{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T23:56:13Z","timestamp":1790898973240,"version":"4.1.0"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":85,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"DOI":"10.1186\/s12889-026-28516-5","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T05:32:03Z","timestamp":1783575123000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Trends and socioeconomic inequalities in contraceptive use, skilled birth attendance, and fertility in Malawi (2015\u20132024)"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8648-1244","authenticated-orcid":false,"given":"Chimwemwe","family":"Ngoma","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"28516_CR1","doi-asserted-by":"publisher","first-page":"38","DOI":"10.3897\/popecon.10.e132902","volume":"10","author":"YV Zinkina","year":"2026","unstructured":"Zinkina YV, Goldstone JA, Shulgin SG, Korotayev AV. Why Does High African Fertility Persist? Women\u2019s Education vs. Women\u2019s Employment. Popul Econ. 2026;10:38\u201352.","journal-title":"Popul Econ"},{"key":"28516_CR2","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1186\/s12978-023-01627-7","volume":"20","author":"AC Church","year":"2023","unstructured":"Church AC, Ibitoye M, Chettri S, Casterline JB. Traditional supports and contemporary disrupters of high fertility desires in sub-Saharan Africa: a scoping review. Reproductive Health. 2023;20:86.","journal-title":"Reproductive Health"},{"key":"28516_CR3","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1186\/s12889-023-15187-9","volume":"23","author":"WD Negash","year":"2023","unstructured":"Negash WD, Eshetu HB, Asmamaw DB. Intention to use contraceptives and its correlates among reproductive age women in selected high fertility sub-saharan Africa countries: a multilevel mixed effects analysis. BMC Public Health. 2023;23:257.","journal-title":"BMC Public Health"},{"key":"28516_CR4","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1186\/s41043-025-01019-6","volume":"44","author":"G Mankelkl","year":"2025","unstructured":"Mankelkl G, Kinfe B. Pooled prevalence of modern contraceptive utilization and its associated factors among reproductive age women in East Africa: derived from demographic and health surveys. J Health Popul Nutr. 2025;44:261.","journal-title":"J Health Popul Nutr"},{"key":"28516_CR5","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1111\/padr.12662","volume":"50","author":"J Corker","year":"2024","unstructured":"Corker J, Biddlecom A, Abbasi-Shavazi MJ, Ezeh A, De Le\u00f3n RGP. Health transitions and the rise of modern contraceptive prevalence: demand, access, and choice. Popul Dev Rev. 2024;50:571\u201395.","journal-title":"Popul Dev Rev"},{"key":"28516_CR6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.25259\/IJMR_1718_2025","volume":"162","author":"N Saggurti","year":"2025","unstructured":"Saggurti N, Gupta H. From population goals to reproductive health autonomy: Reframing India\u2019s fertility transition. Indian J Med Res. 2025;162:1\u20134.","journal-title":"Indian J Med Res"},{"key":"28516_CR7","volume-title":"World family planning 2022: Meeting the changing needs for family planning: Contraceptive use by age and method","author":"United Nations Department of Economic and Social Affairs, Population Division","year":"2022","unstructured":"United Nations Department of Economic and Social Affairs, Population Division. World family planning 2022: Meeting the changing needs for family planning: Contraceptive use by age and method. United Nations; 2022."},{"key":"28516_CR8","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1186\/s12905-022-01769-z","volume":"22","author":"ZT Tesema","year":"2022","unstructured":"Tesema ZT, Tesema GA, Boke MM, Akalu TY. Determinants of modern contraceptive utilization among married women in sub-Saharan Africa: multilevel analysis using recent demographic and health survey. BMC Women S Health. 