Inequalities in modern contraceptive use among men: a HEAT Plus analysis of population-based cross-sectional surveys in East Africa

Abstract

Male involvement is essential for effective family planning, yet men in most of sub-Saharan Africa remain less engaged than women. Their participation is shaped by the socioeconomic context, but evidence on how modern contraceptive use varies across socioeconomic groups among men is limited. This study therefore examined socioeconomic inequalities in modern contraceptive use among men in East Africa. This study analyzed weighted, nationally representative Demographic and Health Survey data from two survey rounds per country for sexually active men aged 15–54 years in Burundi (2010 and 2016), Kenya (2014 and 2022), Rwanda (2014 and 2019), Tanzania (2010 and 2022), and Uganda (2011 and 2016). Inequalities in modern contraceptive use were assessed using HEAT Plus, applying simple (Difference) and complex (Population Attributable Fraction) measures. Modern contraceptive use among men varied across the five countries. Burundi recorded a modest increase between 2010 and 2016, Rwanda and Uganda showed a consistent increase, while Tanzania and Kenya experienced declines between 2014 and 2022. Across the five countries, education, place of residence, wealth index, and decision making on how to spend earnings emerged as the most salient dimensions of inequality in modern contraceptive use among men. Education-related inequalities were particularly pronounced, with PAF estimates indicating that national levels of modern contraceptive use could have been higher by up to about 34.6% in Burundi in 2016, 20.8% in Uganda in 2016, 15.3% in Tanzania in 2022, 8.5% in Kenya in 2022, and 5.6% in Rwanda in 2019 had educational disparities been eliminated. Family planning strategies should prioritize men as direct users of contraception by targeting educational, economic, and access related inequalities, with tailored approaches for men with lower education, those in rural, and poorer settings.