Wealth index and modern contraceptive use among Peruvian women by urban–rural area of residence: a national cross-sectional analysis

Modern contraceptive use is essential for effective family planning and reproductive health. However, evidence on socioeconomic and urban–rural differences in modern contraceptive use among Peruvian women remains limited. This study aimed to evaluate the association between wealth index and the use of modern contraceptive methods among Peruvian women of reproductive age, and to explore whether this association differs between urban and rural areas. We conducted a cross-sectional study using data from the 2024 Peruvian Demographic and Family Health Survey (ENDES). Sexually active women aged 15–49 years were included. The outcome was current use of modern contraceptive methods (e.g., pills, intrauterine devices, injectables, condoms, implants, and emergency contraception). The exposure variable was household wealth index categorized into quintiles. Area of residence (urban/rural) was assessed as a potential effect modifier. Associations and interaction were evaluated using survey-weighted Poisson regression models to estimate prevalence ratios (PR). Data from 20,451 women were analyzed (mean age: 32.4 years; 80.9% urban). Overall, 54.8% reported using modern contraceptive methods. In urban areas, women in the richest wealth quintile had a 24% higher prevalence of modern contraceptive use compared with those in the poorest quintile (aPR: 1.24; 95% CI: 1.09 to 1.41), whereas no significant association was observed in rural areas; however, these stratified estimates should be interpreted as exploratory. Also, the interaction according to area of residence was not statistically significant ( p = 0.616), indicating no formal evidence of effect modification by urban–rural residence. In urban settings, higher wealth was also associated with greater use of oral contraceptive pills and male condoms, and no significant interaction by area of residence was identified for specific contraceptive methods ( p > 0.05). Higher household wealth was associated with greater use of modern contraceptive methods, indicating persistent socioeconomic inequalities. Area of residence did not significantly modify this association; stratified urban, rural, and method-specific findings were less precise and not statistically significant, so these stratified results should be considered exploratory.