2022;22:181.","journal-title":"BMC Women S Health"},{"key":"28516_CR9","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1186\/s12913-023-09172-6","volume":"23","author":"EA Fentie","year":"2023","unstructured":"Fentie EA, Asmamaw DB, Shewarega ES, Negash WD, Teklu RE, Alemu TG, Eshetu HB, Belay DG, Aragaw FM, Fetene SM. Socioeconomic inequality in modern contraceptive utilization among reproductive-age women in sub-Saharan African countries: a decomposition analysis. BMC Health Serv Res. 2023;23:185.","journal-title":"BMC Health Serv Res"},{"key":"28516_CR10","unstructured":"National Statistical Office (NSO), [Malawi], ICF. 2015-16 Malawi Demographic and Health Survey Key Findings. NSO and ICF; 2017. https:\/\/preview.dhsprogram.com\/pubs\/pdf\/SR237\/SR237.pdf."},{"key":"28516_CR11","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s40834-018-0065-x","volume":"3","author":"C Mandiwa","year":"2018","unstructured":"Mandiwa C, Namondwe B, Makwinja A, Zamawe C. Factors associated with contraceptive use among young women in Malawi: analysis of the 2015\u201316 Malawi demographic and health survey data. Contracept Reproductive Med. 2018;3:12.","journal-title":"Contracept Reproductive Med"},{"key":"28516_CR12","volume-title":"Malawi Demographic and Health Survey 2015-16. Zomba","author":"National Statistical Office (NSO) [Malawi], ICF","year":"2024","unstructured":"National Statistical Office (NSO) [Malawi], ICF. Malawi Demographic and Health Survey 2015-16. Zomba. Maryland, USA: Malawi, and Rockville; 2024."},{"key":"28516_CR13","doi-asserted-by":"publisher","DOI":"10.1186\/s41118-020-00098-z","author":"J Bongaarts","year":"2020","unstructured":"Bongaarts J. Trends in fertility and fertility preferences in sub-Saharan Africa: the roles of education and family planning programs. Genus. 2020. https:\/\/doi.org\/10.1186\/s41118-020-00098-z.","journal-title":"Genus"},{"key":"28516_CR14","volume-title":"Malawi Demographic and Health Survey 2024: Final Report","author":"National Statistical Office (NSO) [Malawi], ICF","year":"2025","unstructured":"National Statistical Office (NSO) [Malawi], ICF. Malawi Demographic and Health Survey 2024: Final Report. Maryland, USA: Zomba, Malawi, and Rockville; 2025."},{"key":"28516_CR15","doi-asserted-by":"publisher","unstructured":"Adhikari S, Lutz W, Kebede E. Forecasting Africa\u2019s fertility decline by female education groups. Proc Natl Acad Sci USA. 2024;121(46). https:\/\/doi.org\/10.1073\/pnas.2320247121.","DOI":"10.1073\/pnas.2320247121"},{"key":"28516_CR16","doi-asserted-by":"publisher","first-page":"2488","DOI":"10.1186\/s12889-025-23683-3","volume":"25","author":"RM Anteneh","year":"2025","unstructured":"Anteneh RM, Gashu ZE, Baffa LD, et al. Decomposing socioeconomic and educational inequalities in infant mortality in Sub-Saharan Africa: DHS insights linked to countdown to 2030 and agenda 2063. BMC Public Health. 2025;25:2488.","journal-title":"BMC Public Health"},{"key":"28516_CR17","doi-asserted-by":"publisher","first-page":"371","DOI":"10.4054\/DemRes.2026.54.12","volume":"54","author":"D Yildiz","year":"2026","unstructured":"Yildiz D, Wi\u015bniowski A, Brzozowska Z, Durowaa-Boateng A. A flexible model for reconstructing education-specific fertility rates: The case of sub-Saharan Africa. Demographic Res. 2026;54:371\u2013404.","journal-title":"Demographic Res"},{"key":"28516_CR18","doi-asserted-by":"publisher","first-page":"e0280992","DOI":"10.1371\/journal.pone.0280992","volume":"18","author":"IY Addo","year":"2023","unstructured":"Addo IY, Acquah E, Nyarko SH, Boateng ENK, Dickson KS. Factors associated with unskilled birth attendance among women in sub-Saharan Africa: A multivariate-geospatial analysis of demographic and health surveys. PLoS ONE. 2023;18:e0280992.","journal-title":"PLoS ONE"},{"key":"28516_CR19","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1002\/jid.3534","volume":"33","author":"D Asuman","year":"2021","unstructured":"Asuman D, Fenny AP, Odame DNA. Trends and antecedents of inequalities in maternal healthcare coverage in four African countries. J Int Dev. 2021;33:515\u201344.","journal-title":"J Int Dev"},{"key":"28516_CR20","doi-asserted-by":"publisher","first-page":"e018121","DOI":"10.1136\/bmjgh-2024-018121","volume":"10","author":"N Muhajarine","year":"2025","unstructured":"Muhajarine N, Shakurun N, Ahmed MS, Andre F, Chicumbe S. Inequalities and factors associated with maternal healthcare services utilisation in Mozambique: evidence from the Demographic and Health Survey 2022\u2009\u2013\u20092023. BMJ Global Health. 