Transcript New Evidence to Address Unmet Need for Contraception Guttmacher Institute © July 2007

New Evidence to Address
Unmet Need for Contraception
Guttmacher Institute
© July 2007
Unintended Pregnancy
The world’s population has increased
dramatically in the past century
Population (in billions)
10
2050
(Projected)
8
2000
6
4
1900
2
0
1100
1300
1500
Year
1700
1900
2100
More than one-third of pregnancies in
developing countries are unintended
Induced abortions
Wanted births
19%
50%
Unwanted or
mistimed births
16%
15%
Spontaneous
abortions (miscarriages)
Outcomes of all pregnancies
in developing countries
Most unintended pregnancies occur among
women who were not using any contraceptive
Modern
method
20%
Traditional
method
14%
No method
66%
Unintended pregnancies in developing countries,
by women’s contraceptive use
There are many benefits to
preventing unintended pregnancies
• Fewer unsafe abortions
• Healthier mothers and children
• Greater investments in each child
• Social and economic opportunities for women
• Economic growth
• Reduction of population pressures on
environment
About Unmet Need
What is unmet need?
• Women have an unmet need if they
– are sexually active
– do not want to have a child soon or at all
– are not using any contraceptive method
– are able to conceive
Who has unmet need?
• Fifteen percent of married women in
developing countries:
– 24% in Sub-Saharan Africa
– 11% in South and Southeast Asia
– 10% in North Africa and West Asia
– 12% in Latin America and the Caribbean
Who has unmet need?
• Nine percent of never-married women in
Sub-Saharan Africa
• Five percent of never-married women in
Latin America
The big picture
• Levels of unmet need are higher in some
regions, countries and population groups
than in others
• The proportion of women with unmet need
is greatest, and has declined least, in SubSaharan Africa
• In absolute numbers, unmet need is
concentrated in South and Southeast Asia,
the most populous regions
More than 100 million married women
have an unmet need for contraception
South & Southeast Asia
29 (27%)
Central Asia
Latin America & Caribbean
60 (56%)
7 (7%)
North Africa & West Asia
Sub-Saharan Africa
9 (8%)
3 (3%)
Number (in millions) and % distribution of married women with unmet need
Unmet need among married women has declined in all
regions, but remains highest in Sub-Saharan Africa
% of married women aged 15–49 with unmet need
100
80
60
40
26
17
20
18
14
12
10
24
11
0
Latin America &
Caribbean
North Africa & West South & Southeast Sub-Saharan Africa
Asia
Asia
1990-1995
2000-2005
The overall demand for
contraception is increasing
% of married women aged 15–49
100
80
60
59
69
54
40
60
41
59
14
20
26
24
20
17
12
14
10
18
11
0
199020001995
2005
Latin America &
Caribbean
199020001995
2005
North Africa &
West Asia
Unmet need
199020001995
2005
South & Southeast
Asia
Met need
199020001995
2005
Sub-Saharan
Africa
The level of unmet need among married
women varies widely within regions (1)
14
Uzbekistan
Kyrgyz Republic
Central Asia
9
Kazakhstan
40
Haiti
Guatemala
Bolivia
Honduras
Nicaragua
Latin America &
Caribbean
Dominican Republic
Peru
Brazil
6
Colombia
0
20
% of married women aged 15–49 with unmet need
40
60
80
100
The level of unmet need among married
women varies widely within regions (2)
13
Armenia
Jordan
North Africa &
West Asia
Egypt
Turkey
10
Morocco
28
Nepal
Cambodia
Philippines
India
South &
Southeast
Asia
Bangladesh
Indonesia
5
Vietnam
0
20
40
% of married women aged 15–49 with unmet need
60
80
100
The level of unmet need among married
women varies widely (3)
Rwanda
Uganda
Ghana
Ethiopia
Togo
Mauritania
Senegal
Lesotho
Burkina Faso
Mali
Gabon
Cote d'Ivoire
Malawi
Zambia
Benin
Kenya
Madagascar
Namibia
Tanzania
Guinea
Chad
Cameroon
Mozambique
Nigeria
Niger
CAR
Congo
South Africa
Zimbabwe
38
<
SubSaharan
Africa
13
0
20
40
% of married women aged 15–49 with unmet need
60
80
100
Among married women, the youngest are
the most likely to have an unmet need
% of married women with unmet need
100
80
60
40
20
16
12
17
10
25
21
10
13
7
11
24
23
15
9
8
0
Central Asia Latin America
& Caribbean
North Africa
& West Asia
15-24
25-34
South &
Southeast
Asia
35-49
Sub-Saharan
Africa
Unmet need is usually higher in
rural areas
% of married women aged 15–49 with unmet need
100
80
60
40
20
11
12
14
8
8
12
12
15
20
25
0
Central Asia
Latin America &
Caribbean
North Africa &
West Asia
Urban
Rural
South &
Southeast Asia
Sub-Saharan
Africa
Some never-married women also have an
unmet need for contraception
Haiti
10
Colombia
6
Bolivia
6
Brazil
5
Dominican Rep.
