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