Contraceptive Technologies: Responding to Women’s Needs
- In developing countries, one in four sexually active women who want to avoid becoming pregnant have an unmet need for modern contraception. These women account for 82% of unintended pregnancies in the developing world.
- Sub-Saharan Africa, South Central Asia and Southeast Asia are home to 69% of women in the developing world who have an unmet need for a modern method.
- Each year in these three regions, 49 million women have unintended pregnancies, leading to 21 million unplanned births, 21 million induced abortions (15 million of which are unsafe), 116,000 maternal deaths and the loss of 15 million healthy years of women’s lives.
- Seven in 10 women with unmet need in the three regions cite reasons for nonuse that could be rectified with appropriate methods: Twenty-three percent are concerned about health risks or method side effects; 21% have sex infrequently; 17% are postpartum or breast-feeding; and 10% face opposition from their partners or others.
- In these three regions, the typical woman with reasons for unmet need that could be addressed with appropriate methods is married, is 25 or older, has at least one child and lives in a rural area.
- In the short term, women and couples need more information about pregnancy risk and contraceptive methods, as well as better access to high-quality contraceptive services and supplies.
- In the medium term, adaptations of current methods can make these contraceptives more acceptable and easier to use. n Investment in longer-term work is needed to discover and develop new modes of contraceptive action that do not cause systemic side effects, can be used on demand, and do not require partner participation or knowledge.
- Overcoming method-related reasons for nonuse of modern contraceptives could reduce unintended pregnancy and its consequences by as much as 59% in these regions.
Singh S et al., Adding It Up: The Costs and Benefits of
Investing in Family Planning and Maternal and Newborn
Health, New York: Guttmacher Institute and United Nations
Population Fund (UNFPA), 2009.
Special tabulations of data for Singh S et al., Adding It
Up: The Costs and Benefits of Investing in Family Planning
and Maternal and Newborn Health, New York: Guttmacher
Institute and UNFPA, 2009.
3. Cates W et al., Family planning and the Millennium
Development Goals, Science, 2010, 329(5999):1603.
4. Taskforce on Innovative International Financing for
Health Systems, Healthy Women & Healthy Children: Investing
in Our Common Future, 2009, <http://www.
EN.pdf>, accessed Feb. 5, 2011.
5. Guttmacher Institute, Facts on investing in family planning
and maternal and newborn health, In Brief, New York:
Guttmacher Institute, 2010.
6. Cleland J et al., Family planning: the unfinished agenda,
Lancet, 2006, 358(9549):1810–1827.
7. Townsend JW et al., New strategies for providing hormonal
contraception in developing countries, Contraception,
8. Campbell M, Nuriye NS and Potts M, Barriers to fertility
regulation: a review of the literature, Studies in Family
Planning, 2006, 37(2):87–98.
9. Speidel JJ et al., Making the Case for U.S. International
Family Planning Assistance, Baltimore: Johns Hopkins
Bloomberg School of Public Health, 2009.
10. Harper MJK, In search of a second contraceptive
revolution, Sexuality, Reproduction & Menopause, 2005,
11. Darroch JE, Family planning: overview of epidemiologic
and medical events, in: Ward JW and Warren C, eds., Silent
Victories: The History and Practice of Public Health in
Twentieth Century America, New York: Oxford University
Press, 2007, pp. 253–278.
12. Burkman R, Bell C and Serfaty D, The evolution of
combined oral contraception: improving the risk-to-benefit
ratio, Contraception, 2011, doi: 10.1-16/j.contraception.2010.11.004,
accessed Feb. 5, 2011.
13. Jaffe FS, Commentary: some policy and program implications
of “Contraceptive Failure in the United States,”
Family Planning Perspectives, 1973, 5(3):143–144.
14. Bell D, Summary comments, in: Rockefeller Foundation,
Third Bellagio Conference on Population, May 10–12,
1973, New York: Rockefeller Foundation, 1974, pp. 91–98.
