Impact of internal female migration on unmet need for modern contraception in Zambia.

BACKGROUND: Unmet need for contraception, the proportion of women who want to limit or delay childbirth but use no form of contraception, is the core indicator to evaluate the effectiveness of family planning programs. Understanding how migration influences unmet need is important to identify to whom and how to target sexual and reproductive health programs. We assessed how migration status in rural and urban settings is associated with having an unmet need for family planning. METHODS: Data on sexually active, fecund, reproductive-aged (15-49 years) women from the 2013-14 Zambia Demographic and Health Survey were analysed through univariate and multivariate logistic regression models. RESULTS: Unmet need for modern contraceptive methods was significantly higher among rural to rural migrant women (OR 1.30, 95%CI 1.00-1.70 p < 0.05) and rural non-migrant women (OR 1.41, 95%CI 1.06-1.85 p < 0.01) compared to urban non-migrant women after controlling for age, marital status, parity, religion, education and wealth. CONCLUSION: Women residing in, and migrating between, rural areas were significantly more likely to have an unmet need for contraception. Our findings highlight the importance of understanding migration and migrant streams to strengthen family planning programs. In Zambia, a focus on rural-rural migrants, rural non-migrants and the poorest could improve the health of the entire population.