Published in PLOS One on 2026-06-26, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Million Phiri, Mapitso Lebuso, Nthatisi Leseba, Talent Tapera, Joseph Kazibwe, Nebechukwu Henry Ugwu, Garikayi Bernard Chemhaka
Source: PLOS One • DOI 10.1371/journal.pone.0352594
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Improving utilization of contraceptive methods serves as a powerful catalyst for advancing women’s education, health, and personal autonomy. Many countries have pledged to enhance contraceptive availability as part of their commitment to the Sustainable Development Goals (SDGs), specifically under indicator 3.7.1. This study sought to understand the drivers of modern contraceptive use trend and inequalities among sexually active women of reproductive ages in Lesotho during the period 2004–2023.
The study used four rounds of Lesotho demographic and health survey datasets for the years 2004, 2009, 2014 and 2023. A total sample of 22,325 sexually active women of reproductive ages 15–49 years was used in the analysis. Blinder-Oaxaca decomposition technique was used to analyse drivers of trend change in modern contraceptive while the concentration curves and indices were used to assess the levels of inequality. All analyses were conducted in Stata software version 17 and weighted to account for complex sampling techniques in demographic and health surveys.
The prevalence of modern contraceptive use among sexually active women increased significantly from 36.1% (95% CI: 34.2, 37.9) to 62.7% (95% CI: 61.1, 64.2) during the period 2004–2023. Overall, about 10% of the trend increase in modern contraceptive use was attributable to changes in the compositional characteristics of women. On the other hand, 90% of the trend increase was due to contraceptive behaviour change among sexually active women. Changes in the proportion of women with tertiary education (22.41%) emerged as the major contributor to trend increase in modern contraceptive use. The concentration curves showed that utilization of modern contraceptive methods was profoundly higher among the wealthy than the poor in the first three rounds of the surveys and disappeared in the last round (2023). This pro-rich inequality was persisted throughout the study period except for 2023 where it disappeared. Erreygers concentration Index (EI) values were 0.2360 in 2004, 0.1606 in 2009, 0.0473 in 2014 and −0.0164 in 2023.
The observed reduction in inequality in modern contraceptive use in Lesotho from 2004 to 2023 reflects meaningful progress in women’s reproductive autonomy. This could be explained by improvements in education, health service access, empowerment, and social change. Sustaining these gains will depend on continued investments in the health system, educational opportunities, and community-engaged approaches that are culturally sensitive to respond to the contraceptive barriers and shifting demographic realities.
Introduction
Contraception is widely recognised as a key component of reproductive health, offering significant benefits for maternal and child well-being, gender equality, and socioeconomic development [1–3]. Over recent decades, various international conferences and policy frameworks have been implemented to address family planning challenges and promote universal access to contraceptive services. These include the 1994 International Conference on Population and Development (ICPD), the Sustainable Development Goals (Goal 3.7.1), and the WHO Global Strategy for Sexual and Reproductive Health, and the Maputo Plan of Action (2016–2030) reinforce these global commitments by advocating for equitable access to comprehensive sexual and reproductive health services, including modern contraception [4–7]. At the national level, many countries-including Lesotho, through its National Strategic Development Plan II (2018/19–2022/23) and Reproductive, Maternal, New born, Child, and Adolescent Health (RMNCAH) strategy have prioritised family planning as a key strategy to reduce unmet need and improve health outcomes [8,9].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Million Phiri, Mapitso Lebuso, Nthatisi Leseba, Talent Tapera, Joseph Kazibwe, Nebechukwu Henry Ugwu, Garikayi Bernard Chemhaka. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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