15. Greep RO, Koblinsky MA and Jaffe FS, Reproduction
and human welfare: a challenge to research, BioScience,
16. Atkinson L et al., Prospects for improved contraception,
Family Planning Perspectives, 1980, 12(4):173–192.
17. Office of Technology Assessment, World Population
and Fertility Planning Technologies: The Next 20 Years,
Washington, DC: U.S. Government Printing Office, 1982.
18. Atkinson LE, Lincoln R and Forrest JD, The next contraceptive
revolution, Family Planning Perspectives, 1986,
19. Djerassi C, The bitter pill, Science, 1989, 245(4916):
20. Mastoianni L, Donaldson PJ and Kane TT, eds.,
Developing New Contraceptives: Obstacles and
Opportunities, Washington, DC: National Academy Press,
21. Duncan GW, External review of USAID’s current and
future role in contraceptive research and development,
unpublished report submitted to U.S. Agency for
International Development (USAID), Oct. 5, 2006 (revised
version issued Feb. 14, 2007).
22. Harrison PF and Rosenfield A, eds., Contraceptive Research
and Development: Looking to the Future, Washington,
DC: National Academy Press, 1996.
23. Nass SL and Strauss JF, New Frontiers in Contraceptive
Research: A Blueprint for Action, Washington, DC:
National Academies Press, 2004.
24. United Nations (UN), Keeping the Promise: United to
Achieve the Millennium Development Goals, New York:
25. Cohen SA, As global commitment to reproductive
30 Guttmacher Institute
39. Wellings K et al., Sexual behaviour in context: a global
perspective, Lancet, 2006, 368(9548):1706–1728.
40. Zabin LS et al., Levels of change in adolescent sexual
behavior in three Asian cities, Studies in Family Planning,
41. Trussell J, Contraceptive efficacy, in: Hatcher RA et al.,
eds., Contraceptive Technology, 19th ed., New York: Ardent
42. Frost JJ and Darroch JE, Factors associated with contraceptive
choice and inconsistent method use, United
States, 2004, Perspectives on Sexual and Reproductive
Health, 2008, 40(2):94–104.
43. Ross J et al., Contraceptive method choice in
developing countries, International Family Planning
Perspectives, 2001, 28(1):32–40.
44. Miller K et al., eds., Clinic-Based Family Planning and
Reproductive Health Services in Africa: Findings from Situation
Analysis Studies, New York: Population Council, 1998.
45. Caldwell JD and Caldwell P, Is the Asian family planning
model suitable to Africa? Studies in Family Planning, 1988,
46. Ross J and Smith E, The Family Planning Effort Index:
1999, 2004, and 2009, Washington, DC: Futures Group,
47. Ross J, Stover J and Adelaja D, Family planning programs
in 2004: new assessments in a changing environment,
International Family Planning Perspectives, 2007,
48. Guttmacher Institute, special tabulations of data from
Demographic and Health Surveys, 2009.
49. Special tabulations of data from United Nations Population
Division, World population prospects: the 2008 revision,
2009, <http://esa.un.org/unpp/index.asp>, accessed
50. Jones G and Ramdas K, (Un)tying the Knot: Ideal and
Reality in Asian Marriage, Singapore: National University of
Singapore Press, 2004.
51. Darroch JE and Singh S, Adding It Up: Estimation Methodology,
New York: Guttmacher Institute, forthcoming.
52. Weissman E, Saltner J and Friedman H, Reproductive
Health Costing Model Version 3.0, Part 1b: RH Services—
Total Cost, New York: UNFPA, 2008.
53. Westoff CF, New estimates of unmet need and the
demand for family planning, DHS Comparative Reports,
Calverton, MD: Macro International, 2010, No. 14.
health intensifies, U.S. leadership more important than
ever, Guttmacher Policy Review, 2011, 14(1):2–6.
26. Sharma S and Dayaratna V, Creating conditions for
greater private sector participation in achieving contraceptive
security, Health Policy, 2005, 71(3):347–357.