4
Peru
4
Honduras
2
Nicaragua
2
0
Latin America &
Caribbean
20
40
60
80
% of never-married women aged 15–49 with unmet need
100
More than one in 10 never-married women have an
unmet need in many Sub-Saharan African countries
Benin
Guinea
Gabon
Zambia
Ghana
Tanzania
South Africa
Nigeria
Malawi
Burkina Faso
Uganda
Kenya
Cameroon
Zimbabwe
Rwanda
Ethiopia
18
16
15
12
12
11
11
11
9
8
8
7
6
Sub-Saharan Africa
4
2
0.3
0
20
40
60
80
% of never-married women aged 15–49 with unmet need
100
Reasons Women Do Not Use
Contraceptives
(Married Women)
Reasons for nonuse can be grouped
into a few broad categories
• Opposition to family planning
• Lack of knowledge
• Access and cost
• Health concerns and side effects of methods
• Misconceptions about pregnancy risk
Opposition to family planning is
moderate (1)
% opposing, among married women aged 15–49 with unmet need
100
80
60
40
Latin America &
Caribbean
North Africa &
West Asia
South &
Southeast Asia
Indonesia
Bangladesh
Nepal
Cambodia
Philippines
Morocco
Egypt
Armenia
Colombia
Peru
Bolivia
Honduras
Domincan Republic
Nicaragua
0
Haiti
20
Ghana
Zambia
Cameroon
Madagascar
Congo
Burkina Faso
Lesotho
Malawi
Benin
Mozambique
Uganda
Kenya
Zimbabwe
Namibia
Gabon
Ethiopia
Tanzania
Rwanda
Mali
Senegal
Nigeria
Guinea
Chad
Opposition to family planning is
moderate (2)
% opposing, among married women aged 15–49 with unmet need
100
80
60
Sub-Saharan Africa
40
20
0
Lack of knowledge about contraception
is uncommon (1)
% with no knowledge among married women aged 15–49 with unmet need
100
80
60
Latin America &
Caribbean
North Africa &
West Asia
South &
Southeast Asia
40
20
Bangladesh
Indonesia
Philippines
Nepal
Cambodia
Egypt
Morocco
Armenia
Peru
Colombia
Honduras
Haiti
Dominican
Republic
Nicaragua
Bolivia
0
Zimbabwe
Malawi
Zambia
Lesotho
Kenya
Tanzania
Senegal
Mozambique
Uganda
Guinea
Burkina Faso
Rwanda
Namibia
Ghana
Gabon
Congo
Nigeria
Mali
Ethiopia
Benin
Cameroon
Mauritania
Madagascar
Chad
Lack of knowledge about contraception
is uncommon (2)
% with no knowledge among married women aged 15–49 with unmet need
100
80
60
Sub-Saharan Africa
40
20
0
Problems with access and cost of
contraception are also uncommon (1)
% citing problems among married women aged 15–49 with unmet need
100
80
60
Latin America &
Caribbean
40
North Africa &
West Asia
South &
Southeast Asia
20
Bangladesh
Indonesia
Cambodia
Philippines
Nepal
Egypt
Morocco
Armenia
Honduras
Dominican
Republic
Haiti
Nicaragua
Bolivia
Colombia
Peru
0
0
Malawi
Namibia
Rwanda
Zambia
Senegal
Kenya
Lesotho
Tanzania
Mauritania
Guinea
Cameroon
Congo
Chad
Nigeria
Gabon
Zimbabwe
Ghana
Mozambique
Mali
Ethiopia
Madagascar
Benin
Uganda
Burkina Faso
Problems with access and cost of
contraception are also uncommon (2)
% citing problems among married women aged 15–49 with unmet need
100
80
60
Sub-Saharan Africa
40
20
Concerns about health and side effects
of methods are very common (1)
% citing concerns among married women aged 15–49 with unmet need
100
80
60
Latin America &
Caribbean
North Africa &
West Asia
South &
Southeast Asia
40
20
Bangladesh
Nepal
Indonesia
Philippines
Cambodia
Armenia
Morocco
Egypt
Peru
Honduras
Colombia
Bolivia
Dominican
Republic
Nicaragua
Haiti
0
Cameroon
Burkina
Faso
Nigeria
Mozambique
Benin
Congo
Chad
Rwanda
Gabon
Zambia
Mauritania
Zimbabwe
Ethiopia
Mali
Senegal
Namibia
Uganda
Guinea
Lesotho
Tanzania
Malawi
Ghana
Kenya
Madagascar
Concerns about health and side effects
of methods are very common (2)
% citing concerns among married women aged 15–49 with unmet need
100
80
Sub-Saharan Africa
60
40
20
0
Substantial proportions have
misperceptions about pregnancy (1)
% with misperceptions among married women aged 15–49 with unmet need
100
80
Latin America &
Caribbean
North Africa &
West Asia
South &
Southeast Asia
60
40
Cambodia
Philippines
Indonesia
Bangladesh
Nepal
Egypt
Armenia
Morocco
Bolivia
Nicaragua
Dominican Republic
Colombia
Honduras
Peru
0
Haiti
20
0
Madagascar
Mali
Chad
Ethiopia
Lesotho
Gabon
Tanzania
Mauritania
Namibia
Uganda
Nigeria
Burkina Faso
Senegal
Malawi
80
Ghana
Zimbabwe
Kenya
Cameroon
Congo
Benin
Rwanda
Guinea
Mozambique
Zambia
