**4. Discussion**

The main objective of this study was to identify the factors associated with contraceptive use among women of childbearing age in Rwanda and to identify and map the possible spatial distribution of contraceptive use at district level. Figure 3 shows that contraceptive use was unequally distributed among districts, being higher in districts of the Northern Province and lower in districts of the Western Province. This finding is similar to the findings in [8]. In the dark blue coloured district a grea<sup>t</sup> number of women use contraceptive methods and in the light blue coloured districts a low number of women use contraceptive methods. Figure 3 shows that contraceptive use among women in the dark blue coloured areas was higher, mostly in four districts of the Northern Province (Musanze, Burera, Rulindo, Gicumbi), in four districts from the Southern Province (Kamonyi, Ruhango, Nyanza and Nyaruguru), in two districts from the Eastern Province (Kirehe and Gatsibo), in two districts from Western Province (Nyamasheke and Rusizi) and in Gasabo district in Kigali City [8].

The level of wealth of the family was found to be a significant predictor of contraceptive use among women of reproductive age. The findings from this study indicated that contraceptive use increases with greater wealth of the household. This finding is similar to that of [8,25,26]. This may be due to the fact that the wealthier families can easily access health centre facilities, mass media and education, among other factors, all of which are well known for increasing the use of contraceptives among women.

Exposure to the use of contraceptives was found to play an essential role in its use as well as in family planning. Similar findings were also found in studies by [15,19,27,28]. This may be due to the fact that, for instance, when a woman visits a health centre or is visited by health centre workers or family planning field workers, she is told about the importance of using contraceptive methods. This may explain why a woman in such cases was more likely to use a contraceptive method.

The current findings show a strong association between the number of living children in the family and use of contraceptive methods. It was observed from the results that contraceptive use increases with increasing numbers of living children. This was also found by [16,29–32]. A woman who has many children tends to limit births because of financial burdens of paying school fees and providing health care, among other factors.

The findings from this study pointed towards a significant relationship between religious affiliation and the use of a contraceptive method among women of reproductive age. This was also found in the studies by [33]. In this study, the use of contraceptives was highest among Protestant women, followed by Seventh Day Adventists. Among Catholic women there was not a significant association with contraceptive use compared to women from religions other than Protestant and Seventh Day Adventist. However, in some studies such as [34,35], a significant relationship was found.

The findings from the current study also highlighted a strong association between the education level of the women and contraceptive use. The results showed that the use of any type of contraceptive method increases with women's level of education i.e., educated women are more frequent users of contraceptive use than uneducated women. This result was found in other similar studies [26,27,36–38]. However, studies by [26] in Mali found no significant association between education level of the women and contraceptive use. The significant association is not surprising because education is known as a powerful factor associated with women's empowerment, knowledge about their body and reproductive physiology and other maternal and child health information. The educated women are most likely to perceive the advantage of having few children and its effect on the family or their individual economic productivity.

The results from the current study also revealed a strong association between working status of the women and the use of contraceptive methods among those of childbearing age in Rwanda. The women that were working at the time of the survey were more likely to use contraceptives compared to women who were not working over this period. This was found elsewhere in similar studies [33]. This may be due to the fact that working status sometimes empowers women, not only financially, but also to access contraception information, maternal and child healthcare and this empowerment promotes contraceptive use, especially for family planning.

As was expected, this study revealed a strong, significant association between contraceptive use and marital status. It was found that women who resided with their husband/partner were more likely to use any type of contraceptive methods than women who did not reside with their husband or partner. This was found in other studies by [27].

In light of the findings of the current study, the use of any contraceptive method reduces with increasing age, up to 25 years old, and thereafter, increases up to 42 years old, but thereafter decreases once more. In many similar studies in the literature it was also found that the use of contraceptives reduces with the increasing age of the women [32,36,39]. The low contraceptive use among women from the less than 30-year-old age group may be due to the fact that they are usually newly married and interested in having children in the first years of their marriage. The higher prevalence rate of contraceptive use among women aged between 30 and 42 years old may indicate that most of the women in this age group have reached their desired number of children. It is not surprising that after the age of 42 years, the use of contraceptive methods decreases, likely because many women at this age may not be sexually active. This may be due to the fact that a decrease in fecundity correlates with the onset of menopause.

The findings from the current study revealed that the age of the women at first cohabitation was a very important factor associated with the use of contraceptives among women of childbearing age. This was found elsewhere by [39]. Figure 2 showed that cohabitating at an early age increases the use of contraceptive methods. It was found that contraceptive use increases in the first cohabitation age

group of 10 to 25 years old. This may be due to the fact that at this age a higher number of women are not ye<sup>t</sup> married and may not desire children.