27. Ross J, Weissman E and Stover J, Contraceptive Projections
and the Donor Gap: Meeting the Challenge, Brussels,
Belgium: Reproductive Health Supplies Coalition,
28. Special tabulations of data from United Nations Population
Division, World population prospects: the 2008 revision,
2009, <http://esa.un.org/unpp>, accessed Mar. 6,
29. Bill & Melinda Gates Foundation, Family Planning Strategy
Overview, 2009, <http://www.gatesfoundation.org/
accessed Mar. 7, 2011.
30. USAID, Family planning, 2010, <http://www.usaid.gov/
Mar. 27, 2011.
31. Department for International Development (DFID),
Choices for Women: Planned Pregnancies, Safe Births and
Healthy Newborns, London: DFID, 2010.
32. World Bank, The World Bank’s Reproductive Health
Action Plan 2010–2015, 2010, Washington, DC: World Bank.
33. The Alan Guttmacher Institute (AGI), Hopes and
Realities: Closing the Gap Between Women’s Aspirations
and Their Reproductive Experiences, New York: AGI, 1995.
34. Westoff CF and Bankole A, Reproductive preferences
in developing countries at the turn of the century, DHS
Comparative Reports, Calverton, MD: ORC Macro, 2002,
35. Feyisetan B and Casterline JB, Fertility preferences and
contraceptive change in developing countries, International
Family Planning Perspectives, 2000, 26(3):100–109.
36. Jayaraman A, Mishra V and Arnold F, The relationship
of family size and composition to fertility desires,
contraceptive adoption and method choice in South Asia,
International Perspectives on Sexual and Reproductive
Health, 2009, 35(1):29–38.
37. Westoff CF and Bankole A, Trends in the demand for
family limitation in developing countries, International
Family Planning Perspectives, 2000, 26(2):56–62 & 97.
38. Lloyd CB, ed., Growing Up Global: The Changing
Transitions to Adulthood in Developing Countries,
Washington, DC: National Academies Press, 2005.
Guttmacher Institute 31
68. Rosenberg MJ, Waugh MS and Higgins JE, The effect
of desogestrel, gestodene, and other factors on spotting
and bleeding, Contraception, 1996, 63(2):85–90.
69. Bradley SEK, Schwandt HM and Khan S, Levels,
trends, and reasons for contraceptive discontinuation, DHS
Analytical Studies, Calverton, MD: ICF Macro, 2009, No.
70. Ali MM and Cleland J, Contraceptive switching after
method-related discontinuation: levels and differentials,
Studies in Family Planning, 2010, 41(2):129–133.
71. Alnakash AH, Influence of IUD perceptions on method
discontinuation, Contraception, 2008, 78(4):290–293.
72. Ali MM and Cleland J, Oral contraceptive discontinuation
and its aftermath in 19 developing countries, Contraception,
73. Lee J and Jezewski MA, Attitudes toward oral contraceptive
use among women of reproductive age: a systematic
review, Advances in Nursing Science, 2007, 30(1):E85–
74. Silverman J, Torres A and Forrest JD, Barriers to contraceptive
services, Family Planning Perspectives, 1987,
19(3):94–97 & 101–102.
75. Gallo MF et al., Combination contraceptives: effects on
weight, Cochrane Database of Systematic Reviews, 2008,
Issue 4, No. CD003987.
76. Huber D, Saeedi N and Samadi AK, Achieving success
with family planning in rural Afghanistan, Bulletin of the
World Health Organization, 2010, 88(3):227–231.
77. Stanback J and Twum-Baah KA, Why do family planning
providers restrict access to services? An examination in
Ghana, International Family Planning Perspectives, 2001,
78. Vernon R, Meeting the family planning needs of
postpartum women, Studies in Family Planning, 2009,
79. Salway S and Nurani S, Uptake of contraception during
postpartum amenorrhoea: understandings and preferences
of poor, urban women in Bangladesh, Social Science &
Medicine, 1998, 47(7):899–909.
