More than 160 million women worldwide who need contraception are unable to access it, according to the largest study of its kind.
There has been a huge increase in contraception use globally 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 sterilisation, the research reveals.
However, despite the progress, as many as one 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, the Global Burden of Diseases study, a rolling project based at the University of Washington in Seattle, found. Half the women unable to access contraception live in sub-Saharan Africa and south Asia.
Younger women had the highest levels of unmet need, despite being the group for whom the economic and social benefits of contraception access are likely to be most substantial. There were also key regional differences in the kind of contraceptives used, with women in some regions relying substantially on permanent methods, the study’s authors said.
“Although we’ve observed excellent strides in contraceptive availability since the 1970s at a global level, there’s still a long way to go to ensure that every woman and adolescent girl can benefit from the economic and social empowerment contraceptives can offer,” said Dr Annie Haakenstad, of the Institute for Health Metrics and Evaluation at the University of Washington.
“Our results indicate that where a woman lives in the world and their age still significantly affects their use of contraception.” Expanding access to contraception was linked to women’s social and economic empowerment and better health outcomes, she added.
The study showed permanent methods, such as female sterilisation, are more likely to be used by older women, while younger women and girls tend to use short-acting methods such as oral pills or condoms.
Globally, the proportion of women of reproductive age using modern contraception increased from 28% in 1970 to 48% in 2019. But despite the major increases, 163 million women who were not currently using contraception were considered to have 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 if unmarried, sexually active, able to get 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.
South-east Asia, east Asia and Oceania had the highest use of modern contraceptives (65%) and demand satisfied (90%); whereas sub-Saharan Africa had the lowest use of modern contraceptives (24%) and demand satisfied (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 with other groups, women and girls in the 15-19 and 20-24 age groups were least likely to be able to access contraception. “Importantly, our study calls attention to young women being overrepresented among those who cannot access contraception when they need it,” Haakenstad said.
“These are the women who stand to gain most from contraceptive use, as delaying having children can help women stay in school or get other training opportunities and to enter and maintain paid employment. This can lead to social and economic benefits that last throughout a woman’s lifetime and is an essential driver towards greater gender equity.”
Contraceptive methods vary significantly by location, the researchers found.
In 2019, female sterilisation and oral contraceptives were dominant in Latin America and the Caribbean; the oral conceptive pill and condoms in high-income countries; IUDs and condoms in central Europe, eastern Europe and central Asia.
Female sterilisation accounted for more than half of all contraceptive use in south Asia. In addition, in 28 countries, more than half of women were using the same method, suggesting there may be a limited availability of options in these nations.
Prof Rafael Lozano, of the University of Washington, said: “Our study highlights that not only should contraception be available to all women, but also suitable choices of contraceptives. Diversifying options in areas that may be over-reliant on one method could help increase contraceptive use, particularly when the most used method is permanent.”
Dr Manas Ranjan Pradhan, of the International Institute for Population Sciences, who was not involved in the study, said the study “reinforces calls” for implementation of strategies in countries with “high unmet need” among younger women and girls.