Modern Birth Control Could Prevent 15M Unwanted Pregnancies

Diedtra Henderson

February 06, 2015

Optimal use of modern contraceptives could avert an estimated 15 of 16.7 million unwanted pregnancies each year in 35 low- and middle-income countries, according to a demographic health survey.

Saverio Bellizzi, MSc, from the World Health Organization, Western Pacific Regional Office, Manila, Philippines, and coauthors report their findings online February 3 in Human Reproduction.

"[Modern methods] include combined oral contraceptives, progestogen-only pills, implants, injectable contraceptives, IUDs, male and female condoms, sterilization and [lactational amenorrhea method]," the authors write. "Traditional methods include withdrawal and fertility-awareness methods."

According to the authors, 87 million unintended pregnancies worldwide are a result of underuse of contraceptives. To investigate the potential effect of optimal use of modern contraceptives, Bellizzi and colleagues analyzed demographic health surveys from 2005 to 2012 for women aged 15 to 49 years from 35 countries that represent 33.6% of the world's population. They compared 12,874 women who became pregnant unintentionally with 111,301 sexually active women who did not want to become pregnant and who used modern contraceptives.

Women who eschewed such contraceptives, even though they did not want to become pregnant, did so because of fear of adverse effects (37.3%; n = 5559); opposing birth control, having a sexual partner who opposed it, or religious objections (22.4%; n = 3331); underestimating pregnancy risks (17.6%; n = 2620); and lack of knowledge (3.5%; n = 516). The prevalence of women rejecting contraception because of feared adverse effects ranged from 9.0% in Armenia to 61.0% in Kenya.

Overall, women who did not use birth control were 14.3 times more likely to become pregnant compared with those who did use birth control. That amounts to 16.7 million unwanted pregnancies annually in the 35 countries under study. Fifteen million of the undesired pregnancies could have been prevented with proper use of modern contraceptives. Women with the lowest education levels were 8.6 (95% confidence interval, 8.2 - 9.1) times less likely to rely on birth control. The distribution of unwanted pregnancies by country ranged from 15 (0.1%) in Albania to 1407 (10.9%) in India.

"Analysis of 35 low- and middle-income countries revealed that four out of five undesired pregnancies could have been prevented if [modern methods of contraception] were used," Bellizzi and coauthors write. "The use of traditional methods and not using any method of contraception increased the odds of an undesired pregnancy by 3 and 14 times, respectively."

The authors also point to one in four women in Colombia, Indonesia, and Jordan becoming pregnant despite use of modern contraceptives as a high failure rate that "needs specific attention." In addition to calling for national strategies to improve the use of family planning, such educational efforts need to be linked to access to an "affordable and acceptable range" of contraceptives, the authors write.

"Unfounded health concerns, fear of side effects, opposition to use and an underestimated risk of pregnancy affect all women, regardless of wealth and educational status," the authors conclude. "Systematic efforts are needed to address these issues."

The authors have disclosed no relevant financial relationships.

Human Reproduction. Published online February 3, 2015. Full text

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