Contraceptive knowledge and utilization pattern and determinants among sexually active women in sub-Saharan Africa: spatial and multilevel analysis

Rapid population growth remains a major challenge in sub-Saharan Africa, where unintended pregnancies are highly prevalent. Family planning is an important strategy for preventing unintended pregnancies and supporting individuals in achieving their desired family size. Although addressing family planning knowledge and use among sexually active women is critical, as they may be at risk of unintended pregnancy, many sub-Saharan African countries have yet to meet global targets related to the United Nations Sustainable Development Goals. This study aimed to assess the pooled proportion, spatial variation, and factors associated with knowledge and use of contraceptive methods among sexually active women in sub-Saharan Africa. The analysis used Demographic and Health Survey data from 34 sub-Saharan African countries. A total weighted sample of 256,888 sexually active women was included. ArcGIS version 10.8 and SaTScan version 10.1 were used for spatial analysis. A multilevel multinomial logistic regression model was employed to identify factors associated with different patterns of family planning knowledge and current contraceptive use. Regression coefficients (β) and 95% confidence intervals (CIs) were estimated, and statistical significance was assessed at p < 0.05. Among sexually active women in the included sub-Saharan African countries, the pooled proportions of women who had neither knowledge of nor current use of a contraceptive method, who had knowledge of at least one contraceptive method but were not currently using any contraceptive method, and who had knowledge of and were currently using at least one contraceptive method were 3.96%, 59.65%, and 36.87%, respectively. The study identified significant spatial clustering in the distribution of women with limited knowledge and current use of contraceptive methods. The most likely spatial cluster was located primarily in Western and Central Africa. Higher educational attainment, employment, being currently married (in union), having living children, receiving family planning information from health facilities, later age at first birth, larger household size, exposure to family planning messages through the media, urban residence, and residence in Eastern, Southern, and Western Africa were associated with the likelihood of being in the “knowledge without current contraceptive use” and “knowledge with current contraceptive use” categories compared with the reference category of women who had neither knowledge of nor current use of a contraceptive method. Contraceptive knowledge and use among sexually active women in sub-Saharan Africa are shaped by both individual and community-level factors, with pronounced regional disparities particularly concentrated in western and central areas. To address these gaps, context-specific strategies such as couple-based family planning interventions, health education initiatives, and expanded media outreach are essential to empower women and improve reproductive health outcomes across the region.