Estimating progress towards meeting women’s contraceptive needs in 185 countries: A Bayesian hierarchical modelling study

Abstract

Background Expanding access to contraception and ensuring that need for family planning is satisfied are essential for achieving universal access to reproductive healthcare services, as called for in the 2030 Agenda for Sustainable Development. Monitoring progress towards these outcomes is well established for women of reproductive age (15-49 years) who are married or in a union (MWRA). For those who are not, limited data and variability in data sources and indicator definitions make monitoring challenging. To our knowledge, this study is the first to provide data and harmonised estimates that enable monitoring for all women of reproductive age (15-49 years) (WRA), including unmarried women (UWRA). We seek to quantify the gaps that remain in meeting family-planning needs among all WRA. Methods and findings In a systematic analysis, we compiled a comprehensive dataset of family-planning indicators among WRA from 1,247 nationally representative surveys. We used a Bayesian hierarchical model with country-specific time trends to estimate these indicators, with 95% uncertainty intervals (UIs), for 185 countries. We produced estimates from 1990 to 2019 and projections from 2019 to 2030 of contraceptive prevalence and unmet need for family planning among MWRA, UWRA, and all WRA, taking into account the changing proportions that were married or in a union. The model accounted for differences in the prevalence of sexual activity among UWRA across countries. Among 1.9 billion WRA in 2019, 1.11 billion (95% UI 1.07-1.16) have need for family planning; of those, 842 million (95% UI 800-893) use modern contraception, and 270 million (95% UI 246-301) have unmet need for modern methods. Globally, UWRA represented 15.7% (95% UI 13.4%-19.4%) of all modern contraceptive users and 16.0% (95% UI 12.9%-22.1%) of women with unmet need for modern methods in 2019. The proportion of the need for family planning satisfied by modern methods, Sustainable Development Goals (SDG) indicator 3.7.1, was 75.7% (95% UI 73.2%-78.0%) globally, yet less than half of the need for family

Uncertain population futures: Critical reflections on the IHME Scenarios of future fertility, mortality, migration and population trends from 2017 to 2100

“…10 Global estimates of family planning indicators by the team of UNPD researchers (UNPD 2019b; Kantorová et al 2020) illustrates well the degree of uncertainty in the estimates of unmet need for modern contraception in lowfertility countries. Due to missing data, the 95% uncertainty interval often gives a wide range around the point estimate.…”

Non-use of Contraceptive Methods Among Married: Analysis of the 2018 Guinea Demographic and Health Survey

“…The unmet need for family planning (FP) is de ned as the proportion of women who do not want to become pregnant but are not using contraception [1]. In 2019, among the 1.9 billion women in the reproductive age group (15-49 years) worldwide, 270 million have an unmet need for contraception [2,3]. According to the Sustainable Development Goals (SDGs), the global proportion of women with the need for FP satis ed by modern methods was 75.7% in 2019; however, less than half of the need for FP was met in Central and Western Africa [2].…”

“…In 2019, among the 1.9 billion women in the reproductive age group (15-49 years) worldwide, 270 million have an unmet need for contraception [2,3]. According to the Sustainable Development Goals (SDGs), the global proportion of women with the need for FP satis ed by modern methods was 75.7% in 2019; however, less than half of the need for FP was met in Central and Western Africa [2]. In 2017, 24% of women of reproductive age in developing countries who wanted to avoid pregnancy did not use a modern contraceptive method [4,5].…”

Unintended pregnancy and abortion: what does it tell us about reproductive health and autonomy?

“…Contraception is one of the most important tools for enabling couples and individuals to exercise the right to decide freely and responsibly the number and spacing of their children, and worldwide the use of contraceptive methods has increased. 2 However, some women want to avoid pregnancy yet do not use any contraceptive method, because they do not have access to contraceptives or prefer not to use them for various reasons. 3 Additionally, even those using contraception may do so imperfectly or experience method failure.…”

“…Bearak and colleagues employ a new model to derive simultaneously the estimates of unintended pregnancies and abortions, based on a framework that also incorporates previously published estimates of contraceptive use by specific methods and of the overall need for family planning. 2 , 6 This conceptual framework helps to illuminate the most critical mechanisms that determine the outcomes, in this case the fact that an increase in the use of effective contraceptive methods contributed to a reduction in the incidence of unintended pregnancies, despite an impressive increase in the need for family planning over the past three decades due to changing fertility preferences.…”