Globally, nearly 163M women had unmet contraception needs
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An estimated 162.9 million women globally had an unmet need for contraception in 2019, with those aged 15 to 19 years with the highest unmet demand, an analysis published in The Lancet showed.
The study, which evaluated surveys conducted between 1970 and 2019, also identified regional disparities in the amount of unmet need and the types of contraceptives used.
“Although we’ve observed excellent strides in contraceptive availability since the 1970s at a global level, 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,” Annie Haakenstad, ScD, MA, an assistant professor in the University of Washington Institute for Health Metrics and Evaluation in Seattle, said in a press release. “Our results indicate that where a woman lives in the world and their age still significantly impacts their use of contraception.”
Defining contraceptive use, need
Using 1,162 population-based surveys of women aged 15 to 49 years in 204 countries and territories, Haakenstad and colleagues estimated the contraceptive prevalence rate (CPR), which included all forms of contraception, such as traditional methods like withdrawal and douches. They also estimated the modern CPR (mCPR), which included modern contraceptive methods, such as male or female sterilization, male or female condoms and IUDs.
The researchers also analyzed the contraceptive methods used, as well as the rate of demand satisfied. Demand satisfied was defined as the proportion of women using modern contraception who were:
- fertile, sexually active or partnered and not wanting a child within the next 2 years;
- currently pregnant and wanted to have delayed or prevented their current pregnancy; or
- postpartum amenorrheic from a birth within the past 2 years and wanted to have delayed or prevented their most recent pregnancy.
Global, regional trends
Overall, the average CPR in 2019 was 51.9% (95% uncertainty interval [UI], 51%-52.8%), the mCPR was 47.7% (95% UI, 46.9%-48.6%) and the demand satisfied was 79.1% (95% UI, 78.5%-79.8%), which were increases of 18.7 (95% UI, 17.1-20.3), 20.1 (95% UI, 18.7-21.6) and 24.3 (95% UI, 22.6-26.1) percentage points, respectively, from the 1970 rates.
Between 1970 and 2019, all countries had statistically significant increases in CPR, mCPR and demand satisfied, except for Somalia, where these rates remained mostly unchanged, according to the study. By 2019, the proportion of traditional contraception methods had decreased, while the proportion of modern methods increased.
In 2019, the mCPR was lowest in South Sudan (1.9%) and highest in Norway (87.9%); in the United States, the mCPR was 59.3%. Regionally, the average mCPR was highest in Southeast Asia, East Asia and Oceania (64.7%; 95% UI, 63.3%-65.9%), which also had the highest rate of demand satisfied (90.4%; 95% UI, 89.5%-91.2%). Conversely, sub-Saharan Africa had the lowest average mCPR (23.6%; 95% UI, 23.1%-24.2%) and demand satisfied (52%; 95% UI, 51.2%-52.8%).
Rates of demand satisfied
Among 1.176 billion women with a need for contraception, 162.9 million were estimated to not have those needs met, 29.3% (95% UI, 27.9%-30.6%) of whom lived in sub-Saharan Africa and 27.2% (95% UI, 24.4%-30.3%) of whom lived in south Asia. The unmet need was largest in South Sudan (35.1%; 95% UI, 32.6%-38%), Central African Republic (29.2%; 95% UI, 27%-31.3%) and Vanuatu (28.4%; 95% UI, 25.6%-31.3%). In the U.S., the unmet need was 2.5%.
Younger women had the lowest rate of demand satisfied globally. By age group, the rate of demand satisfied was lowest among women aged 15 to 19 years (64.8%; 95% UI, 62.9%-66.7%) and 20 to 24 years (71.9%; 95% UI, 68.9%-74.2%), with 43.2 million women (95% UI, 39.3-48 million) aged 15 to 24 years with unmet contraceptive needs in 2019.
“To address this demand, family planning programs must determine whether existing methods are equally preferred and accessible to younger women in comparison to older women,” Haakenstad and colleagues wrote. “Globally, younger women are more likely to use condoms and the oral contraceptive pill, whereas older women are more likely to use female sterilization.”
Moving forward, the researchers suggested modifying family planning programs to meet the needs of women with unsatisfied demand for contraception while maintaining programs that work for current contraceptive users.
References:
- Haakenstad A, et al. Lancet. 2022;doi:10.1016/S0140-6736(22)00936-9.
- The Lancet: 160 million women worldwide have unmet contraception needs; new study reveals large differences in types of contraceptives used across regions and age groups. https://www.eurekalert.org/news-releases/959252. Published July 21, 2022. Accessed July 29, 2022.
Perspective
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This is an interesting study. I was impressed by the increase in modern contraception usage by many of the countries with lower socioeconomic levels. This study reveals that women in the 15-to-24-year age group are in the most need for increased access to modern contraception options. Many of the modern contraception options are highly effective but can be expensive, and some require someone experienced in the procedure (ie, implants or IUD), which limits access. This study is limited by recall bias and social/cultural expectations and norms that may not be accounted for in the answers on the surveys.
As far as the significance for these findings in the U.S., focusing on access to reliable, inexpensive, modern contraception for women in the 15-to-24-year age group is imperative. In a wealthy country like the U.S., there is no excuse for the lack of access to affordable, extremely reliable contraception for younger women. Access should be easy and not require multiple hoops to jump through.
In addition, this study is a reminder of the importance of sexual health education for this age group. Also, we must not only target women who are not married or in a long-term relationship, but also the women who are married or in a long-term relationship because unintended pregnancies are not uncommon in this group of women.
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