BackgroundWorldwide, the importance of contraception to control fertility has been recognized. A useful indicator of the gap between reproductive preferences and the provision of contraception is “unmet need for contraception”. The aims of this paper are to estimate the levels of unmet need for contraception among married and single women, and to explore factors associated with unmet need for contraception for spacing and limiting births in Mexico.MethodsWe used the Mexican National Survey of Demographic Dynamics 2014, using a sub-sample of 56,797 sexually active women aged 15–49 years who were either currently in union or who had never been in union to estimate the prevalence of unmet need for spacing and limiting births. We applied multivariable binary logistic regressions to examine the relationship between unmet need for spacing and limiting considering associated factors.ResultsUnmet need for contraception was estimated at 11.5% among women in union (6.4% limiting; 5.1% spacing), and 28.9% for women never in union (8% limiting; 20.9% spacing). In the logistic regression for unmet need for spacing, the likelihood was statistically significant associated with younger women (OR = 6.8; CI = 2.95–15.48); women never in union (OR = 1.6; CI = 1.40–1.79); low levels of education (OR = 1.4; CI = 1.26–1.56); and residing in poor regions (OR = 1.9; CI = 1.52–2.49). Those with full access to public services were significantly less likely to have unmet need for spacing (OR = 0.8; CI = 0.66–0.88).In the logistic regression for unmet need for limiting, being younger (OR = 6.3; CI = 4.73–8.27), never in union and sexually active (OR = 3.0; CI = 2.47–3.54); with less schooling (OR 1.13; CI: 1.02–1.26); rural residence (OR = 1.2; CI = 1.07–1.32); and residing in poor regions (OR = 1.5; CI = 1.23–1.93) were factors positively associated with this unmet need. Women with private health services were the least likely to have unmet need for limiting (OR = 0.5; CI = 0.37–0.77).ConclusionsYounger women currently in union and never in union had the highest unmet needs of contraception for spacing and limiting. The results from this study suggest that in Mexico family planning services must prioritize the contraception needs of all young women, both in union and not in union, with appropriate and suitable services to cover their needs.

Background In South Africa, large increases in early adult mortality during the 1990s and early 2000s have reversed since public HIV treatment rollout in 2004. In a rural population in KwaZulu-Natal, we investigate trends in parental mortality and orphanhood from 2000–2014. Methods Using longitudinal demographic surveillance data for a population of approximately 90,000, we calculated annual incidence and prevalence of maternal, paternal and double orphanhood in children and adolescents (<20 years) and, overall and cause-specific mortality of parents by age. Results The proportion of children and adolescents (<20 years) for whom one or both parents had died rose from 26% in 2000 to peak at 36% in 2010, followed by a decline to 32% in 2014. The burden of orphanhood remains high especially in the oldest age group: in 2014, 53% of adolescents 15–19 years had experienced the death of one or both parents. In all age groups and years, paternal orphan prevalence was three-five times higher than maternal orphan prevalence. Maternal and paternal orphan incidence peaked in 2005 at 17 and 27 per 1,000 person years respectively (<20 years) before declining by half through 2014. The leading cause of parental death throughout the period, HIV/AIDS and TB cause-specific mortality rates declined substantially in mothers and fathers from 2007 and 2009 respectively. Conclusions The survival of parents with children and adolescents <20 years has improved in tandem with earlier initiation and higher coverage of HIV treatment. However, comparatively high levels of parental deaths persist in this rural population in KwaZulu-Natal, particularly among fathers. Community-level surveillance to estimate levels of orphanhood remains important for monitoring and evaluation of targeted state welfare support for orphans and their guardians.