Multilevel Determinants of Long-Term Contraceptive Use Among Women in Nigeria

This thesis investigates the determinants of long-term contraceptive use among women in Nigeria through a mixed-methods design, applying the Theory of Planned Behaviour (TPB) to analyse both quantitative and qualitative findings. TPB provides a framework for understanding how attitudes, subjective norms, and perceived behavioural control shape reproductive health behaviours, including contraceptive decision-making.The quantitative phase draws on data from the 2018 Nigeria Demographic and Health Survey, which shows that only 12.2% of women in Nigeria currently use long-term contraceptive methods. Multilevel logistic regression examined individual, household and community-level predictors of uptake. Women with more favourable attitudes toward contraception (those with higher education and greater parity), those in supportive normative environments (communities with higher female education levels), and those with greater perceived control (women from wealthier households or those in employment) were significantly more likely to use long-term methods. These findings align with TPB constructs, illustrating how behavioural intentions and actual use are shaped by personal and contextual factors.The qualitative phase explores socio-cultural and structural influences on contraceptive use. Thematic analysis identified demand and supply barriers. On the demand side, negative attitudes (fear of side effects), restrictive subjective norms (religious and cultural opposition, partner disapproval), and low perceived behavioural control (limited knowledge about long-term contraceptives) constrained uptake. On the supply side, barriers included inadequate service availability and cost-related access issues. These findings further illustrate how TPB constructs manifest in population health, influencing women's ability to act on reproductive intentions.This study highlights critical policy and programmatic gaps in promoting long-term contraceptive use in Nigeria. It underscores the need for community-level interventions addressing both demand and supply-side barriers, while targeting underlying attitudinal, normative, and control-related factors identified through TPB. Recommendations include expanding reproductive health education, improving service delivery infrastructure, and promoting gender-equitable norms to empower women in making informed contraceptive choices.