{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:19:11Z","timestamp":1760235551318,"version":"build-2065373602"},"reference-count":44,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2021,9,6]],"date-time":"2021-09-06T00:00:00Z","timestamp":1630886400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100011864","name":"International Union for the Scientific Study of Population","doi-asserted-by":"publisher","award":["OPP1179495"],"award-info":[{"award-number":["OPP1179495"]}],"id":[{"id":"10.13039\/501100011864","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Urban populations have been increasing at an alarming rate, with faster growth in urban slums than that in nonslums over the past few decades. We examine the association between slum residence and the prevalence of contraceptive use among women of reproductive age, and assess if the effect was modified by household wealth. We conducted cross-sectional analysis comprising 1932 women in slums and 632 women in nonslums. We analyzed the moderating effect through an interaction between household wealth and neighborhood type, and then conducted stratified multivariable logistic-regression analysis by the type of neighborhood. Fewer women living in nonslum neighborhoods used modern methods compared to those living in slum neighborhoods. Within slum neighborhoods, the odds of using modern contraceptive methods were higher among women visited by community health workers than among those who had not been visited. Parity was one of the strong predictors of modern contraceptive use. Within nonslum neighborhoods, women from the wealthiest households were more likely to use modern contraceptives than those from the poorest households. Household wealth moderated the association between the type of neighborhood and modern contraceptive use. The study findings suggested heterogeneity in modern contraceptive use in Kinshasa, with a surprisingly higher contraceptive prevalence in slums.<\/jats:p>","DOI":"10.3390\/ijerph18179400","type":"journal-article","created":{"date-parts":[[2021,9,6]],"date-time":"2021-09-06T21:47:38Z","timestamp":1630964858000},"page":"9400","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Heterogeneity of Modern Contraceptive Use among Urban Slum and Nonslum Women in Kinshasa, DR Congo: Cross-Sectional Analysis"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3828-6214","authenticated-orcid":false,"given":"Pierre Z.","family":"Akilimali","sequence":"first","affiliation":[{"name":"Department of Biostatistics and Epidemiology, Kinshasa School of Public Health, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7134-7878","authenticated-orcid":false,"given":"Nguyen-Toan","family":"Tran","sequence":"additional","affiliation":[{"name":"Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, P.O. Box 123, Sydney, NSW 2007, Australia"},{"name":"Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1206 Gen\u00e8ve, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anastasia J.","family":"Gage","sequence":"additional","affiliation":[{"name":"School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"UN-HABITAT (2003). The Challenge of Slums: Global Report on Human Neighborhood 2003, Earthscan Publications Ltd.. London and Sterling.","DOI":"10.1108\/meq.2004.15.3.337.3"},{"key":"ref_2","unstructured":"WHO (2002). The World Health Report 2002: Reducing Risks, Promoting Healthy Life."},{"key":"ref_3","unstructured":"INS (2020, March 20). Enqu\u00eate par Grappes \u00e0 Indicateurs Multiples, 2017\u20132018, Rapport de R\u00e9sultats de L\u2019enqu\u00eate. Kinshasa, R\u00e9publique D\u00e9mocratique du Congo. Available online: https:\/\/mics-surveys-prod.s3.amazonaws.com\/MICS6\/West%20and%20Central%20Africa\/Congo%2C%20Democratic%20Republic%20of%20the\/2017-2018\/Survey%20findings\/Congo%2C%20Democratic%20Republic%20of%20the%2C%202017-18%20MICS%20SFR_French.pdf."},{"key":"ref_4","unstructured":"Minist\u00e8re du Plan and Macro International (2008). Enqu\u00eate D\u00e9mographique et de Sant\u00e9, R\u00e9publique D\u00e9mocratique du Congo 2007, Minist\u00e8re du Plan and Macro International."},{"key":"ref_5","unstructured":"Minist\u00e8re du Plan et Suivi de la Mise en \u0152uvre de la R\u00e9volution de la Modernit\u00e9 (MPSMRM), Minist\u00e8re de la Sant\u00e9 Publique (MSP), and ICF International (2014). Enqu\u00eate D\u00e9mographique et de Sant\u00e9 en R\u00e9publique D\u00e9mocratique du Congo 2013\u20132014, MPSMRM, MSP, and ICF International. Available online: https:\/\/dhsprogram.com\/publications\/publication-FR300-DHS-Final-Reports.cfm."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Muanda, M., Ndongo, P.G., Taub, L.D., and Bertrand, J.T. (2016). Barriers to modern contraceptive use in Kinshasa, DRC. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0167560"},{"key":"ref_7","unstructured":"United Nations (2015). World Population Prospects: The 2015 Revision, Volume II: Demographic Profiles (ST\/ESA\/SER.A\/380)."},{"key":"ref_8","unstructured":"World Bank (2020, March 20). Revue de L\u2019Urbanisation en R\u00e9publique D\u00e9mocratique du Congo: Des Villes Productives et Inclusives pour L\u2019\u00c9mergence de la R\u00e9publique D\u00e9mocratique du Congo, Available online: https:\/\/openknowledge.worldbank.org\/handle\/10986\/28931."