Estimating Unmet Need for Family Planning in Health Districts of Burkina Faso: Multi-Level Spatial Disaggregation Using the 2021 DHS and the 2019 GPHC

Abstract Background In Burkina Faso, unmet need for family planning (UNFP) remains a persistent public health challenge, with modern contraceptive prevalence still suboptimal among married women despite sustained programmatic investment. This study produces subnational estimates of UNFP in Burkina Faso at four administrative levels (regions, provinces, health districts, and communes) by combining microdata from the 2021 Demographic and Health Survey (DHS) and the 2019 General Population and Housing Census (GPHC). Methods The estimation strategy draws on the Small Area Estimation (SAE) framework through two complementary components: (i) the Elbers, Lanjouw, and Lanjouw (ELL) method for predicting individual probabilities from census data, and (ii) the Delta method for quantifying uncertainty around aggregated estimates. A binary logistic regression model was fitted to survey data and projected onto the census. Results Statistically significant predictors include age, education level, parity, and household wealth; place of residence was not statistically significant, suggesting that barriers to family planning extend beyond the urban/rural divide. The estimated national UNFP prevalence was 15.15% [14.39; 16.56], compared with 15.5% in the DHS report, indicating strong overall agreement. Spatial disaggregation reveals three structural configurations: (i) a corridor of high-prevalence districts spanning the Centre-Nord, Nord, and Plateau Central regions, associated with pronatalist norms and service gaps; (ii) the Bogodogo and Boulmiougou districts of Ouagadougou show levels comparable to those of the first group, likely driven by rural-to-urban migration; and (iii) low prevalence in the Sahel and Est districts, which must be interpreted cautiously given security-related constraints on data collection. Conclusion These findings confirm the value of SAE for geographically targeted family planning interventions. We recommend prioritizing the continuous availability of modern contraceptive methods in the high-prevalence districts of the Centre-Nord, Nord, and Plateau Central regions and in peri-urban areas of Ouagadougou, and integrating ELL-based estimates into subnational monitoring systems to guide programmatic decisions.