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Machine Learning Algorithm-Based Contraceptive Practice among Ever-Married Women in Bangladesh: A Hierarchical Machine Learning Classification Approach

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Iqramul Haq, Md. Ismail Hossain, Md. Moshiur Rahman, Md. Injamul Haq Methun, Ashis Talukder, Md. Jakaria Habib and Md. Sanwar Hossain

Submitted: January 31st, 2022 Reviewed: February 10th, 2022 Published: April 17th, 2022

DOI: 10.5772/intechopen.103187

Machine Learning and Data Mining - Annual Volume 2022 Authored by Marco Antonio Aceves Fernandez

From the Annual Volume

Machine Learning and Data Mining - Annual Volume 2022 [Working Title]

Dr. Marco Antonio Aceves Fernandez

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Contraception enables women to exercise their human right to choose the number and spacing of their children. The present study identified the best model selection procedure and predicted contraceptive practice among women aged 15–49 years in the context of Bangladesh. The required information was collected through a well-known nationally representative secondary dataset, the Bangladesh Demographic and Health Survey (BDHS), 2014. To identify the best model, we applied a hierarchical logistic regression classifier in the machine learning process. Seven well-known ML algorithms, such as logistic regression (LR), random forest (RF), naïve Bayes (NB), least absolute shrinkage and selection operation (LASSO), classification trees (CT), AdaBoost, and neural network (NN) were applied to predict contraceptive practice. The validity computation findings showed that the highest accuracy of 79.34% was achieved by the NN method. According to the values obtained from the ROC, NN (AUC = 86.90%) is considered the best method for this study. Moreover, NN (Cohen’s kappa statistic = 0.5626) shows the most extreme discriminative ability. From our research, we suggest using the artificial neural network technique to predict contraceptive use among Bangladeshi women. Our results can help researchers when trying to predict contraceptive practice.


  • contraceptive
  • machine learning algorithms
  • NN
  • hierarchical

1. Introduction

Family planning is indispensable in facilitating the prosperity and autonomy of women, their families, and their communities. Contraceptive choices, maternal and newborn health care, sexually transmitted infections, and sexual health are the main concepts of reproductive health [1]. The states agreed in 2001 that among the Millennium Development Goals (MDGs), target 5b was called for by 2015 for universal access to reproductive health. Global contraceptive prevalence is 64% (41% in low-income countries) and the global unmet need for family planning is 12% (22% in low-income countries) as reported at the end of the MDGs period. Sustainable Development Goals (SDGs) targets 3.7 and 5.6 call for universal access to sexual and reproductive health care services and sexual and sexual and reproductive health and reproductive rights, respectively [2, 3].

It has been calculated that maternal mortality has been reduced globally by 30% by the increase in contraceptive use [4]. Unintended pregnancies, pregnancy spacing, and reducing high-risk pregnancies are the consequences of contraceptive use [5, 6, 7]. Current studies show that every year, contraceptive use could reduce nearly 230 million births by stopping unwanted pregnancies [8]. As a result, the use of contraception improves the health of women and their children [6, 9]. However, the prevalence of contraceptive practice varied between 11.3% and 72.1% in different countries, namely Mozambique, 11.3%, Ghana, 21.5%, Bangladesh (modern method), 54.0%, and Sweden, 72.1% [9, 10, 11, 12].

Previous research has shown that various variables are significantly associated with contraceptive use, such as maternal age, maternal and husband’s educational level, wealth status, maternal age at first marriage, and so on [11, 13]. Through the promotion of family planning, appropriate diagnostics, and interventions, the prevalence of contraceptive use is increasing. Popular statistical methods (binary logistic regression) have been applied to determine important indicators of contraceptive use among women. But the main goal is to predict contraceptive practice among women aged between 15 and 49 in Bangladesh. Machine learning is a scientific method that can build models for prediction purposes. According to the research, traditional statistical procedures were shown to be ineffective in this form of modeling. Machine learning approaches have long been shown to be more successful and promising in handling a variety of complicated and nonlinear issues [14, 15, 16].

