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Ambitious global goals have been established to provide universal access toaffordable modern contraceptive methods. The UN's sustainable development goal3.7.1 proposes satisfying the demand for family planning (FP) services byincreasing the proportion of women of reproductive age using modern methods. Tomeasure progress toward such goals in populous countries like Nigeria, it'sessential to characterize the current levels and trends of FP indicators suchas unmet need and modern contraceptive prevalence rates (mCPR). Moreover, thesubstantial heterogeneity across Nigeria and scale of programmaticimplementation requires a sub-national resolution of these FP indicators.However, significant challenges face estimating FP indicators sub-nationally inNigeria. In this article, we develop a robust, data-driven model to utilize allavailable surveys to estimate the levels and trends of FP indicators inNigerian states for all women and by age-parity demographic subgroups. Weestimate that overall rates and trends of mCPR and unmet need have remained lowin Nigeria: the average annual rate of change for mCPR by state is 0.5%(0.4%,0.6%) from 2012-2017. Unmet need by age-parity demographic groups variedsignificantly across Nigeria; parous women express much higher rates of unmetneed than nulliparous women. Our hierarchical Bayesian model incorporates datafrom a diverse set of survey instruments, accounts for survey uncertainty,leverages spatio-temporal smoothing, and produces probabilistic estimates withuncertainty intervals. Our flexible modeling framework directly informsprogrammatic decision-making by identifying age-parity-state subgroups withlarge rates of unmet need, highlights conflicting trends across surveyinstruments, and holistically interprets direct survey estimates.

Sub-national levels and trends in contraceptive prevalence, unmet need, and demand for family planning in Nigeria with survey uncertainty