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 the use of contraception worldwide 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, research reveals.
However, despite progress, as many as 1 in 14 women worldwide who wanted contraception were not using it in 2019, according to the world’s most comprehensive assessment of global contraception, published in The Lancet.
Stark disparities also exist between regions, according to 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.
Young 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 key regional differences in the type of contraceptives used, with women in some regions relying mostly on permanent methods, the study authors said.
“While we have seen great progress in the availability of contraceptives since the 1970s globally, there is still a long way to go to ensure that every woman and adolescent girl can experience the economic and social empowerment that contraceptives can offer,” said Dr. Annie. Haakenstad, from the Institute for Health Metrics and Evaluation at the University of Washington.
“Our results indicate that where a woman lives in the world and her age still significantly affect her contraceptive use.” Expanding access to contraception is 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 than oral pills or condoms.
Globally, the proportion of women of childbearing age using modern contraception rose from 28% in 1970 to 48% in 2019. But despite the significant increases, 163 million women who were not currently using contraception were considered 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 single, sexually active, capable of becoming pregnant and not wanting a child within two years, or if they were pregnant or had just given birth but would have preferred to delay or prevent their pregnancy.
Southeast Asia, East Asia, and Oceania had the highest rates of modern contraceptive use (65%) and demand met (90%); while sub-Saharan Africa had the lowest rate of modern contraceptive use (24%) and demand met (52%).
Between countries, levels of modern contraceptive use ranged 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 15-19 and 20-24 age brackets were the least likely to have access to contraception. “Importantly, our study draws attention to the overrepresentation of young women among those who cannot access contraception when they need it,” Haakenstad said.
“Women have the most to gain from contraceptive use because delaying childbearing can help women stay in school or obtain other educational opportunities and enter and maintain paid employment. This can lead to social and economic benefits that last a woman’s lifetime and is a key driver towards greater gender equity.
Birth control methods vary widely by location, the researchers found.
In 2019, female sterilization and oral contraceptives dominated 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 total contraceptive use in South Asia. Additionally, in 28 countries, more than half of women used the same method, suggesting that the availability of options in these countries may be limited.
Professor Rafael Lozano, from the University of Washington, said: “Our study underscores that not only should contraception be available to all women, but also appropriate contraceptive choices. Diversifying options in areas that may be overly dependent on one method could help increase contraceptive use, especially when the most used method is permanent.
Dr Manas Ranjan Pradhan of the International Institute of Population Sciences, who was not involved in the study, said the study “reinforces calls” for implementing strategies in countries with “high unmet need” among young women and girls.