Abstract / Summary
Modern contraceptive use in Nigeria remains low and unequally distributed. Existing research has extensively examined socioeconomic and demographic determinants, but less is known about how multiple dimensions of disadvantage coexist and relate to contraceptive use. This study identified distinct profiles of cumulative vulnerability among Nigerian women, examined inequalities in modern contraceptive use across these profiles, and assessed changes between 2018 and 2024. We analyzed pooled cross-sectional data from the 2018 and 2024 Nigeria Demographic and Health Surveys, comprising 80,871 women aged 15-49 years. Latent class analysis was used to identify vulnerability profiles based on six indicators of socioeconomic, informational and empowerment-related disadvantage. Survey-weighted and multilevel logistic regression models were used to examine associations between vulnerability profiles and modern contraceptive use, including differences by survey year. Average marginal effects and adjusted predicted probabilities were estimated. Five vulnerability profiles were identified. The extreme vulnerability profile, characterized by predominantly rural residence, limited education, minimal internet and media access, and low decision-making autonomy, was the largest, accounting for 39.2% of women. Its prevalence increased from 38.3% in 2018 to 40.1% in 2024, while the proportion of women in the most advantaged profile increased from 10.4% to 15.7%. Compared with women in the most advantaged profile, those in the extreme vulnerability profile had a 30.9-percentage-point lower adjusted probability of modern contraceptive use (95% confidence interval: -32.8 to -29.0). This difference was 26.5 percentage points (95% confidence interval: -28.4 to -24.7) after accounting for variation between survey clusters. Adjusted contraceptive use increased across all profiles between 2018 and 2024, but substantial inequalities persisted. Evidence of a differential change for the extreme vulnerability profile was present in the survey-weighted model but not in the multilevel model. Modern contraceptive use in Nigeria is strongly associated with cumulative vulnerability. Despite improvements between 2018 and 2024, substantial inequalities persisted across vulnerability profiles. These findings underscore the importance of addressing overlapping socioeconomic, informational and empowerment-related barriers and monitoring contraceptive-use inequalities across population groups.