However, not many studies have explored machine learning methods to develop predictive models for studying contraceptive methods. Therefore, various well-known machine learning algorithms were applied to predict contraceptive practices among 15–49-year-old women in Bangladesh in this study. Before prediction, we applied a Hierarchical Logistic Regression classifier in machine learning approaches that were used to select potential risk factors associated with the contraceptive practice of women. To our best knowledge, the originality of the study is that it is almost new in the field of machine learning classifier approach in the contraceptive practice of Bangladesh context, for the first time using such methods, which will assist future data scientists.


2. Methods

2.1 Data source

In this study, the necessary information has been extracted from a representative secondary national data set, the Bangladesh Demographic and Health Survey (BDHS), 2014. This survey was carried out through a joint effort of the National Institute of Population Research and Training (Bangladesh), Mitra Associates (Bangladesh), and ICF International (USA).

The entire list of enumeration areas (EAs) that encompasses the entire country, provided by the Bangladesh Bureau of Statistics (BBS) for the 2011 population and housing census of the People’s Republic of Bangladesh, served as the sampling frame for the 2014 BDHS. An EA was a geographical zone with an average of 120 households. The survey uses a two-stage stratified sampling process that includes information on the EA region, residence (urban or rural), and the number of residential households counted. Viable interviews were conducted in 98% of the selected households (out of 17,989 total). For this study, 17,863 ever-married women aged 15–49 years were included in the final analysis. Note that to learn more about the detailed sampling procedure of the 2014 BDHS, see the final published report of the survey [17].

2.2 Dependent variable

Since the main purpose of this study was to predict contraception practice among women aged 15–49 years, the response variable was “current contraception use”, which was classified as “Yes or No”. If the respondent currently utilizes a contraceptive method, she falls into the “Yes” group, otherwise, she falls into the “No” group.

2.3 Independent variables

Besides the response variable, a set of 21 demographic and socioeconomic risk factors were included in the analysis, which was associated with contraceptive practice and considered predictor variables. Several studies found that demographic and socioeconomic characteristics such as current age, division, religion, residence, respondent’s working status, FP media exposure, age at first marriage, currently breastfeeding, wealth status, women’s education, husband’s education, child ever born, number of living children, ideal number of children, fertility preference, marital status, and decision making for using contraception are potential risk factors that determine contraception practice among women [10, 11, 18, 19, 20, 21, 22, 23, 24]. The list of independent variables and their measures are presented in Table 1.

1Women current age (years)15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49
2DivisionBarisal, Chittagong, Dhaka, Khulna, Rajshahi, Rangpur, Sylhet
3ReligionIslam, other
4Sex of household headMale, female
5ResidenceUrban, rural
6Respondent working statusNo, yes
7Family planning (FP) media exposureNo, yes
8Age at first marriage<18, 18+
9Currently breastfeedingNo, yes
10Currently amenorrhoeicNo, yes
11Currently abstainingNo, yes
12Wealth statusPoor, middle, rich
13Women educationNo education, primary education, secondary+
14Husband educationNo education, primary education, secondary+
15Sexually transmitted infection (STI)No, yes
16Children ever born0–1, 2–3, 4+
17Number of living childrenNone, 1–2, 3+
18Ideal number of children0–1, 2–3, 4+
19Fertility preferenceNo more, have another, undecided, declared infecund, sterilized
20Marital StatusMarried, others
21Decision making for using contraceptionRespondent, others

Table 1.

Description of independent variables.

2.4 Statistical analysis

The frequency distribution was used to describe the background characteristics of the respondents. In this study, we developed a Hierarchical Logistic Regression classifier in machine learning approaches that were used to select potential risk factors related to the contraceptive practice of women in Bangladesh by using the largest value of AUC (p < 0.05). One of the procedures for enhancing the performance of machine learning is hierarchical learning, which is inspired by human learning [25]. The DeLong test is an extensively used test to compare the difference between two AUCs [26]. That model was significant, with the largest AUC value, and was considered the final model in this analysis. The steps are depicted in Figure 1.

Figure 1.

Flow diagram for hierarchical logistic regression classifier in the machine learning process.

To meet the objective of the study, we fitted numerous numbers of model where the full model is denoted by Mi(wherei=21) using Hierarchical Logistic Regression classifier in the Machine Learning Process. The steps are described below:

Step 1:Consider jthmodel defined as Mjj=123iwhich is consist of jpredictors. Thus, the initial model was named Model1 and defined as M1where j=1, then fit the model M1by using machine learning logistic classifier (MLLC).

