Elsevier

The Lancet

Volume 381, Issue 9878, 11–17 May 2013, Pages 1642-1652
The Lancet

Articles
National, regional, and global rates and trends in contraceptive prevalence and unmet need for family planning between 1990 and 2015: a systematic and comprehensive analysis

https://doi.org/10.1016/S0140-6736(12)62204-1Get rights and content

Summary

Background

Expansion of access to contraception and reduction of unmet need for family planning are key components to improve reproductive health, but scarce data and variability in data sources create difficulties in monitoring of progress for these outcomes. We estimated and projected indicators of contraceptive prevalence and unmet need for family planning from 1990 to 2015.

Methods

We obtained data from nationally representative surveys, for women aged 15–49 years who were married or in a union. Estimates were based on 930 observations of contraceptive prevalence between 1950 and 2011 from 194 countries or areas, and 306 observations of unmet need for family planning from 111 countries or areas. We used a Bayesian hierarchical model combined with country-specific time trends to yield estimates of these indicators and uncertainty assessments. The model accounted for differences by data source, sample population, and contraceptive methods included in the measure.

Findings

Worldwide, contraceptive prevalence increased from 54·8% (95% uncertainty interval 52·3–57·1) in 1990, to 63·3% (60·4–66·0) in 2010, and unmet need for family planning decreased from 15·4% (14·1–16·9) in 1990, to 12·3% (10·9–13·9) in 2010. Almost all subregions, except for those where contraceptive prevalence was already high in 1990, had an increase in contraceptive prevalence and a decrease in unmet need for family planning between 1990 and 2010, although the pace of change over time varied between countries and subregions. In 2010, 146 million (130–166 million) women worldwide aged 15–49 years who were married or in a union had an unmet need for family planning. The absolute number of married women who either use contraception or who have an unmet need for family planning is projected to grow from 900 million (876–922 million) in 2010 to 962 million (927–992 million) in 2015, and will increase in most developing countries.

Interpretation

Trends in contraceptive prevalence and unmet need for family planning, and the projected growth in the number of potential contraceptive users indicate that increased investment is necessary to meet demand for contraceptive methods and improve reproductive health worldwide.

Funding

United Nations Population Division and National University of Singapore.

Introduction

Provision of access to voluntary family planning, especially effective contraceptive methods, for women and men is not only crucial to directly improve reproductive health outcomes, but is also positively associated with improvements in health, schooling, and economic outcomes.1, 2, 3 Monitoring of family planning rates and trends globally, regionally, and nationally draws attention to progress towards achievement of universal access to reproductive health—a target in Millennium Development Goal (MDG) 5 to improve maternal health—and indicates the investments needed and progress expected from programmatic efforts to expand access to effective contraceptive methods.4, 5 Global efforts to improve women's and children's health and increase access to family planning information, services, and supplies6, 7 mean a heightened demand for frequent, comparable, and timely estimates of family planning indicators to monitor progress.

However, analysis of family planning levels and trends is challenging because the number of observations per country are scarce or not recent. In a new compilation of data for family planning indicators for 194 countries and areas, 43% of countries and areas had no data for unmet need for family planning and 65% of countries had no data for unmet need since 2005.8 Methodological differences between data sources, both within and across countries, also complicate the derivation of reliable estimates of trends in family planning indicators.

Studies in which investigators have assessed rates and trends in contraceptive prevalence and unmet family planning need across many countries have tended to use straightforward approaches. Such methods include use of the most recent observation as indicative of present rates or application of linear extrapolation based on the two most recent observations,5, 9, 10, 11 use of a spline-based extrapolation method,1 or restriction of the data sources or region examined.5, 12 Investigators of some studies derived future trends in contraceptive prevalence from projected fertility rates.13, 14 An annual series of estimates has not been published. In this report, we aimed to estimate and project national, regional, and global trends in contraceptive prevalence and unmet need for family planning from 1990 to 2015, the period during which the MDGs are to be met.

Section snippets

Data

Contraceptive prevalence is measured as the percentage of women who report themselves or their partners as using at least one contraceptive method of any type (modern or traditional; appendix p 5). Unmet need for family planning is defined as the percentage of women who want to stop or delay childbearing but who are not using any method of contraception to prevent pregnancy. Observations of unmet need for family planning in our database are, whenever possible, based on the revised algorithm of

Results

Between 1990 and 2010, contraceptive prevalence in MWRA increased worldwide, in developing countries as a group, and in most subregions except for those where contraceptive prevalence was already high (figure 1 and table 1). Globally, contraceptive prevalence rose from 54·8% (95% uncertainty interval 52·3–57·1) in 1990, to 63·3% (60·4–66·0) in 2010, or 8·5 percentage points (4·7–12·1, PPI>0·99). This increase was driven mainly by a rise in contraceptive prevalence in developing countries, from

Discussion

In a comprehensive and systematic manner, we generated the annual values of contraceptive prevalence, unmet need for family planning, and associated indicators, such as unmet need for modern methods, for 194 countries or areas for 1990–2015. Key advantages of our estimation approach compared with previous studies are that our annual estimates are available for a long period for all countries with at least one datapoint for contraceptive prevalence (eg, we generated estimates of unmet need for

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