More than 160 million women worldwide who need contraception do not have access to it, according to the largest study of its kind.
There has been a huge increase in contraceptive use globally since 1970, driven by a major shift from the use of less effective, traditional methods to more effective, modern contraceptives, including oral pills, IUDs and male and female sterilization, the research shows.
However, despite progress, as many as one in 14 women worldwide who wanted contraception did not use it in 2019, according to the world’s most comprehensive assessment of global contraception, published in the Lancet.
Strong differences also exist between regions, found the Global Burden of Diseases study, an ongoing project based at the University of Washington in Seattle. Half of the women who do not have access to contraception live in sub-Saharan Africa and South Asia.
Younger women had the highest levels of unmet need, despite being the group for whom the economic and social benefits of contraceptive access are likely to be greatest. There were also important regional differences in the types of contraceptives used, with women in some regions relying heavily on permanent methods, the study’s authors said.
“While we have seen great progress in the availability of contraception since the 1970s globally, there is 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 ,” said Dr Annie Haakenstad, of the Institute for Health Metrics and Evaluation at the University of Washington.
“Our results indicate that where a woman lives in the world and their age still significantly influence their use of contraception.” Expanding access to contraception was linked to women’s social and economic empowerment and better health outcomes, she added.
The study showed that permanent methods, such as female sterilization, are more likely to be used by older women, while younger women and girls tend to use short-acting methods such as oral pills or condoms.
Globally, the proportion of women of reproductive age using modern contraception increased from 28% in 1970 to 48% in 2019. But despite the large increases, 163 million women who were not currently using contraception were considered to be in need in 2019, out of 1.2 billion women who needed contraception in total.
Women were defined as needing contraception when they were married or if they were unmarried, sexually active, could become pregnant and did not want to have a child within two years, or if they were pregnant or had just given birth but would have preferred to delay or prevent the pregnancy . .
Southeast Asia, East Asia and Oceania had the highest use of modern contraceptives (65%) and demand met (90%). while sub-Saharan Africa had the lowest use of modern contraceptives (24%) and demand met (52%).
Between countries, levels of modern contraceptive use varied from 2% in South Sudan to 88% in Norway. Unmet need was highest in South Sudan (35%), Central African Republic (29%) and Vanuatu (28%) in 2019.
The study finds that compared to other groups, women and girls in the age groups 15-19 and 20-24 were least likely to have access to contraception. – It is important that our study draws attention to the fact that young women are overrepresented among those who do not have access to contraception when they need it, said Haakenstad.
“These are the women who benefit most from contraceptive use, as delaying childbearing can help women stay in school or gain other training opportunities and enter and maintain paid employment. This can lead to social and economic benefits such as lasts throughout a woman’s lifetime and is an important driver towards greater equality between the sexes.”
Contraceptive methods vary significantly by location, the researchers found.
In 2019, female sterilization and oral contraceptives were dominant in Latin America and the Caribbean; the oral contraceptive pill and condoms in high-income countries; IUDs and condoms in Central Europe, Eastern Europe and Central Asia.
Female sterilization accounted for more than half of all contraceptive use in South Asia. Additionally, in 28 countries, more than half of women used the same method, suggesting that there may be limited availability of alternatives in these nations.
Prof Rafael Lozano, of the University of Washington, said: “Our study highlights that not only contraception should be available to all women, but also appropriate choice of contraceptives. Diversifying the options in areas that may be over-reliant on one method can help increase contraceptive use, especially when the most used method is permanent.”
Dr Manas Ranjan Pradhan, of the International Institute for Population Sciences, who was not involved in the study, said the study “reinforces calls” for implementing strategies in countries with “high unmet need” among younger women and girls.