Elsevier

The Lancet

Volume 381, Issue 9879, 18–24 May 2013, Pages 1756-1762
The Lancet

Articles
Trends in contraceptive need and use in developing countries in 2003, 2008, and 2012: an analysis of national surveys

https://doi.org/10.1016/S0140-6736(13)60597-8Get rights and content

Summary

Background

Data for trends in contraceptive use and need are necessary to guide programme and policy decisions and to monitor progress towards Millennium Development Goal 5, which calls for universal access to contraceptive services. We therefore aimed to estimate trends in contraceptive use and unmet need in developing countries in 2003, 2008, and 2012 .

Methods

We obtained data from national surveys for married and unmarried women aged 15–49 years in regions and subregions of developing countries. We estimated trends in the numbers and proportions of women wanting to avoid pregnancy, according to whether they were using modern contraceptives, or had unmet need for modern methods (ie, using no methods or a traditional method). We used comparable data sources and methods for three reference years (2003, 2008, and 2012). National survey data were available for 81–98% of married women using and with unmet need for modern methods.

Findings

The number of women wanting to avoid pregnancy and therefore needing effective contraception increased substantially, from 716 million (54%) of 1321 million in 2003, to 827 million (57%) of 1448 million in 2008, to 867 million (57%) of 1520 million in 2012. Most of this increase (108 million) was attributable to population growth. Use of modern contraceptive methods also increased, and the overall proportion of women with unmet need for modern methods among those wanting to avoid pregnancy decreased from 29% (210 million) in 2003, to 26% (222 million) in 2012. However, unmet need for modern contraceptives was still very high in 2012, especially in sub-Saharan Africa (53 million [60%] of 89 million), south Asia (83 million [34%] of 246 million), and western Asia (14 million [50%] of 27 million). Moreover, a shift in the past decade away from sterilisation, the most effective method, towards injectable drugs and barrier methods, might have led to increases in unintended pregnancies in women using modern methods.

Interpretation

Achievement of the desired number and healthy timing of births has important benefits for women, families, and societies. To meet the unmet need for modern contraception, countries 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. Our findings confirm a substantial and unfinished agenda towards meeting of couples' reproductive needs.

Funding

UK Department for International Development, the Bill & Melinda Gates Foundation, and the UN Population Fund (UNFPA).

Introduction

In developing countries, desire for small families and motivation for healthy spacing of births has steadily increased.1, 2 To achieve their childbearing preferences, women and their partners need effective contraception to prevent unintended pregnancies. Measurement of levels and trends in contraceptive use and unmet need for contraceptive services in developing countries is crucial to inform the decisions of health-care providers, programme planners, and those in charge of resource allocation. Commitments and additional resources for the 69 poorest countries, generated by the 2012 London Summit on Family Planning,3 promise substantial progress towards meeting Millennium Development Goal (MDG) 5, which calls for universal access to the contraceptive services that women and couples need to have the number of births they want, when they want them.

Numbers of women needing contraception and the proportion with unmet need are somewhat moving targets—population growth and the increasing desire to control the number and timing of births lead to increases in the numbers of women needing contraception. Rapid improvements should be made in coverage and quality of services if women's needs are to be adequately met with quality care and the number and proportion of women with unmet need for contraception are to decrease over time.

To increase understanding of family planning challenges, achievements, and gaps from the past few years, and to identify the magnitude of immediate unmet needs, we used available survey data and comparable methods to estimate contraceptive use and unmet need in developing regions and subregions in 2003, 2008, and 2012.

Section snippets

Study design

We estimated the numbers of women in developing countries using, and with unmet need for, modern contraceptives by applying survey-based proportions of women by use and need category to numbers of women aged 15–49 years. Our approach was similar to that used in other studies.4, 5, 6, 7 We classed women as using modern contraceptives if they or their partner used one or more of the following methods: sterilisation, intrauterine devices, implants, injectable drugs, contraceptive pill, male

Results

Of the 1·5 billion women of reproductive age in developing countries in 2012, 867 million (57%) wanted to avoid pregnancy and therefore needed contraception (table 1). The remaining 653 million women did not need contraception for various reasons: they were unmarried and not sexually active (24% of all women); had recently had an intended birth, were pregnant with an intended pregnancy, or wanted to be pregnant soon (11%); or were sexually active but infecund (8%).11 The number of women wanting

Discussion

The growing preference for small families and for better control of the timing of births, combined with population growth, resulted in a large increase in the number of women of reproductive age wanting to avoid pregnancy and in need of effective contraception. This increased need was partly accompanied by increased use of modern methods, and the proportion of women using modern methods increased slightly. In fact, in developing countries overall, about three in four women wanting to avoid

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