2025;10:e018121.","journal-title":"BMJ Global Health"},{"key":"28516_CR21","doi-asserted-by":"publisher","first-page":"e098443","DOI":"10.1136\/bmjopen-2024-098443","volume":"16","author":"PM Sawadogo","year":"2026","unstructured":"Sawadogo PM, Biney A, a E. What are the drivers of the change in modern contraceptive use among women in sub-Saharan Africa? A repeated cross-sectional multivariable Blinder-Oaxaca decomposition analysis. BMJ Open. 2026;16:e098443.","journal-title":"BMJ Open"},{"key":"28516_CR22","doi-asserted-by":"publisher","first-page":"693","DOI":"10.2307\/2525981","volume":"14","author":"R Oaxaca","year":"1973","unstructured":"Oaxaca R. Male-Female wage differentials in urban labor markets. Int Econ Rev. 1973;14:693.","journal-title":"Int Econ Rev"},{"key":"28516_CR23","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1186\/s12905-025-03636-z","volume":"25","author":"TA Olowolafe","year":"2025","unstructured":"Olowolafe TA, Adebowale AS, Fagbamigbe AF, Onwusaka OC, Aderinto N, Olawade DB, Wada OZ. Decomposing the effect of women\u2019s educational status on fertility across the six geo-political zones in Nigeria: 2003\u20132018. BMC Women S Health. 2025;25:107.","journal-title":"BMC Women S Health"},{"key":"28516_CR24","unstructured":"DHS Program. Assistance during Delivery. Guide to DHS Statistics. 2026. https:\/\/dhsprogram.com\/data\/Guide-to-DHS-Statistics\/Assistance_during_Delivery.htm.\u00a0Accessed 23 Jun 2026."},{"key":"28516_CR25","doi-asserted-by":"publisher","first-page":"2784","DOI":"10.1038\/s41598-024-53332-5","volume":"14","author":"FB Getaneh","year":"2024","unstructured":"Getaneh FB, Belete AG, Ayres A, Ayalew T, Muche A, Derseh L. A generalized Poisson regression analysis of determinants of early neonatal mortality in Ethiopia using 2019 Ethiopian mini demographic health survey. Sci Rep. 2024;14:2784.","journal-title":"Sci Rep"},{"key":"28516_CR26","doi-asserted-by":"publisher","first-page":"2285","DOI":"10.1186\/s12889-024-19816-9","volume":"24","author":"E Mponda","year":"2024","unstructured":"Mponda E, Kaombe TM. Comparison of univariate and bivariate Poisson regression methods in the analysis of determinants of female schooling and fertility in Malawi. BMC Public Health. 2024;24:2285.","journal-title":"BMC Public Health"},{"key":"28516_CR27","unstructured":"StataCorp. Stata Stat Software: Release 15. College Station: StataCorp LLC; 2017."},{"key":"28516_CR28","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/s12978-022-01332-x","volume":"19","author":"I Boadu","year":"2022","unstructured":"Boadu I. Coverage and determinants of modern contraceptive use in sub-Saharan Africa: further analysis of demographic and health surveys. Reproductive Health. 2022;19:18.","journal-title":"Reproductive Health"},{"key":"28516_CR29","doi-asserted-by":"publisher","first-page":"1719985","DOI":"10.3389\/frph.2025.1719985","volume":"7","author":"R Mwandama","year":"2025","unstructured":"Mwandama R, Nkhoma S, Dunga SH. Demand for and use of modern contraception among young women aged 15\u201324 years in Malawi: evidence from the Malawi demographic health survey, 2015\u20132016. Front Reproductive Health. 2025;7:1719985.","journal-title":"Front Reproductive Health"},{"key":"28516_CR30","doi-asserted-by":"publisher","DOI":"10.1186\/s40834-026-00448-w","author":"TG Wondmeneh","year":"2026","unstructured":"Wondmeneh TG. Magnitude of short birth intervals and associated factors among reproductive-age women in sub-Saharan Africa: a multilevel modified Poisson regression analysis of recent DHS data (2021\u20132024). Contracept Reproductive Med. 2026. https:\/\/doi.org\/10.1186\/s40834-026-00448-w.","journal-title":"Contracept Reproductive Med"},{"key":"28516_CR31","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1186\/s12978-024-01904-z","volume":"21","author":"PL Hajison","year":"2024","unstructured":"Hajison PL, Mpachika-Mfipa F, Pitso L, Tshotetsi L, Chimatiro CS. Fertility awareness, perceived factors and approaches to improve contraceptive uptake among sexually active adolescent girls in Phalombe, Malawi: a mixed-methods study. Reproductive Health. 