Contraception: Unmet Needs Projected to Rise by 2015

Jennifer Garcia

March 11, 2013

Despite an overall increase in contraceptive use worldwide among married or cohabitating women of reproductive age, 233 million women are projected to have an unmet need for modern family planning methods by 2015, according to results from a new study published online March 12 in the Lancet. The largest increases are expected in developing countries.

Leontine Alkema, PhD, from the Department of Statistics and Applied Probability and the Saw Swee Hock School of Public Health, National University of Singapore, and colleagues evaluated data from the United Nations Population Division database on 194 countries between 1990 and 2010. The researchers found that contraceptive prevalence worldwide among married or cohabiting women of reproductive age (15 - 49 years) increased from 54.8% (95% uncertainty interval [UI], 52.3% - 57.1%) in 1990 to 63.3% (95% UI, 60.4% - 66.0%) in 2010.

During the same period, unmet need for family planning (defined as the proportion of women who would like to delay or stop childbearing but who were not using any method of contraception) decreased worldwide from 15.4% (95% UI, 14.1% - 16.9%) in 1990 to 12.3% (95% UI, 10.9% - 13.9%) in 2010.

However, because of population growth and increased efforts to improve global awareness of family planning, the investigators predict demand for contraception will increase from 900 million in 2010 to 962 million in 2015.

"Our findings support calls to increase investments in family planning, especially in regions where contraceptive prevalence is still low, unmet need is high, and the growth in the number of women of reproductive age is rapid," the authors write.

The researchers used a Bayesian hierarchical model to estimate parameters for logistic growth. This model allowed for projections of trends based on information from subregional, regional, and global trends in countries for which little information was available.

The results of this study apply to women who are married or in a union, however, the authors note that "[t]he model developed in this study can be expanded to generate systematic and comprehensive annual estimates and projections of family planning indicators for all women."

During the study period, the largest increases in contraceptive prevalence were in southern Asia and eastern, northern, and southern Africa. Women in central and western Africa had the lowest rates of contraceptive use, with fewer than 1 in 5 married or cohabiting women in this area using any contraception.

"[This report] illustrate[s] the usefulness of rigorous modelling to provide convincing estimates of health indicators when empirical data are patchy or non-existent," John Cleland, MA, from the Department of Population Health, London School of Hygiene and Tropical Medicine, University of London, United Kingdom, and Iqbal H. Shah, from the Susan Thompson Buffett Foundation, Omaha, Nebraska, write in an accompanying commentary.

"An important but neglected contributor to unmet need is the narrow range of methods used in many high-prevalence and low-prevalence countries," write Cleland and Shah. They note that increasing the range of methods available could provide a significant benefit.

"The success of efforts to increase contraceptive use and reduce unmet need can now be monitored by regular updates of the modelling devised by Alkema and colleagues," they conclude.

Funding for this study was provided by the United Nations Population Division and National University of Singapore. One author received consulting fees from the United Nations Population Division. The other authors and editorialists have disclosed no relevant financial relationships.

Lancet. Published online March 12, 2013. Article abstract, Commentary extract