Health Inequalities in Unmet Need for Family Planning Among Ugandan Women: Repeated Cross Sectional Surveys in the Years 2014 to 2018.

Abstract Background: Health inequalities in unmet need for family planning have been documented in Uganda, however, little is known about their magnitude and whether these have remained the same. Objective This study sought to examine health inequalities in unmet need for family planning among Ugandan women between 15-49 years of age in the years 2014 to 2018. Methods: Five data sets of the Performance Monitoring Accountability 2020 family planning cross-sectional surveys were used to assess health inequalities in unmet need for family planning across four socio-economic position variables (age, education, wealth status and geographical location) at five time points (2014 to 2018).Chi-square (χ 2 ) test and a logistic regression-based measure, the Relative Index of Inequality (RII) were used to assess differences and relative health inequalities respectively. Results: The data of 19,670 women aged 15 to 49 years were analysed. Between 2014 and 2018, unmet need for family planning (limiting, spacing and total) were 2 or more times more prevalent among the uneducated (RII value range:1.94 to 2.73), and poorest women(RII value range:1.90 to 3.78), in comparison with women with post-secondary education and richest women respectively. Unmet need for family planning was more prevalent among women older than 35 years (RII between 0.41 and 0.63). No geographic-related health inequalities were observed. Education-related inequalities reduced, wealth-related health inequalities increased, while age-related inequalities remained fairly consistent. Conclusion: Age, education and wealth related health inequalities were observed in unmet need for family planning. The magnitude of health inequalities varied between 2014 and 2018, with largest inequalities based on wealth status variable.