Step 2:Adding a variable in the previous model and defined as Mj+1and again also fit model Mj+1by using MLLC approach.

Step 3:Identify the best model by using Delong’s Test, which is considered the largest area under the curve at a 5% level of significance.

Step 4:If Mj+1>Mjbased on AUC at 5% level of significance, then Model Mj+1has a significantly different AUC from Model Mjwith p < 0.05. In this case, the best model was considered as Mj+1, otherwise the model was Mj.

Step 5:The process is repeated successively until the desired number of risk factors/features are identified.

After selecting the final model, we applied the 7 most popular machine learning classifiers to predict contraceptive practice among ever-married women aged 15–49 in Bangladesh. In this study, we used seven different popular ML algorithms (Logistic Regression (LR), Random Forest (RF), Naïve Bayes (NB), Least Absolute Shrinkage and Selection Operation (LASSO), Classification Trees (CT), AdaBoost, and Neural Network (NN)). A detailed description of the algorithms used is available in the literature [27, 28, 29, 30, 31, 32].

The Statistical Package for Social Science (SPSS) version 25 and R version 4.0.0 software were used for data management and analysis.

2.5 Proposed approach

Data from ever-married women aged 15–49 was used in this study. Only ever-married women aged 15–49 was considered for the final analysis based on this criterion. Then, apply data preparation methods; for example, first find out missing data from the overall dataset. It is well known that the main drawbacks of missing information in a dataset are the reduced statistical power (because it reduces the number of samples n, the estimates will have larger standard errors). The main disadvantages of missing data in a dataset are statistical power reductions, which are well-known (because it reduces the number of samples n, the estimates will have larger standard errors). There are numerous imputation methods for imputing missing values nowadays, including direct deletion, mode imputation, hot-deck imputation, and so on [33]. A lower threshold of 5% missingness has been suggested in the literature [34]. We utilized the direct deletion method because this study had a low rate of missing values, which means we removed all missing values from the data set and conducted the analysis using the entire data set. The next step after missing value processing is to normalize/standardize the variables, which is useful when the data distribution is unknown. As a result, normalization is not required for any machine learning approach, especially in categorical data. Finally, all machine learning classifiers included in this study were performed on 70% of the respondents in each group (training data set, n = 12,504) and acquired by the remaining 30% (test data set, n = 5358). All models were trained to support 10-fold cross-validation. On the training set, we performed 10-fold cross-validation, and on the testing set, we estimated performance. The results of the development of the seven machine learning classifiers are depicted in Figure 2.

Figure 2.

Flow chart of the development of the seven machine learning classifiers.

2.6 Model evaluation

We used the following criteria to evaluate the ML algorithms’ performance: confusion matrix, receiver operating characteristic (ROC), and the area under that curve (AUC). Generally, a confusion matrix has four possible prediction outcomes, such as TR = true positives, TN = true negatives, FP = false positives, and FN = false negatives. Several performance measures, including accuracy, precision, recall, and the F1 score, are usually calculated using these four potential outcomes to assess the classifier. The ROC curves have been calculated by utilizing the predicted outcomes as well as the true outcomes. To examine the ML algorithms’ discriminating powers, the AUC of the ROC has been averaged for the test data sets [35]. Theoretically, the AUC should be between 0 and 1, with 1 being the most extreme value for an ideal classifier. Since the usual lower bound for random classification is 0.5, an AUC greater than 0.5 has at least some capacity to separate between cases and non-cases [36]. In addition to these measures, we also used Cohen’s kappa statistic, which is a better measure to examine the agreement between two raters. It is calculated by utilizing the predicted and the actual classifications in a data set. The value of Cohen’s kappa statistic is 1.


