Reproductive Health Outcomes in Nigeria and Zambia: : A cross-sectional study in Global Health

Unmet need for family planning remains a public health concern in Sub-Saharan Africa and is closely linked to unwanted pregnancy and adverse reproductive health outcomes. Socioeconomic status is widely recognized as a key determinant of reproductive health shaping access to contraception, fertility preferences, and reproductive autonomy. Aim: This study aims to examine the association between socioeconomic factors (wealth, residence, age, marital status and education) and the reproductive health outcomes; unmet need for family planning and unwanted pregnancy in Nigeria and Zambia, two countries with differing abortion legislation. Method: This study analyzed cross-sectional data from the Demographic and Health Survey. The study population included women aged 15-49 years. Descriptive analyses were performed to examine the distribution of unmet need and unwanted pregnancy across socioeconomic groups, followed by bivariate analysis. Multivariate regression was used to assess associations while controlling for all variables included in the study. Results: Unmet need for family planning was prevalent across all socioeconomic groups. Higher prevalence of unmet need was generally observed among women in the lower wealth quintiles and those with lower education level. However, in some cases women in the middle and higher socioeconomic groups also demonstrated higher odds of unmet need compared to the reference group. Bivariate analyses show significant associations between socioeconomic factors and unmet need for family planning in both countries. In the multivariate models these remain significant for all socioeconomic factors in Nigeria and for wealth, marital status and education in Zambia. With regard to unwanted pregnancy, the bivariate analyses show significant association between socioeconomic factors and the outcome except for marital status. These associations remain significant for wealth and education in Nigeria, and wealth in Zambia in the multivariable model. Conclusion: Unmet need for family planning continues to represent a significant reproductive health challenge in Sub-Saharan Africa and might contribute to unwanted pregnancy. The findings indicate that socioeconomic disadvantages alone do not fully explain patterns of unmet need. Public health interventions should therefore adopt approaches that address both structural barriers and reproductive preferences across different socioeconomic groups.