CONTEXT: Although a growing number of studies have examined how community factors influence contraceptive
use, few have explored how such factors affect method choice.
METHODS: Data from the 1998 South Africa Demographic and Health Survey and the 1998 Eastern Cape Facility
Survey were used to examine community and health facility influences on the method choices of 1,165 women aged
15–49 who lived in the Eastern Cape. Relative risk ratios from multilevel multinomial models assessed how method
choice varied between communities.
RESULTS: The likelihood of using the pill or a more permanent method rather than the injection rose with the proportion
of women in a community who controlled their earnings (risk ratios, 3.2 and 3.8, respectively). In communities with higher proportions of females with only a primary education, women were less likely to use the pill instead of the injection (0.1). Higher doctor staffing levels were associated with a greater likelihood of using the pill or a more permanent method (1.5 and 1.4), and having more expired methods in stock was associated with increased use of a more
permanent method (2.1). Several facility factors were associated with a decreased likelihood of using the pill rather
than the injection: higher numbers of community health workers in an area and higher numbers of facility
nurses who had received training on HIV/AIDS in the last year (0.9 for each).Yet a substantial amount of variation in
method choice was not accounted for by these variables.
CONCLUSION: Future research should emphasize the collection of community-level data on structural, behavioral and
cultural factors to help explain the variation in method choice between communities.