3. Results

3.1 Sociodemographic characteristics of women

Table 2 shows the percentage distribution of women according to the selected socio-demographic characteristics of Bangladesh. The majority of women (19%) are between the ages of 25 and 29. The majority of them (35%) are from the Dhaka division, Muslims (90%), living in male-headed households (89%), and in the rural areas (72%). In terms of working status, slightly more than two-thirds (67%) of women are not currently involved in any kind of income-generating activities, and 80% of them do not have any media exposure. The majority of women (77% of them) married before their 18th birthday, and 79% of them were not breastfeeding their children at the time of the survey. The findings also show that around 96 to 97% of women are not amenorrheic (96%) or abstaining (97%). In terms of wealth status, 42% of the women were from rich families. Approximately half of the women (46%) had secondary or higher education. The majority of the husbands (44%) had a secondary or higher level of education. The number of women who knew about sexually transmitted infections (STIs) was found to be 67%. The majority of women (46%) have had 2–3 children, while 53% have 1–2 living children. The ideal number of children was 2–3 (86%) and more than half (57%) of the women were not interested in having another child. The vast majority of women are currently married (94%), and only 9% can make the decision to use a contraception method on their own. Regarding contraception use, according to the 2014 BDHS, 58.9% of women used it.

CharacteristicsSample women
Women current age (years)
Sex of household head
Respondent working status
Family planning (FP) media exposure
Age at first marriage
Currently breastfeeding
Currently amenorrhoeic
Currently abstaining
Wealth status
Women education
No education445524.9
Secondary +819945.9
Husband education
No education518929.0
Sexually transmitted infection (STI)
Children ever born
Number of living children
Ideal number of children
Fertility preference
No more955556.7
Have another529331.4
Declared infecund5613.3
Marital Status
Decision making for using contraception
Contraception use status
Not Using733641.1

Table 2.

Percentage distribution of ever- married women age between 15 and 49 by selected socio-demographic characteristics.

3.2 Create model

In the initial step of the analysis, we applied hierarchal logistic regression to select the final model. Here, each variable was considered as one model. We added a potential risk factor (variable) to the previous model that was considered a new model in this analysis (Table 3). For example, in the initial model M1we considered (arbitrary) respondent age, M1+Divisionwas considered as M2. Similarly, we consider another model by adding a variable to the previous model until the desired number of models is reached in this analysis. The details are presented in Table 3.

M1 = respondent ageM12 = M11 + wealth status
M2 = M1 + divisionM13 = M12 + women education
M3 = M2 + religionM14 = M13 + husband education
M4 = M3 + Sex of household headM15 = M14 + sexually transmitted infection (STI)
M5 = M4 + residenceM16 = M15 + children ever born
M6 = M5 + respondent working statusM17 = M16 + number of living children
M7 = M6 + FP media exposureM18 = M17 + ideal number of children
M8 = M7 + age at first marriageM19 = M18 + fertility preference
M9 = M8 + currently breastfeedingM20 = M19 + marital status
M10 = M9 + currently amenorrhoeicM21 = M20 + decision making for using contraception
M11 = M10 + currently abstaining

Table 3.

Create a model-based hierarchical approach.

3.3 Best model selection

All models were statistically significant (p < 0.001) except models M7and M12. Based on the Delong test, we excluded two variables (FP media exposure and wealth status) from our final analysis. The remaining significant variables were considered risk factors for predicting contraceptive practice among women aged 15–49 years in Bangladesh. From Table 4, Model M21was the final model for analysis, and selected risk factors were also used for the final analysis. The details of the best model selection procedure are given in Table 4.

ModelAUCDeLong’s test for AUC (p-value)DecisionModel selection
M10.629−9.26 (0.000)M2 has a significantly different AUC from M1M2 is selected
M30.662−2.16 (0.031)M3 significantly different AUC from M2M3 is selected
M40.713−16.21 (0.000)M4 significantly different AUC from M3M4 is selected
M50.714−2.03 (0.041)M5 had significantly different AUC from M4M5 is selected
M60.715−2.24 (0.025)M6 had significantly different AUC from M5M6 is selected
M70.716−0.61 (0.545)M7 had not significantly different AUC from M6M7 is not selected
M80.716−2.63 (0.008)M8 had a significantly different AUC from M6M8 is selected
M90.723−4.34 (0.000)M9 had a significantly different AUC from M8M9 is selected
M100.762−14.38 (0.000)M10 had a significantly different AUC from M9M10 is selected
M110.773−8.05 (0.000)M11 had a significantly different AUC from M10M11 is selected
M120.773−0.72 (0.472)M12 had not a significantly different AUC from M11M12 is not selected
M130.774−2.22 (0.029)M13 had a significantly different AUC from M11M13 is selected
M140.775−2.17 (0.030)M14 had a significantly different AUC from M13M14 is selected
M150.776−2.13 (0.033)M15 had a significantly different AUC from M14M15 is selected
M160.799−11.81 (0.000)M16 had a significantly different AUC from M15M16 is selected
M170.813−9.26 (0.000)M17 had a significantly different AUC from M16M17 is selected
M180.816−4.74 (0.000)M18 had a significantly different AUC from M17M18 is selected
M190.828−11.45 (0.000)M19 had a significantly different AUC from M18M19 is selected
M200.847−14.69 (0.000)M20 had a significantly different AUC from M19M20 is selected
M210.866−21.75 (0.000)M21 had a significantly different AUC from M20M21 is selected