80. Labbok MH et al., Trends in exclusive breastfeeding:
findings from the 1990s, Journal of Human Lactation,
81. WHO, Medical Eligibility Criteria for Contraceptive Use,
4th ed., Geneva: WHO, 2010.
82. Wu J et al., Contraceptive nonuse among US women
54. Ortayli N and Malarcher S, Equity analysis: identifying
who benefits from family planning programs, Studies in
Family Planning, 2010, 41(2):101–108.
55. World Health Organization (WHO), Selected Practice
Recommendations for Contraceptive Use, second ed.,
Geneva: WHO, 2004.
56. Sedgh G et al., Women with an unmet need for
contraception in developing countries and their reasons
for not using a method, Occasional Report, New York:
Guttmacher Institute, 2007, No. 37.
57. Creanga AA et al., Low use of contraception among
poor women in Africa: an equity issue, Bulletin of the
World Health Organization, 2011, 89(4):258–266.
58. WHO, The World Health Report 2000—Health
Systems: Improving Performance, Geneva: WHO, 2000.
59. Tawfik L and Kinoti SN, The Impact of HIV/AIDS on
Health Systems and the Health Workforce in Sub-Saharan
Africa, Washington, DC: Academy for Educational Development,
60. Scheffler RM et al., Estimates of health care professional
shortages in Sub-Saharan Africa by 2015,
Health Affairs, 2009, 28(5):w849–w862, doi: 10.1377/
hlthaff.28.5w849, accessed Feb. 5, 2011.
61. MEASURE DHS, STATcompiler, no date, <http://www.
statcompiler.com>, accessed Nov. 24, 2009.
62. Hamid S, Stephenson R and Rubenson B, Marriage
decision making, spousal communication, and reproductive
health among married youth in Pakistan, Global Health
Action, 2011, doi: 10.3402/gha.v4i0.5079, accessed Feb. 5,
63. Association of Reproductive Health Professionals
(ARHP), Choosing a Birth Control Method: A Quick
Reference Guide for Clinicians, Washington, DC: ARHP,
64. Bachmann G and Korner P, Bleeding patterns associated
with oral contraceptive use: a review of the literature,
Contraception, 2007, 76(3):182–189.
65.Grimes DA and Schulz KF, Nonspecific side effects of
oral contraceptives: nocebo or noise? Contraception, 2011,
66. Miller PC et al., The effect of oral contraceptive
formulation and field-workers: a cautionary tale,
International Journal of Gynaecology & Obstetrics, 1985,
67. Vessey M, Yeates D and Flynn S, Factors affecting mortality
in a large cohort study with special reference to oral
contraceptive use, Contraception, 2010, 82(3):221–229.
32 Guttmacher Institute
97. Cleland J, Ali MM and Shah I, Dynamics of contraceptive
use, in: United Nations Population Division, Levels and
Trends of Contraceptive Use as Assessed in 2002, New
York: United Nations, 2006, pp. 87–115.
98. K4Health, Implants toolkit, no date, <http://www.
k4health.org/toolkits/implants>, accessed Mar. 28, 2011.
99.Ramchandran D and Upadhyay UD, Implants: the next
generation, Population Reports, 2007, Series K, No. 7.
100. K4Health, Injectables toolkit, no date, <http://www.
k4health.org/toolkits/injectables>, accessed Mar. 28, 2011.
101. Salem R, New attention to the IUD: expanding
women’s contraceptive options to meet their needs,
Population Reports, 2006, Series B, No. 7.
102. K4Health, IUD toolkit, no date, <http://www.k4health.
org/toolkits/iud>, accessed Mar. 28, 2011.
103. Hugon-Rodin J, Chabbert-Buffet N and Bouchard P,
The future of women’s contraception: stakes and modalities,
Annals of the New York Academy of Sciences, 2010,
104. Rowlands S, New technologies in contraception,
BJOG, 2009, 116(2):230–239.
