The Millennium Development Goals (MDG) were developed in recognition that vast populations live in extreme poverty. Access to universal reproductive health, remains the most lagging of all the health-related MDGs.
Unwanted pregnancy persists
Every year, 87 million women worldwide become pregnant unintentionally because of the underuse of modern contraceptives. Unwanted pregnancies can lead to disabilities, induced abortions, lower educational and employment potentials and death. The risk of undesired pregnancy is almost three times greater among those who use traditional methods of contraception and 14 times greater for those who do not use any method. In 35 countries studied, 15 million of the 16.7 million undesired pregnancies occurring annually could have been prevented with the optimal use of modern contraceptives.
Contraceptive prevalence rate, total fertility rate, unmet need for family planning
Around 25–40% of maternal deaths can be eliminated if unplanned pregnancies are prevented. When the use of contraceptives is low in a country, the total fertility rate is often high. Some countries have maintained stable population growth by reaching a total fertility rate in the region of 1.8.
Contraceptive prevalence rates (CPR) in countries with a high MMR and a low proportion of skilled care at birth are usually low, as was the case in Papua New Guinea (32%), Lao People's Democratic Republic (38%) and Cambodia (51%) in 2012. China, Viet Nam and Mongolia have a high CPR, ranging from 55% to 85%, while the Philippines reached 51% in 2012.i
The total fertility rate in countries with a low CPR is usually high, as the case in Cambodia, Lao People's Democratic Republic and Papua New Guinea at 2.9–3.8 in 2013.ii Most of the countries with a high total fertility rate often have a limited choice of contraceptive methods.
Many couples wish to limit or space their pregnancies and yet do not use contraception. They are said to have an unmet need for family planning. It was highest in Papua New Guinea (27%), Mongolia (22%), Lao People's Democratic Republic (20%), and the Philippines (19%),while in Viet Nam it was as low as 4%.i The high rates of unmet need for family planning reflect low accessibility to family planning information and services and poor quality of care. Other reasons include lack of necessary knowledge on family planning, limited contraceptive choice, fear of side-effects of contraceptive methods and social and cultural issues, such as women’s unequal bargaining power in decision-making related to family planning and the high cost of contraception in some countries.
Common reasons for not using contraceptives
- unfounded fear of side-effects or other health-related concerns;
- opposition to use of contraceptives from religious groups, spouses and partners;
- lack of knowledge, for example of where to access contraceptives; and
- risk of pregnancy taken too lightly.
What we can do
In many developing countries, women, men and couples may not have access to suitable contraceptives that meet their needs at different stages of life. Frontline health workers need to have essential skills to assist and counsel couples in finding the most suitable method while debunking misconceptions about modern contraceptives. Social and other media can complement efforts by reaching wide audiences with accurate information.
Modern methods of contraception are key
Optimal use of modern methods of contraception can:
- reduce unintended pregnancies by 70% from 74 million to 22 million per year;
- cut maternal deaths by 67% from 290 000 to 96 000;
- prevent newborn deaths by 77% from 2.9 million to 660 000;
- reduce the burden of disability related to pregnancy and delivery experienced by women and newborns by two thirds; and
- eliminate transmission of HIV from mothers to newborns, achieving a 93% reduction to 9000 cases annually.
i Global Health Observatory Data Repository. World Health Organization.
ii World Health Statistics 2015. World Health Organization, 2015.