Table 4.

Best model selection based on Delong’s test.

3.4 Performance parameter of machine learning algorithms

This study used seven different machine algorithms to classify contraceptive practices among married women both training and an experimental/test dataset. Performance parameters (such as accuracy, precision, recall, F1, specificity, and AUC value) were used to compare the predictive performance of these algorithms. In addition, Cohen Kappa’s statistical information was used to determine the discriminant accuracy of the algorithm. The prediction results with performance parameters for each algorithm are shown in Table 5 and Figure 3.

Model nameAccuracy (95% CI)Cohen’s kappaPrecessionRecallF1AUCSpecificity
LR78.52 (77.39, 79.61)0.555981.2382.3981.8186.5773.03
RF77.57 (76.43, 78.68)0.528878.3285.3581.6984.0766.53
NB76.56 (75.40, 77.69)0.499575.7388.3281.5484.1759.90
LASSO79.08 (77.96, 80.16)0.560179.3986.8582.9686.5968.06
CT78.57 (77.45, 79.67)0.546478.1688.0682.8185.5965.13
AdaBoost78.50 (77.37, 79.59)0.552380.2084.0882.1086.1570.59
NN79.34 (78.23, 80.42)0.562678.7188.7683.4486.9065.99

Table 5.

Performance evaluation for seven ML algorithms (test data set).

Figure 3.

Area under curve of all seven machine learning classifiers.

Table 5 shows that the logistic regression classifier has an accuracy of 78.52%. The precision and recall of the fitted model were 81.23% and 82.39%, respectively, while the F1 score was 81.81%. The area under the curve (AUC) was calculated to be 86.57%. The prediction performance result of a random forest was displayed with an accuracy of 77.57%. Here, the precision, recall, and F1 score of the random forest classifier were 73.82%, 85.35%, and 81.99%, respectively. The AUC, in this case, was 84.07%. The final accuracy of the naïve Bayes classifier was 76.56%, with a precision of 75.73% and a recall of 88.32%. The F1 score and the AUC value, in this case, were 81.54% and 84.17%, respectively. Using Least Absolute Shrinkage and Selection Operator (LASSO) analysis, the accuracy in the test data set was seen as 79.08% with precession and recall of 79.39% and 86.85% respectively, and the F1 score was 82.96%. According to the test observation results, the classification tree method showed 78.57% accuracy in predicting contraceptive practice among married women, with a precession of 78.16%, a recall of 88.06%, an F1 score of 82.81%, and an AUC value of 85.59%. For AdaBoost, these values are 78.05% (accuracy), 80.20% (precession), 84.88% (recall), 82.10% (F1 score) and 86.15% (AUC). Finally, we used an artificial neural network and obtained an accuracy of 79.34%. Here, other parameters such as precession, recall, F1 score, and AUC are 78.71%, 88.76%, 83.44%, and 86.90% respectively. Among the seven classifiers, we obtained the best performance from NN in terms of both accuracy and AUC. Cohen’s kappa value is 0.5626.

This violin plot shows the relationship of seven classifiers to accuracy. The shaded areas detail the distribution of the data in each classifier. Figure 4 shows that NN provided the highest mean accuracy, followed by LASSO and AdaBoost. Unlike the boxplot, the entire distribution of the 10-fold accuracy can be visualized in this violin plot (Figure 4).

