Despite the world seeing major increases in contraception use since 1970, a wide gap remains across the world. In a new study by Lancet, the authors noted that over 160 million women and adolescents with need to prevent childbearing remained without contraception in 2019.
GAPS IN CONTRACEPTIVE
The report mentioned that share of women of reproductive age using modern contraception increased from 28 per cent in 1970 to 48 per cent in 2019. The demand satisfied rose from 55 per cent in 1970 to 79 per cent in 2019. Despite all the major increases, 163 million women were not using contraception in 2019 (out of 1.2 billion women who needed contraception in total).
Meanwhile, Dr Annie Haakenstad (Institute for Health Metrics and Evaluation (IHME), University of Washington, USA) said that there’s still a long way to go to ensure that every woman and adolescent girl can benefit from the economic and social empowerment contraceptives can offer. “Our results indicate that where a woman lives in the world and their age still significantly impacts their use of contraception,” said Annie Haakenstad.
FAILURE TO REACH GOAL
The study was based on data from 1,162 self-reported representative surveys on women’s contraceptive use. The authors used modeling to produce national estimates of various family planning indicators, including the proportion of women of reproductive age (15-49 years) using any contraceptive method, the proportion of women of reproductive age using modern methods, the types of contraceptives in use, demand satisfied with modern methods, and unmet need for any contraceptive method. The Women were defined as needing contraception when they were married or if unmarried, sexually active, able to get pregnant and not wanting a child within two years, or if they were pregnant or had just given birth but would have preferred to delay or prevent their pregnancy.
CONTRACEPTIVES DIFFERED BETWEEN REGIONS AND COUNTRIES
South-east Asia, East Asia and Oceania had the highest use of modern contraceptives (65%) and demand satisfied (90%). Sub-Saharan Africa had the lowest use of modern contraceptives (24%) and demand satisfied (52%). Between countries, levels of modern contraceptive use ranged from 2% in South Sudan to 88% in Norway. Unmet need was highest in South Sudan (35%), Central African Republic (29%) and Vanuatu (28%) in 2019.
The Family Planning 2020 Initiative (FP2020) set a goal of increasing the number of women using modern contraception by 120 million between 2012 and 2020 in 69 priority countries. The study estimated that the number of women using contraception increased by 69 million between 2012 and 2019 in these countries (excluding Western Sahara), leaving the initiative 51 million short of reaching its goal if these levels remained unchanged in 2020.
YOUNG WOMEN FACE HIGHEST LEVELS OF UNMET NEED
In the study, the authors found that women and adolescents in the 15-19 and 20-24 age groups have the lowest rates of demand satisfied globally – estimated at 65% and 72%, respectively. Those aged 15-24 comprise 16% of total need but 27% of unmet need – amounting to 43 million young women and adolescents worldwide not having access to contraceptives they need in 2019.
They noted that the largest gaps globally were among young, married women. Dr Haakenstad said that the study called attention to young women being over-represented among those who cannot access contraception when they need it. “These are the women who stand most to gain from contraceptive use, as delaying having children can help women stay in school or get other training opportunities and to enter and maintain paid employment. This can lead to social and economic benefits that last throughout a woman’s lifetime and is an essential driver towards greater gender equity,” the author said.
LACK OF CONTRACEPTIVE VARIETY
The authors suggest that the dominance of single methods could indicate a lack of suitable choices for women and adolescent girls.
In 2019, female sterilisation and oral contraceptives were dominant in Latin America and the Caribbean; oral conceptive pill and condoms in high-income countries; IUDs and condoms in central Europe, Eastern Europe and central Asia. Female sterilisation comprised more than half of all contraceptive use in south Asia. In addition, in 28 countries, more than half of women were using the same method, indicating that there may be a limited availability of options in these areas.
Professor Rafael Lozano, Institute for Health Metrics and Evaluation (IHME), University of Washington, USA, says, “Our study highlights that not only should contraception be available to all women, but also suitable choices of contraceptives. Diversifying options in areas that may be over-reliant on one method could help increase contraceptive use, particularly when the most used method is permanent. To widen access, we urge policymakers to use these estimates to look at how contraceptive choice interacts with age and marital status in their countries.”
The authors also note some limitations of their study. The criteria used to identify women in need of contraception may not capture certain women in need, including women who underreport sexual activity due to social stigma (for example among unpartnered women or adolescents), women who are not sexually active precisely because they lack contraception, or women who are dissatisfied with their current method of contraception. In addition, the estimates are based on more available data from partnered than unpartnered women.
Expanding access to contraception is linked to women’s social and economic empowerment and better health outcomes and is a key goal of international initiatives and is a Sustainable Development Goal (SDG) indicator. Contraception use is also associated with reductions in maternal and neonatal mortality by preventing unintended pregnancies. By allowing women to plan childbearing, contraception enables adolescents and women to remain in school pursue further education and work that lead to social and economic empowerment later in life.
Methods of contraception include oral contraceptive pills, implants, injectables, patches, vaginal rings, Intra uterine devices, condoms, male and female sterilization, lactational amenorrhea methods, withdrawal and fertility awareness based methods.
Cultural and social factors have an impiortant role to play in family planning decisions. Enhanced education, beginning in schools, regarding the fertility cycle, birth spacing benefits, and the importance of individual family planning is needed.