2024;21:161.","journal-title":"Reproductive Health"},{"key":"28516_CR32","doi-asserted-by":"publisher","first-page":"1420","DOI":"10.1186\/s12913-025-13579-8","volume":"25","author":"T Salamba","year":"2025","unstructured":"Salamba T, Izudi J, Masegese T, et al. Effect of healthcare worker vs. non-health worker delivered health education on modern contraceptive uptake among women in Malawi: a quasi-experimental study. BMC Health Serv Res. 2025;25:1420.","journal-title":"BMC Health Serv Res"},{"key":"28516_CR33","first-page":"576","volume":"6","author":"M Kamanga","year":"2025","unstructured":"Kamanga M, Walker D, Malata A, et al. Behavioral drivers influencing women\u2019s decision to use Self-Injectable contraception provided by community health surveillance assistants in rural Malawi. Women S Health Rep. 2025;6:576\u201385.","journal-title":"Women S Health Rep"},{"key":"28516_CR34","doi-asserted-by":"publisher","first-page":"1541","DOI":"10.1186\/s12889-019-7865-z","volume":"19","author":"G Abekah-Nkrumah","year":"2019","unstructured":"Abekah-Nkrumah G. Trends in utilisation and inequality in the use of reproductive health services in Sub-Saharan Africa. BMC Public Health. 2019;19:1541.","journal-title":"BMC Public Health"},{"key":"28516_CR35","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1186\/s12978-021-01076-0","volume":"18","author":"MK Mutua","year":"2021","unstructured":"Mutua MK, Wado YD, Malata M, Kabiru CW, Akwara E, Melesse DY, Fall NA, Coll CVN, Faye C, Barros AJD. Wealth-related inequalities in demand for family planning satisfied among married and unmarried adolescent girls and young women in sub-Saharan Africa. Reproductive Health. 2021;18:116.","journal-title":"Reproductive Health"},{"key":"28516_CR36","doi-asserted-by":"publisher","first-page":"e2028","DOI":"10.1002\/hsr2.2028","volume":"7","author":"IE Donkoh","year":"2024","unstructured":"Donkoh IE, Okyere J, Seidu A, Ahinkorah BO, Aboagye RG, Yaya S. Association between knowledge and use of contraceptive among women of reproductive age in sub-Saharan Africa. Health Sci Rep. 2024;7:e2028.","journal-title":"Health Sci Rep"},{"key":"28516_CR37","doi-asserted-by":"publisher","first-page":"e0254281","DOI":"10.1371\/journal.pone.0254281","volume":"16","author":"KS Dickson","year":"2021","unstructured":"Dickson KS, Adde KS, Ameyaw EK. Women empowerment and skilled birth attendance in sub-Saharan Africa: A multi-country analysis. PLoS ONE. 2021;16:e0254281.","journal-title":"PLoS ONE"},{"key":"28516_CR38","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1186\/s12905-024-03166-0","volume":"24","author":"JJ Kalulu","year":"2024","unstructured":"Kalulu JJ, Masoambeta J, Stones W. Determinants of teenage pregnancy in Malawi: a community-based case-control study. BMC Women S Health. 2024;24:335.","journal-title":"BMC Women S Health"},{"key":"28516_CR39","doi-asserted-by":"publisher","first-page":"2169","DOI":"10.1186\/s12889-022-14610-x","volume":"22","author":"WD Negash","year":"2022","unstructured":"Negash WD, Belachew TB, Asmamaw DB, Bitew DA. Four in ten married women demands satisfied by modern contraceptives in high fertility sub-Saharan Africa countries: a multilevel analysis of demographic and health surveys. BMC Public Health. 2022;22:2169.","journal-title":"BMC Public Health"}],"container-title":["BMC Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12889-026-28516-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-026-28516-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-026-28516-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T23:42:07Z","timestamp":1790898127000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12889-026-28516-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,9]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["28516"],"URL":"https:\/\/doi.org\/10.1186\/s12889-026-28516-5","relation":{},"ISSN":["1471-2458"],"issn-type":[{"value":"1471-2458","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,9]]},"assertion":[{"value":"10 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study utilized anonymized secondary data. The original data collection was approved by the Malawi National Health Sciences Research Committee (NHSRC). Permission to access and use the data was obtained from the DHS Program. Ethical approval for this secondary analysis was not required as the data were fully anonymized. No additional ethical standards were applicable.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declares no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"2747"}}