Figure 4.

Violin plots of the 10-fold cross-validation.


4. Discussion

This is the very first study that uses a hierarchical logistic classifier in a machine learning approach. Then the predictive performance of the hierarchical logistic classifier was compared with the other six machine learning algorithms’ predictive power. In this study, the use of contraception among ever-married women in Bangladesh has been predicted using sociodemographic factors. This study can provide policymakers and academics with a starting point to examine key outlines in a larger framework and raise noteworthy interventions.

The study found that the prevalence of contraception was almost 59% in Bangladesh. The prevalence rate of contraceptives in India is 54%, while the rates were 47%, 34%, and 65%, respectively, for Nepal, Pakistan, and Sri Lanka [37, 38]. As the government of Bangladesh is committed to the London Summit on Family Planning to improve contraceptive access and use among impoverished people in both urban and rural areas [39], the findings of this study will provide grounding direction for the increase in the prevalence of contraception.

In this study, we used hierarchical LR, RF, NB, LASSO, CT, AdaBoost, and NN machine learning techniques to predict contraceptive practice among ever-married women in Bangladesh. The current analysis was to evaluate which performed better based on the accurate prediction rate of contraceptive use for 2014, BDHS data sets. Moreover, there was no evidence of scientific study that used a hierarchical logistic classifier and several supervised learning. In this study, 70% of the respondents were used for model tuning purposes, and the remaining 30% were used to check model performance, for the model tuning was performed using 10-fold cross-validation on the training dataset. The researcher observed that cross-validation is most commonly used to evaluate model performance [40]. The prediction of contraceptive use was measured by performance parameters (such as accuracy, precision, recall, F1, and AUC value) compared to the performance of seven different machine learning classifiers in this analysis. Cohen’s kappa, the proportion of predicted to actual classification in the dataset, is used to assimilate model perfection. Among the used models, the Neural Network outperformed other models with an accuracy of 79.34%. Additionally, in terms of Cohen kappa, the result of this analysis also highlighted that the Neural Network provides the best predictive performance (Cohen’s κ= 0.5626). This indicates Neural Networks have achieved better performance than other LR, RF, Lasso Regression, NB, CT, and AdaBoost. Hailemariam et al. proposed a J48 decision tree that performed better than Naïve Bayes to predict contraceptive practice in Ethiopian women [41]. However, Hailemariam et al. have not used the neural network in their study [41]. In a data mining study in India, the CART model produces pretty satisfactory results for finding the predictors of contraception use among married women [42]. However, Vaz and his team member also found that the Random Forest model was the most accurate model for predicting women’s fertile periods [43]. Machine learning algorithms can be quite helpful in predicting infertility in women, according to a study conducted in Nigeria [44].


5. Conclusions

In this paper, we investigate the hierarchical logistic regression classifier in machine learning approaches to identify potential risk factors related to contraceptive practices of women in Bangladesh. In summary, we conclude that all of the selected covariates were significant determinants for contraceptive practice except FP Mass media exposure and wealth status according to the hierarchical logistic regression classifier in machine learning approaches based on the Delong test. Here, we compared seven supervised machine learning algorithms to predict contraceptive practice among ever-married women aged between 15 and 49 years in Bangladesh. The NN model has exhibited the best results based on the performance parameters, having demonstrated an accuracy of 79.34%, a precision of 78.71%, a recall of 88.76%, an F1 score of 83.44%, and an AUC value of 86.90. Among the seven algorithms, the NN model performs the best in terms of accuracy, Cohen’s kappa statistic, and area under the curve (AUC). This study recommends the use of the NN model and policymakers should pay attention to continuing this study in the future.



A special thank goes to the Demographic Health Surveys for enabling us to use Bangladesh Demographic Health Survey data for our study from


Conflicts of interest

The authors declare that they are not competing of interest.



This study did not receive funding.


Data availability

This study was analyzed using secondary data, which were available at “”.


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Written By

Iqramul Haq, Md. Ismail Hossain, Md. Moshiur Rahman, Md. Injamul Haq Methun, Ashis Talukder, Md. Jakaria Habib and Md. Sanwar Hossain

Submitted: January 31st, 2022 Reviewed: February 10th, 2022 Published: April 17th, 2022