Family planning (FP) is among the indicators of the Millennium Development Goals (MDG). FP prevents unwanted pregnancies and eliminates recourse to abortions. Both short and long inter-pregnancy interval (IPI) is associated with adverse pregnancy outcomes such as preterm birth, low birth weight, small for gestation age and perinatal death [1] . To prevent these adverse pregnancy outcomes, birth spacing has been considered as an effective intervention. A recent commentary on Family Planning in the Lancet, accurately summarised the impact of meeting the contraceptive needs as “According to Singh and colleagues [2] , meeting the contraceptive needs of 215 million women with a unmet need for modern contraception would reduce unintended pregnancies by more than two thirds, avert 70% of maternal deaths, 44% of newborn deaths, and 73% of unsafe abortions, and reduce by 76% the number of women needing medical care for complications related to unsafe abortion. In addition to these health benefits, the resulting reduction in fertility and population growth would bring substantial socioeconomic and environmental benefits” [3] . FP enables couples or family/women to plan when to have children and use birth control to delay (spacing) or number of children.

Unmet need for family planning decreased worldwide from 15.4% in 1990 to 12.3% in 2010 [4] . Tanzania is among the countries that have made slow progress towards achieving MDG 4 and 5. It has a high unmet need for contraceptives 25% and has high total fertility rate 5.4, high maternal mortality rate (446 per 100,000) and high neonatal mortality rate (25 per 1000) compared with the target of 5%, 4.7, 193 per 100,000, and 19 per 1000 by 2015 [5] .

Previous analysis of TDHS showed an association between family planning use and socio-demographic characteristics. However, there is limited information about effects of partner characteristics (male-female age difference, education, and male controlling behavior), women empowerment, decision making on family planning, partner desire for childbearing and intimate partner violence, on contraceptive use. Addressing these identified factors may help to improve access and use of modern contraceptives, resulting in reduction of neonatal and maternal mortality rate.

According to TDHS 2010 report, knowledge, attitudes, practice, beliefs and socio-demographic factors were associated with modern contraceptive use among women of reproductive group. Literature also has showed that women empowerment, partner characteristics, partner violence, wife beating, and child preference are associated with modern contraceptive use among married women in low income countries [6] -[9] . But, the TDHS 2010 did not address these important factors. The few studies that have investigated have reported contradictory findings such as association of intimate partner violence and contraceptive. Some results were positive and others negative and had used relative small samples. This study investigated two major gaps (questions) that were not addressed in the 2010 TDHS report, 1) What are the factors that promote use of modern contraceptive use among women of reproductive age in Tanzania? 2) What are the barriers for use of modern contraception in this group? Therefore, we aimed to investigate the factors influencing modern contraceptive use among women of reproductive age in Tanzania.

In this study we assessed the determinants of modern contraceptive use among women of reproductive age. We found women empowerment, male-female age difference of less or equal to nine, and advised at health care facilities on family planning were predictors of modern contraceptive use.

This study shows that woman having no age gap and age difference of less than or equal to 9 years of partners has higher odds of using modern contraceptive use compared with women who are older than their partners. There was an increase in FP use with as male age increases, women are less likely to use modern contraceptive. Age gap among couples could act as a power on decision making, as age gap increases women are likely to receive order from their husbands. This study is in consistent with [6] [13] -[15] . The plausible explanation could be both studies used DHS data that uses standardized questionnaires, however, the study was conducted in similar low income countries. Male-age difference has an impact on modern contraceptive use in which women are placed in high risk during their lifetime especially maternal life risk time.

This study shows that child desire was negatively associated with use of modern contraceptive. This finding is similar to previous studies [2] [7] [16] -[18] . In the present study when husbands want more children, women were less likely to use contraceptives compared with when couples wants the same number of children. One possible explanation for this could be attributed to culture that allows men or families to have many children. In African countries the notion of children being an asset for future security has negative effect on utilization of contraceptive use as a consequence lead to poor interpregnancy interval and adverse pregnancy outcomes. If husband desire to have more children may lead to decreased contraceptive use, education and messages on family planning use is still needed to promote awareness in the community.

A finding from this study suggests that women who are empowered have greater odds of using contraceptive. These findings are similar with previous studies [10] [11] [19] -[21] . Empowerment gives freedom of choice, thus also can enable women to make better choice of modern contraceptive. In the other hand, women have an opportunity to discuss with their partners on the use of modern contraceptive. This has an impact not only to contraceptive use but also to reproductive health that in turn has good perinatal and maternal outcome thus reduce neonatal and maternal mortality rate.