},{"key":"ref_9","unstructured":"Rakodi, C. (1997). Kinshasa: A reprieved mega-city?. The Urban Challenge in Africa: Growth and Management of Its Largest Cities, United Nations University Press."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Matthews, Z., Channon, A., Neal, S., Osrin, D., Madise, N., and Stones, W. (2010). Examining the \u201curban advantage\u201d in maternal health care in developing countries. PLoS Med., 7.","DOI":"10.1371\/journal.pmed.1000327"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"White, M.J., and Lindstrom, D.P. (2005). Internal migration. Handbook of Population, Springer.","DOI":"10.1007\/0-387-23106-4_12"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Ochako, R., Izugbara, C., Okal, J., Askew, I., and Temmerman, M. (2016). Contraceptive method choice among women in slum and non-slum communities in Nairobi, Kenya. BMC Womens Health, 16.","DOI":"10.1186\/s12905-016-0314-6"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Fotso, J.C., Izugbara, C., Saliku, T., and Ochako, R. (2014). Unintended pregnancy and subsequent use of modern contraceptive among slum and non-slum women in Nairobi, Kenya. BMC Pregnancy Childbirth, 14.","DOI":"10.1186\/1471-2393-14-224"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1363\/45e7519","article-title":"Closing the Poor-Rich Gap in Contraceptive Use in Rwanda: Understanding the Underlying Mechanisms","volume":"45","author":"Muhoza","year":"2019","journal-title":"Int. Perspect. Sex Reprod. Health"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1353\/dem.0.0035","article-title":"Urbanization and fertility: An event-history analysis of coastal Ghana","volume":"45","author":"White","year":"2008","journal-title":"Demography"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1080\/0032472031000142516","article-title":"Demand Theories of the Fertility Transition\u2014An Iconoclastic View","volume":"41","author":"Cleland","year":"1987","journal-title":"Popul. Stud."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1810","DOI":"10.1016\/S0140-6736(06)69480-4","article-title":"Family planning: The unfinished agenda","volume":"368","author":"Cleland","year":"2006","journal-title":"Lancet"},{"key":"ref_18","unstructured":"UN-Habitat (2020, June 23). The Challenge of Slums: Global Report on Human Settlements 2003. Chapter 1: Development Context and the Millennium Agenda. Revised and Updated Version. Available online: unhabitat.org."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.contraception.2016.05.015","article-title":"Moving towards the goals of FP2020\u2013classifying contraceptives","volume":"94","author":"Festin","year":"2016","journal-title":"Contraception"},{"key":"ref_20","first-page":"115","article-title":"Estimating wealth effects without expenditure data\u2014Or tears: An application to educational enrollments in States of India","volume":"38","author":"Filmer","year":"2001","journal-title":"Demography"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.ajog.2009.08.022","article-title":"Disparities in family planning","volume":"202","author":"Dehlendorf","year":"2010","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_22","unstructured":"Kaye, K., Suellentrop, K., and Sloup, C. (2009). The Fog Zone: How Misperceptions, Magical Thinking, and Ambivalence Put Young Adults at Risk for Unplanned Pregnancy, The National Campaign to Prevent Teen and Unintended Pregnancy."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1023\/A:1026643621387","article-title":"Perceptions of hormonal contraceptive safety and side effects among low-income Latina and non-Latina women","volume":"4","author":"Guendelman","year":"2000","journal-title":"Matern. Child Health J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.contraception.2006.02.010","article-title":"Disparities in contraceptive knowledge, attitude and use between Hispanic and non-Hispanic whites","volume":"74","author":"Ali","year":"2006","journal-title":"Contraception"},{"key":"ref_25","unstructured":"Todd, S., and Sommers, B. (2012). Overview of the Uninsured in the United States: A Summary of the 2012 Current Population Survey Report."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1007\/s11524-011-9667-1","article-title":"Family planning use among urban poor women from six cities of Uttar Pradesh, India","volume":"89","author":"Speizer","year":"2012","journal-title":"J. Urban Health"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Tukue, D., Gebremeskel, T.G., Gebremariam, L., Aregawi, B., Hagos, M.G., Gebremichael, T., Tesfay, H.N., and Arefaine, Z.G. (2020). Prevalence and determinants of modern contraceptive utilization among women in the reproductive age group in Edaga-hamus Town, Eastern zone, Tigray region, Ethiopia, June 2017. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0227795"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"542","DOI":"10.9745\/GHSP-D-16-00236","article-title":"Pilot Research as Advocacy: The Case of Sayana Press in Kinshasa, Democratic Republic of the Congo","volume":"4","author":"Binanga","year":"2016","journal-title":"Glob. Health Sci. Pract."