The Connectivity Paradox: Why Digital Access is not Associated with Contraceptive Use among Women in Cambodia

Background: Digital media access has expanded rapidly in Cambodia, offering new channels for reproductive health information. Understanding how digital connectivity relates to contraceptive behavior among women of reproductive age is essential for evaluating the potential role of technology-supported health interventions. Objective: To examine whether digital connectivity—measured as access to digital communication channels (mobile phones, internet) and reported exposure to family planning SMS—is associated with modern contraceptive use among women of reproductive age in Cambodia. Methods: This cross-sectional study analyzed data from 34,402 women aged 15-49 years in the 2021-22 Cambodia Demographic and Health Survey. Digital connectivity was measured using mobile phone ownership, internet use, and SMS exposure related to family planning. A composite Digital Connectivity Index (0-3) was created. Survey-weighted logistic regression models were estimated to assess associations with modern contraceptive use, adjusting for age, education, wealth, residence, marital status, and parity. Results: Overall, 45.7% (95% CI: 44.9-46.4%) of women used modern contraception. Digital connectivity varied: 20.0% had no exposure, 23.6% had one channel, 47.8% had two channels, and 8.6% had three channels. In unadjusted analysis, digital connectivity showed no significant association with modern contraceptive use (OR=1.02, 95% CI: 0.97-1.09, p=0.437). This remained non-significant after adjusting for age and education (OR=1.02, 95% CI: 0.96-1.08, p=0.613) and in the fully adjusted model (AOR=1.05, 95% CI: 0.99-1.12, p=0.133). The strongest predictors were marital status (currently married: AOR=3.98, 95% CI: 1.65-9.61, p=0.002) and rural residence (AOR=1.20, 95% CI: 1.04-1.39, p=0.013). Women aged 25-34 had marginally higher odds of use (AOR=1.15, 95% CI: 0.99-1.33, p=0.076), while wealth showed a U-shaped pattern with middle quintile having lower odds (AOR=0.85, 95% CI: 0.73-0.99, p=0.035). Conclusion: Among women of reproductive age in Cambodia, digital connectivity is not independently associated with modern contraceptive use when accounting for sociodemographic factors. Traditional determinants such as marital status, age, and rural residence remain the dominant predictors. Digital health interventions should prioritize content quality and behavior change mechanisms rather than merely expanding access to digital channels.