In the present study, women who experienced physical violence had 14 percent decreased odds of contraceptive usage, but this association did not reach statistical significant. Low use of modern contraceptive could be a defensive mechanism to avoid conflicts and facilitate men’s interest and culture during their future life time thus in turn leads to poor perinatal and maternal outcome. Previous author [18] has also reported that women who experience physical violence are less likely to use modern contraceptive. The lower usage of modern contraceptive in both studies could be explained by social cultural factors as reported. Our finding is contrary in a study done by Dalal and his colleagues in Bangaladesh [8] , the woman who is found that experienced physical intimate partner violence used more contraceptives compared with those who did not experience such problem. The differences in our study and that of other authors explained the difference in physical violence that exists among regions which in turn reflect the extent of contraceptive use among regions.

This study shows that women who experienced sexual violence were less likely to use contraceptive though it was not statistically significant, probably women are reluctant to use contraceptive to satisfy men interest of desire for more children thus preventing divorce and future violence. Contraceptive use could be the source of conflict among couples, to escape from such harassment women are likely to withdraw from using contraceptive use to allow men’s interest to prevail within the family. Similar in a study done by Dalal [8] and his colleagues found that sexual violence was not an important predictor for modern contraceptive use, contrary to a study done in Jordan by Montes, O’Hara and their colleagues [18] [22] found the odds of currently using contraception were greater for women who reported experiencing sexual violence compared those who did not. IPV could be associated with use of modern contraceptive among married/cohabiting women as means of protection for future problems especially unwanted pregnancy in case of sexual violence. Thus the public could face increased intimate partner violence in a community that have negative attitude towards modern contraceptive especially when men wants more children, however in another side IPV might be a source of reduced contraceptive use leading to unwanted pregnancy as well as poor perinatal and maternal outcome among women this in turn could lead to high neonatal and maternal mortality rate.

The predictors of modern contraceptive use in our study correspond with other studies in low income countries. Women empowerment, male-female age difference, child desire were important predictors for use of modern contraceptives. However, prevalence of modern contraceptive use is still low. This highlights the need to promote contraceptive use, thus in turn contribute toward the reduction of neonatal and maternal mortality rate. Further studies are recommended to explore the association of controlling behavior of male partners, physical violence, sexual violence, wife beating, service provision and contraceptive use.

Our study has strength and limitations; one of the strength of this study is the large sample size which could be a representativeness of other women of reproductive age group in the general population, and thus making our results generalizable. The DHS data were collected using a standardized questionnaire which has been validated; this enables collection of most of information relevant for this study and hence minimizes information bias. However, some information were not collected in TDHS such as religion which is a known factor associated with contraceptive use thus limited to assess this factor. In addition, in subgroup analysis such as domestic violence in relation with contraceptive use, it was difficult to assess this association due to small number of subjects in each category resulting to low power.

Another limitation of using secondary source data is subject to missing of important information (Variables) and recall bias.

The predictors of modern contraceptive use in our study correspond with other studies in low income countries. Women empowerment, male-female age difference, and child desire were important predictors for use of modern contraceptives. However, prevalence of modern contraceptive use is still low. This highlights the need to promote contraceptive use, and thus in turn contribute toward the reduction of neonatal and maternal mortality rate. Further studies are recommended to explore the association of controlling behavior of male partners, physical violence, sexual violence, wife beating, service provision and contraceptive use.

Promoting modern contraceptive use will result to compliance to appropriate inter-pregnancy interval, and thus reduce adverse maternal and perinatal outcomes. It will lead to control of the current country population growth.

We thanks for Kilimanjaro Christian Medical University College and THRIVE for their financial support. We also extend thanks to DHS Measure, for allowing us to use TDHS 2010 dataset for this study.

The author declared that they have no competing interests.

Paulo LinoKidayi,SiaMsuya,JimTodd,Chuki ChristinaMtuya,TaraMtuy,Michael JohnsonMahande, (2015) Determinants of Modern Contraceptive Use among Women of Reproductive Age in Tanzania: Evidence from Tanzania Demographic and Health Survey Data. Advances in Sexual Medicine,05,43-52. doi: 10.4236/asm.2015.53006