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Globally, more than 160 million (16 crore) women and adolescents who wanted to avoid pregnancy were not using contraceptives in 2019. According to a new study in the Lancet, major disparities in contraceptive use still exist between regions. Globally, nearly 60% of women with unmet need resided in sub-Saharan Africa and south Asia, and 43 million (4.3 crore) women with unmet need for contraception were between 15 and 24 years old.
The study reinforces calls for implementation of strategies and programmes tailored to adolescents in countries with high unmet need among younger women. The dominance of a single method in many countries restricts modern contraceptive prevalence rate and contributes to an unmet need. Extreme skewness in method choice, particularly the dominance of female sterilisation in many low-income countries where healthcare autonomy is limited and standards of care might be low, highlights the need for concerted efforts to broaden the choice of available contraceptive methods and ensure informed choice, the study has said.
Dr Annie Haakenstad, Institute for Health Metrics and Evaluation (IHME), University of Washington, USA, said in the report: “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. Our results indicate that where a woman lives in the world and their age still significantly impact their use of contraception.”
Dr Manas Ranjan Pradhan , assistant professor, department of fertility and social demography, International Institute for Population Sciences, who was not involved in the study, has said in a linked comment, “The study estimates 1.176 billion women had need for contraception, of whom 162.9 million had unmet need; of those with an unmet need, 56.5% resided in sub-Saharan Africa and south Asia and 26.5% were aged 15–24 years in 2019. The
higher unmet need among partnered adolescent women represents a risk for unintended pregnancies, affecting the subsequent socioe-conomic empowerment of these groups.”
The recent National Family Health Survey-5 indicated that 18 per cent in the 15-19 age group had unmet need for family contraception. Meanwhile, the authors found large differences between regions in the types of contraceptives used, with women in some regions relying substantially on permanent contraceptive methods. In India the contraceptive prevalence rate (CPR) in 2019 was 46.7 per cent. There has been a 30.3 per cent absolute change in CPR from 1970 to 2019 in India. According to the study, the main mode for contraception in India has been female sterilization (62.2 per cent) followed by condom use (13.9 per cent ) and pills (7.7 percent).
Based on data from 1,162 self-reported representative surveys from 204 countries and territories between 1970 and 2019 on women’s contraceptive use, the authors used modelling 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 Family Planning 2020 Initiative (FP2020) set a goal of increasing the number of women using modern contraception by 120 (12 crore) million between 2012 and 2020 in 69 priority countries. The study estimated that the number of women using contraception increased by 69 (6.9 crore) million between 2012 and 2019 in these countries (excluding Western Sahara), leaving the initiative 51 million (5.1 crore) short of reaching its goal if these levels remained unchanged in 2020.
When contacted, Dr Pradhan told The Indian Express that if women select contraceptives out of choice then it is fine. “However, several studies have shown that lack of informed choice is of concern,” said Dr Pradhan.