105. Upadhyay UD, New contraceptive choices, Population
Reports, 2005, Series M, No. 19.
106. Merkatz RB, Tokay B and Sitruk-Ware RL, Methods
for female contraception: a model for innovation in drug
delivery systems, Clinical Pharmacology & Therapeutics,
107. K4Health, Condom use, no date, <http://www.
k4health.org/toolkits/condoms>, accessed Mar. 28, 2011.
108. Beksinska M et al., Female condom technology:
new products and regulatory issues, Contraception, 2011,
109. Holt BY et al., Multipurpose prevention technologies
for sexual and reproductive health: gaining momentum
and promise, Contraception, 2010, 81(3):177–180.
110. Darroch JE, Male fertility control—Where are the
men? Contraception, 2008, 78(4 Suppl.):S7–S17.
111. Blithe D, Male contraception: What is on the horizon?
Contraception, 2008, 78(4 Suppl.):S23–S27.
112. Aitken RJ et al., Bridging the gap between male and
female fertility control: contraception-on-demand, Contraception,
2008, 78(4 Suppl.):S28–S35.
113. AGI, In Their Own Right: Addressing the Sexual and
Reproductive Health Needs of Men Worldwide, New York:
at risk for unplanned pregnancy, Contraception, 2008,
83. Miller WB, Why some women fail to use their contraceptive
method: a psychological investigation, Studies in
Family Planning, 1986, 18(1):27–32.
84. Minnis AM, Shiboski SC and Padian NS, Barrier contraceptive
method acceptability and choice are not reliable
indicators of use, Sexually Transmitted Diseases, 2003,
85. Frost JJ, Singh S and Finer LB, Factors associated
with contraceptive use and nonuse, United States, 2004,
Perspectives on Sexual and Reproductive Health, 2007,
86. WHO, Emergency contraception, Fact sheet no. 244,
en/index.html>, accessed Mar. 9, 2011.
87. Nath A and Sitruk-Ware R, Progesterone vaginal ring for
contraceptive use during lactation, Contraception, 2010,
88. Kapp N, Curtis K and Nanda K, Progestogen-only
contraceptive use among breastfeeding women: a
systematic review, Contraception, 2010, 82(1):17–37.
89. Sitruk-Ware R et al., Nestorone: clinical applications for
contraception and HRT, Steroids, 2003, 68(10–13):907–913.
90. Brito MB et al., Safety of the etonogestrol-releasing
implant during the immediate postpartum period: a pilot
study, Contraception, 2009, 80(6):519–526.
91. Biddlecom AE and Fapohunda BM, Covert contraceptive
use: prevalence, motivations, and consequences,
Studies in Family Planning, 1998, 29(4):360–372.
92. Cleland JG, Ndugwa RP and Zulu EM, Family planning
in sub-Saharan Africa: progress or stagnation? Bulletin of
the World Health Organization, 2011, 89(2):137–143.
93. Frost LJ and Reich MR, Creating access to health technologies
in poor countries, Health Affairs, 2009, 28(4):962–
94. Frost JJ, Guttmacher Institute, personal communication,
Mar. 16, 2011.
95. Guttmacher Institute, South Central and Southeast
Asia—facts on investing in family planning and maternal
and newborn health, In Brief, New York: UNFPA and
Guttmacher Institute, 2010.
96. Guttmacher Institute, Sub-Saharan Africa—facts on
investing in family planning and maternal and newborn
health, In Brief, New York: UNFPA and Guttmacher
Guttmacher Institute 33
114. Folger SG et al., Guidance on medical eligibility criteria
for contraceptive use: identification of research gaps,
Contraception, 2010, 82(1):113–118.
115 Blanc AK et al., Patterns and trends in adolescents’
contraceptive use and discontinuation in developing countries
and comparisons with adult women, International
Perspectives on Sexual and Reproductive Health, 2009,
116. Ezeh AC, Kodzi I and Emina J, Reaching the urban
poor with family planning services, Studies in Family
Planning, 2010, 41(2):109–116.