Modern contraceptive use, unmet need, and demand satisfied among women of reproductive age who are married or in a union in the focus countries of the Family Planning 2020 initiative: a systematic analysis using the Family Planning Estimation Tool

Abstract

SummaryBackgroundThe London Summit on Family Planning in 2012 inspired the Family Planning 2020 (FP2020) initiative and the 120×20 goal of having an additional 120 million women and adolescent girls become users of modern contraceptives in 69 of the world's poorest countries by the year 2020. Working towards achieving 120 × 20 is crucial for ultimately achieving the Sustainable Development Goals of universal access and satisfying demand for reproductive health. Thus, a performance assessment is required to determine countries' progress.MethodsAn updated version of the Family Planning Estimation Tool (FPET) was used to construct estimates and projections of the modern contraceptive prevalence rate (mCPR), unmet need for, and demand satisfied with modern methods of contraception among women of reproductive age who are married or in a union in the focus countries of the FP2020 initiative. We assessed current levels of family planning indicators and changes between 2012 and 2017. A counterfactual analysis was used to assess if recent levels of mCPR exceeded pre-FP2020 expectations.FindingsIn 2017, the mCPR among women of reproductive age who are married or in a union in the FP2020 focus countries was 45·7% (95% uncertainty interval [UI] 42·4–49·1), unmet need for modern methods was 21·6% (19·7–23·9), and the demand satisfied with modern methods was 67·9% (64·4–71·1). Between 2012 and 2017 the number of women of reproductive age who are married or in a union who use modern methods increased by 28·8 million (95% UI 5·8–52·5). At the regional level, Asia has seen the mCPR among women of reproductive age who are married or in a union grow from 51·0% (95% UI 48·5–53·4) to 51·8% (47·3–56·5) between 2012 and 2017, which is slow growth, particularly when compared with a change from 23·9% (22·9–25·0) to 28·5% (26·8–30·2) across Africa. At the country level, based on a counterfactual analysis, we found that 61% of the countries that have made a commitment to FP2020 exceeded pre-FP2020 expectations for modern contraceptive use. Country success stories include rapid increases in Kenya, Mozambique, Malawi, Lesotho, Sierra Leone, Liberia, and Chad relative to what was expected in 2012.InterpretationWhereas the estimate of additional users up to 2017 for women of reproductive age who are married or in a union would suggest that the 120 × 20 goal for all women is overly ambitious, the aggregate outcomes mask the diversity in progress at the country level. We identified countries with accelerated progress, that provide inspiration and guidance on how to increase the use of family planning and inform future efforts, especially in countries where progress has been poor.FundingThe Bill & Melinda Gates Foundation, through grant support to the University of Massachusetts Amherst and Avenir Health.

Effectiveness of post-partum family planning interventions on contraceptive use and method mix at 1 year after childbirth in Kinshasa, DR Congo (Yam Daabo): a single-blind, cluster-randomised controlled trial

“…This dynamic differed in the control groups, as the prevalence in Burkina Faso did not change from month 6 to month 12, when it reached 29%, a proportion that did not overtake the 30% in national prevalence projected for 2018. 22 In DR Congo, however, the prevalence in the control group kept increasing until 12 months, when it reached 35% and surpassed by 8 percentage points the 27% in projected prevalence for 2017 for married women in Kinshasa. 23 It was unlikely that women from control study sites went to intervention sites to receive the package, or that components of the package reached contraceptive services in control sites, as neither situations were reported by service providers or research assistants assigned to each of the centres.…”

Women with bleeding disorders: Clinical and psychological issues

“…26 Even in high-resource countries, such as the United States of America, politicians have taken decisions that are likely to limit women's access to contraceptive agents by proposing the removal of the mandate for health insurance to cover contraception that will effectively make them more expensive for women. This will in part be due to access to and delivery of health care in countries with more limited financial resources but in addition, there are sociocultural barriers to accessing information, services and supplies of agents for contraception, many of which are also be important for managing HMB.…”

“…This will in part be due to access to and delivery of health care in countries with more limited financial resources but in addition, there are sociocultural barriers to accessing information, services and supplies of agents for contraception, many of which are also be important for managing HMB. 26 Even in high-resource countries, such as the United States of America, politicians have taken decisions that are likely to limit women's access to contraceptive agents by proposing the removal of the mandate for health insurance to cover contraception that will effectively make them more expensive for women. 27 This may have an unintended impact on women's ability to afford contraceptive agents for treatment of HMB and introduce barriers to equity in health care.…”

Decomposition analysis of modern contraceptive use among currently married women in Ethiopia: EDHS 2000-2016

“…Other evidence shows that the unmet need for modern methods ranges from 10.2% to 39.9% in Nicaragua and the democratic republic of Congo, respectively. The modern contraceptive prevalence rate (mCPR) is as lowest (2.6%) in Somalia and as the highest (77.4%) in Nicaragua (5). According to the DHS report of Sub Sahara Africa countries indicated that mCPR among married women was 2.3% in Ethiopia (2005-2011), 2.4% in Malawi (2004)(2005)(2006)(2007)(2008)(2009)(2010), and a dramatic 6.9% in Rwanda (2005-2010), (6).…”