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Hernandez, J.H., Akilimali, P., Glover, A., and Bertrand, J.T. (2020). Feasibility and acceptability of using medical and nursing students to provide Implanon NXT at the community level in Kinshasa, Democratic Republic of Congo. BMC Womens Health, 24.","DOI":"10.1186\/s12905-020-00993-9"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.contraception.2018.08.002","article-title":"An observational study to test the acceptability and feasibility of using medical and nursing students to instruct clients in DMPA-SC self-injection at the community level in Kinshasa","volume":"98","author":"Bertrand","year":"2018","journal-title":"Contraception"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.ijedudev.2009.08.001","article-title":"Why are there proportionately more poor pupils enrolled in non-state schools in urban Kenya in spite of FPE policy?","volume":"30","author":"Moses","year":"2010","journal-title":"Int. J. Educ. Dev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/s12939-017-0538-6","article-title":"Differential effects of community health worker visits across social and economic groups in Uttar Pradesh, India: A link between social inequities and health disparities","volume":"16","author":"Seth","year":"2017","journal-title":"Int. J. Equity Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.4102\/phcfm.v9i1.1281","article-title":"Trust of community health workers influences the acceptance of community-based maternal and child health services","volume":"9","author":"Grant","year":"2017","journal-title":"Afr. J. Prim. Health Care Fam. Med."},{"key":"ref_34","first-page":"13","article-title":"Acceptability and Utilization of Community Health Workers after the Adoption of the Integrated Community Case Management Policy in Kabarole District in Uganda","volume":"2","author":"Muhumuza","year":"2015","journal-title":"Health Syst. Policy Res."},{"key":"ref_35","unstructured":"Nelago, I. (2008). Contraceptive Choice and Use of Methods among Young Women in Namibia, African Population Studies."},{"key":"ref_36","unstructured":"University of Kinshasa School of Public Health, and The Bill & Melinda Gates Institute for Population and Reproductive Health at The Johns Hopkins Bloomberg School of Public Health (2021, July 25). Performance Monitoring for Action (PMA) Survey Phase 1, DRC Kinshasa_Phase 1 Results Brief_English_Final. Available online: https:\/\/www.pmadata.org\/sites\/default\/files\/data_product_results\/DRC%20Kinshasa_Phase%201%20Results%20Brief_English_Final.pdf."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/S0968-8080(06)27231-8","article-title":"Blood Blockages and Scolding Nurses: Barriers to Adolescent Contraceptive Use in South Africa","volume":"14","author":"Wood","year":"2006","journal-title":"Reprod. Health Matters"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"40","DOI":"10.2307\/3583196","article-title":"Utilisation of Reproductive Health Services by Adolescent Boys in the East- ern Region of Ghana","volume":"5","author":"Koster","year":"2001","journal-title":"Afr. J. Reprod. Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1080\/0954012031000068290","article-title":"Improving Young Peolpe\u2019s Access to Reproductive Health Care in Rural Zimbabwe","volume":"15","author":"Langhaug","year":"2003","journal-title":"AIDS Care"},{"key":"ref_40","unstructured":"World Bank (2008). Democratic Republic of Congo Urbanization Review: Productive and Inclusive Cities for an Emerging Democratic Republic of Congo. Directions in Development."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.ejogrb.2005.06.033","article-title":"Use of various contraceptive methods and time of conception in a community-based population","volume":"123","author":"Kaplan","year":"2005","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_42","first-page":"CD005347","article-title":"Copper containing, framed intra-uterine devices for contraception","volume":"4","author":"Kulier","year":"2007","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e022295","DOI":"10.1136\/bmjopen-2018-022295","article-title":"Differences in family planning outcomes between military and general populations in Kinshasa, Democratic Republic of the Congo: A cross-sectional analysis","volume":"8","author":"Akilimali","year":"2018","journal-title":"BMJ Open"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Akilimali, P.Z., Nzuka, H.E., La Nasa, K.H., Wumba, A.M., Kayembe, P., Wisniewski, J., and Bertrand, J.T. (2021). The gap in contraceptive knowledge and use between the military and non-military populations of Kinshasa, DRC, 2016\u20132019. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0254915"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/17\/9400\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:57:38Z","timestamp":1760165858000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/17\/9400"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,6]]},"references-count":44,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["ijerph18179400"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18179400","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2021,9,6]]}}}