Advancing Sexual and Reproductive Health and Rights
 
International Perspectives on Sexual and Reproductive Health
Volume 39, Number 3, September 2013
DIGEST

Unmet Need for Contraceptives in Developing World Has Declined, But Remains High in Some Countries

Between 2003 and 2012, the proportion of women aged 15–49 in developing countries who wanted to avoid pregnancy increased from 54% to 57%, according to an analysis of data on contraceptive need and use throughout the developing world.1 The number of such women increased by 151 million, though most of the increase (72%) is attributable to population growth. Among women who wished to avoid pregnancy, the proportion who had an unmet need for a modern method of contraception decreased from 29% in 2003 to 26% in 2012. Nonetheless, the proportion remained high in Sub-Saharan Africa (60%), western Asia (50%) and south Asia (34%). The analysis also revealed a shift away from use of the most effective method, sterilization, to greater use of injectables and barrier methods.

As part of the effort to monitor progress toward the goal of universal access to contraceptives outlined in Millennium Development Goal 5, the researchers estimated levels of modern contraceptive use and unmet need in developing countries. Modern contraceptive use was defined as the use by a woman or her partner of at least one of the following methods: sterilization, IUD, implant, injectable, oral contraceptives, male condoms or other supply methods (such as spermicide). Women were categorized as wanting to avoid pregnancy if they were using a modern method; if they did not use contraceptives but were married (or unmarried and sexually active), fecund and did not want a child in the next two years; or if they were pregnant (or experiencing postpartum amenorrhea) but had not wanted to become pregnant for at least two more years, if at all. Women who wanted to avoid pregnancy but were using no method or a traditional method (such as periodic abstinence or withdrawal) were considered to have an unmet need for modern contraceptives.

Using Demographic and Health Surveys and similar national surveys for developing nations, the researchers tabulated the proportions of women who were using modern methods to avoid pregnancy and those who had unmet need. Estimates were made for 2003, 2008 and 2012; values for countries that lacked data were estimated from weighted subregional averages, information from previous studies or data from similar countries. For each country, separate estimates were made for women who were currently, formerly or never married (or in union); these proportions were applied to estimates (from United Nations and national survey data) of numbers of women in each marital status category. Also, the researchers calculated the proportion of women using each type of modern contraceptive. Country-specific results were aggregated to yield estimates for geographic regions and subregions, as well as for the 69 poorest countries.

In 2003, 716 million (54%) of the 1.32 billion women aged 15–49 in developing countries wanted to avoid pregnancy; in 2012, 867 million (57%) of the 1.52 billion women of reproductive age wished to do so. Seventy-two percent of the increase in the number of women who wanted to avoid pregnancy (108 million out of 151 million women) is attributable to population growth; the remainder reflects changing patterns of marriage and sexual activity and women’s increasing motivation to avoid unintended pregnancy.

The proportion of women who wanted to avoid pregnancy varied greatly by region in 2012, ranging from less than half in central and western Asia and most regions of Africa to two-thirds or more in eastern Asia, southern Africa and South America. Although the proportion of women wanting to avoid pregnancy increased by three percentage points overall between 2003 and 2012, larger increases occurred in eastern Asia (from 66% to 72%), eastern Africa (from 39% to 45%), southern Africa (from 63% to 70%), the Caribbean (from 52% to 59%) and South America (from 62% to 68%).

Between 2003 and 2012, the number of women using a modern method increased by 139 million; 106 million of this increase can be attributed to population growth and the remaining 33 million to an increase in the proportion of women using modern methods. In 2012, levels of modern method use among those who wanted to avoid pregnancy were highest in eastern Asia (94%), southern Africa (83%), Central America (77%) and South America (79%). Levels of use were moderate (46–66%) in south Asia, western Asia and eastern Africa, and very low (≤26%) in middle and western Africa. However, between 2003 and 2012, method use increased substantially among women wanting to avoid pregnancy in southeast Asia (from 64% to 72%), eastern Africa (from 31% to 46%), southern Africa (from 75% to 83%), Central America (from 71% to 77%) and South America (from 73% to 79%), as well as in the 69 poorest developing countries (from 55% to 61%).

The most commonly used modern method in developing countries in 2012 was sterilization (38%), followed by IUDs (28%), oral contraceptives and barrier methods (13% each), and injectables or implants (9%). However, the predominant method varied by region: Sterilization was the most common method in Asia as a whole, as well as in Latin America and the Caribbean; IUDs predominated in eastern, central and western Asia; long-acting hormonal contraceptives (mostly injectables) were the most frequently used methods in Sub-Saharan Africa overall and in southeast Asia; oral contraceptives accounted for the largest proportion of method use in Northern Africa; and barrier methods were the most commonly used contraceptives in middle and western Africa. The number of women using each type of method increased between 2003 and 2012; however, the proportion of contraceptive users who relied on sterilization decreased, while barrier and long-acting hormonal methods each accounted for a growing share of the method mix.

The proportion of women wanting to avoid pregnancy who had an unmet need for modern methods declined from 29% in 2003 to 26% in 2012. Of the 222 million women in developing countries with an unmet need for modern methods, 162 million (73%) lived in the 69 poorest countries. The proportion of women with unmet need decreased in every subregion between 2003 and 2012, but those proportions remained high in many areas, including middle Africa (81%), western Africa (74%), eastern Africa (54%), western Asia (50%) and south Asia (34%).

The researchers acknowledge several limitations. Notably, the sexual activity of unmarried women is likely to be somewhat underreported in Sub-Saharan Africa and Latin America, and extensively underreported in Asia and northern Africa (when available at all). In addition, in some cases the same data source was used for both 2003 and 2008, or both 2008 and 2012, because it was the only available source for both reference years; this may have resulted in an underestimation of change, particularly for 2008–2012. Nonetheless, the researchers note that although the number of women who want to avoid pregnancy is rising, the proportion with unmet need for modern contraceptives appears to have declined, albeit only slightly. To address the remaining unmet need for modern contraceptives, developing nations “need to increase resources, improve access to contraceptive services and supplies, and provide high-quality services and large-scale public education interventions to reduce social barriers.”—L. Melhado

REFERENCE

1. Darroch JE and Singh S, Trends in contraceptive need and use in developing countries in 2003, 2008 and 2012: an analysis of national surveys, Lancet, 2013, 381(9879):1756–1762.