Substantial proportions have
misperceptions about pregnancy (2)
% with misperceptions among married women aged 15–49 with unmet need
100
Sub-Saharan Africa
60
40
20
The importance of some reasons
for non-use has changed over time
% of married women aged 15–49 with unmet need
100
80
19
20
1986–1989
Lack of knowledge
34
25
Health/side effects
24
5
7
10
12
Bolivia
19
21
11
Mali
21
36
27
Ghana
26
25
6
7
Uganda
5
44
Kenya
43
Peru
24
20
Colombia
38
Ghana
13
Peru
Colombia
0
6
11
7
11
16
23
28
Dominican Republic
20
6
Bolivia
18
29
9
Uganda
13
13
10
Mali
12
Kenya
40
7
18
20
Dominican Republic
60
2002–2005
Opposition
Reasons Women Do Not Use
Contraception
(Never-Married Women)
Lack of knowledge about contraception among
never-married women is uncommon…
% with no knowledge among never-married women aged 15–49 with unmet need
100
80
60
Latin America &
Caribbean
40
Sub-Saharan Africa
Malawi
Burkina Faso
Zimbabwe
Zambia
Tanzania
Kenya
Congo
Madagascar
Uganda
Mali
Mozambique
Ghana
Rwanda
Namibia
Gabon
Lesotho
Cameroon
Nigeria
Benin
Peru
Nicaragua
Dominican Republic
Colombia
Honduras
Haiti
0
Bolivia
20
0
Kenya
Mali
Malawi
Tanzania
Madagascar
Ghana
Nigeria
Rwanda
Zambia
Congo
Cameroon
Namibia
Latin America &
Caribbean
Lesotho
Zimbabwe
Burkina Faso
Uganda
Gabon
Mozambique
Benin
Nicaragua
Honduras
Colombia
Dominican Rep.
40
Haiti
60
Bolivia
Peru
… as are access and cost
constraints
% citing constraints among never-married women aged 15–49 with unmet need
100
80
Sub-Saharan Africa
20
0
Mali
Mozambique
Zimbabwe
Zambia
Rwanda
Malawi
Madagascar
Gabon
Burkina Faso
Congo
Cameroon
Lesotho
Latin America &
Caribbean
Benin
Tanzania
Namibia
Uganda
Kenya
Nigeria
Ghana
Bolivia
Colombia
Peru
Honduras
Dominican Republic
Nicaragua
40
Haiti
Levels of concern about side
effects tend to be low
% citing concerns among never-married women aged 15–49 with unmet need
100
80
60
Sub-Saharan Africa
20
Never-married women commonly think
they do not need to use a method
% who think they need no method among never-married women aged 15–49 with unmet need
100
Latin America &
Caribbean
80
Sub-Saharan Africa
60
40
Benin
Namibia
Nigeria
Burkina Faso
Gabon
Lesotho
Cameroon
Uganda
Ghana
Zimbabwe
Mali
Mozambique
Congo
Tanzania
Kenya
Zambia
Madagascar
Rwanda
Malawi
Haiti
Nicaragua
Dominican Republic
Bolivia
Honduras
Colombia
0
Peru
20
Most women with unmet need
intend to use a method in the future
% of women who intend to use a method
96
100
82
80
77
76
67
60
40
20
0
Married
Latin America & Caribbean
Never-married
Sub-Saharan Africa
South & Southeast Asia
Recommendations
Recommendations:
Satisfy Unmet Need
• Special attention should be given to
populations in which the gap between
fertility desires and contraceptive practice is
greatest—many of which are in SubSaharan Africa
Recommendations:
Address Health and Side Effects
• To be effective, programs must include
counseling and education to help women
disentangle fact from fiction regarding
health concerns and side effects of
methods
Recommendations:
Provide Contraceptive Options
• It is important to ensure that women have
as many contraceptive options as possible,
to help them find a method that most
closely matches their needs—for example,
for a temporary or permanent method of
contraception, or for a hormonal or barrier
method—and their tolerance for side effects
Recommendations:
Improve Contraceptive Technology
• Developing new methods and otherwise
improving contraceptive technologies would
make it easier for women and their partners
to avoid unwanted pregnancies
Recommendations:
Educate Women About Risk
• Women who do not seek contraceptive
services because they do not believe they
are at risk of getting pregnant require
information through outreach efforts beyond
a clinical setting.
Recommendations:
Reduce Societal Barriers
• Efforts to promote societal acceptance of
contraceptive use can help women
overcome the cultural and social barriers to
using contraceptives and achieving their
desired family size.
This presentation was developed
with support from the Bill and
Melinda Gates Foundation
For more information, visit www.guttmacher.org