and utilization. J. Obstet. Gynecol. India 2011; 61(6): 626–634.

Haynes

Boulet

Fox

, et al. Contraceptive use at last intercourse among reproductive-aged women with disabilities: an analysis of population-based data from seven states. Contraception 2018; 97(6): 538–545.

Aslan

Yılmaz

Acar

Reproductive Health, sexual function and satisfaction levels in women with physical, hearing, and Visual Disabilities. Sex Disabil 2021; 39: 595–608.

10.

Kumi-Kyereme

Sexual and reproductive health services utilisation amongst in-school young people with disabilities in Ghana. Afr J Disabil 2021; 10: 671.

11.

Olajide

Omisore

Arije

, et al. Awareness and use of modern contraceptives among physically challenged in-school adolescents in Osun state, Nigeria. Afr J Reprod Health 2014; 18(2): 87–96.

12.

Ademokoya

Igbeneghu

PE.

Sexual behaviours and contraceptive use among adolescents with learning disabilities in Ibadan north local government area, Oyo state, Nigeria. Eur J Spéc Educ Res 2016; 1(2).

13.

Ayiga

Kigozi

Access to and uptake of contraception by women with Disabilities. J Soc Sci 2016; 12(4): 171–181.

14.

Mark Ooko

. Determinants of contraceptive use: a comparative study of disabled and non-disabled women in Kenya. Nairobi: University of Nairobi; 2012.

15.

Trani

J-F

Browne

Kett

, et al. Access to health care, reproductive health and disability: a large scale survey in Sierra Leone. Soc Sci Med 2011; 73(10): 1477–1489.

16.

Beyene

Munea

Fekadu

GA.

Modern contraceptive use and associated factors among women with disabilities in Gondar City, Amhara Region, North West Ethiopia: A Cross Sectional Study. Afr J Reprod Health 2019; 23(2): 101–109.

17.

Mesfin Yesgat

Gebremeskel

Estifanous

, et al. Utilization of family planning methods and associated factors among reproductive-age women with disability in Arba Minch Town, southern Ethiopia. Open Access J Contracept 2020; 11: 25–32.

18.

Kellali

Gebremariam

Fisseha

Modern contraceptive methods utilization and associated factors among women with disabilities in Mekelle Town, Tigray, Ethiopia. Int J Pharm Biol Sci Fundam 2017; 13(1): 1–8.

19.

Mekonnen

Bayleyegn

Aynalem

, et al. Level of knowledge, attitude, and practice of family planning and associated factors among disabled persons, north-Shewa zone, Amhara regional state, Ethiopia. Contracept Reprod Med 2020; 5(1): 1–7. DOI: 10.5281/zendo.60199.

20.

Yimer

Modiba

LM.

Modern contraceptive methods knowledge and practice among blind and deaf women in Ethiopia. A cross-sectional survey. BMC Womens Health 2019; 19(1): 1–13.

21.

Abiodun

Ehimhen

IP.

Sexual behaviours and contraceptive use among adolescents with learning disabilities in Ibadan north local government area, Oyo state, Nigeria. Eur J Spéc Educ Res 2016; 1(2): 50–67.

22.

Alemu

Fantahun

Sexual and reproductive health status and related problems of young people with disabilities in selected associations of people with disability, Addis Ababa, Ethiopia. Ethiop Med J 2011; 49(2): 97–108.

23.

Munn

Moola

Lisy

, et al. Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. Int J Evid Based Healthc 2015; 13(3): 147–153.

24.

Sterne

Egger

Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol 2001; 54(10): 1046–1055.

25.

Sedgwick

Meta-analyses: what is heterogeneity?

BMJ 2015; 350: h1435.

26.

Rücker

Schwarzer

Carpenter

, et al. Undue reliance on I2 in assessing heterogeneity may mislead. BMC Med Res Methodol 2008; 8(1): 79–9.

27.

Higgins

JPT

Thompson

. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21(11): 1539–1558.

28.

Tessema

Bishaw

Bunare

TS.

Assessment of the magnitude and associated factors of unmet need for family planning among women of reproductive age group with disabilities in Bahir dar City, Amhara region, north West Ethiopia. Open J Epidemiol 2015; 05(01): 51–58.

29.

Odhiambo

Determinants of contraceptive use: a comparative study of disabled and non-disabled women in Kenya. Nairob: University of Nairobi; 2012.

30.

Parnes

Cameron

Christie

, et al. Disability in low-income countries: Issues and implications. Disabil Rehabil 2009; 31(14): 1170–1180.

31.

Oliver

RL.

Varieties of value in the consumption satisfaction response. ACR North American Advances 1996; 23: 143–147.

32.

MacLachlan

Chataika

Wazakili

, et al. Facilitating disability inclusion in Poverty Reduction Processes: group consensus perspectives from Disability Stakeholders in Uganda, Malawi, Ethiopia, and Sierra Leone. disabil glob 2014; 1(1): 107–127.

33.

Casebolt

Singh

Speizer

, et al. Use of modern contraceptives by women with disabilities in Rajasthan, India: an analysis of the annual health survey. Sex Reprod Healthc 2022; 31: 100699.

34.

Horner-Johnson

Moe

Stoner

, et al. Contraceptive knowledge and use among women with intellectual, physical, or sensory disabilities: A systematic review. Disabil Health J 2019; 12(2): 139–154.

35.

Nonvignon

Novignon

Trend and determinants of contraceptive use among women of reproductive age in Ghana. Etude Popul Afr 2014; 28: 956–967.

36.

Agha

Is low income a constraint to contraceptive use among the Pakistani poor?

J Biosoc Sci 2000; 32(2): 161–175.

37.

Mohammed

Woldeyohannes

Feleke

, et al. Determinants of modern contraceptive utilization among married women of reproductive age group in North Shoa Zone, Amhara Region, Ethiopia. Reprod Health 2014; 11(1): 13–17.

38.

Seidu

A-A

Malau-Aduli

McBain-Rigg

, et al. Level of inclusiveness of people with disabilities in Ghanaian health policies and reports: A Scoping Review. Disabil 2021; 1(3): 257–277.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB