Estimating progress towards meeting women’s contraceptive needs in 185 countries: A Bayesian hierarchical modelling study

Abstract

Background

Expanding access to contraception and ensuring that need for family planning is satisfied are essential for achieving universal access to reproductive healthcare services, as called for in the 2030 Agenda for Sustainable Development. Monitoring progress towards these outcomes is well established for women of reproductive age (15–49 years) who are married or in a union (MWRA). For those who are not, limited data and variability in data sources and indicator definitions make monitoring challenging. To our knowledge, this study is the first to provide data and harmonised estimates that enable monitoring for all women of reproductive age (15–49 years) (WRA), including unmarried women (UWRA). We seek to quantify the gaps that remain in meeting family-planning needs among all WRA.

Methods and findings

In a systematic analysis, we compiled a comprehensive dataset of family-planning indicators among WRA from 1,247 nationally representative surveys. We used a Bayesian hierarchical model with country-specific time trends to estimate these indicators, with 95% uncertainty intervals (UIs), for 185 countries. We produced estimates from 1990 to 2019 and projections from 2019 to 2030 of contraceptive prevalence and unmet need for family planning among MWRA, UWRA, and all WRA, taking into account the changing proportions that were married or in a union. The model accounted for differences in the prevalence of sexual activity among UWRA across countries.

Among 1.9 billion WRA in 2019, 1.11 billion (95% UI 1.07–1.16) have need for family planning; of those, 842 million (95% UI 800–893) use modern contraception, and 270 million (95% UI 246–301) have unmet need for modern methods. Globally, UWRA represented 15.7% (95% UI 13.4%–19.4%) of all modern contraceptive users and 16.0% (95% UI 12.9%–22.1%) of women with unmet need for modern methods in 2019. The proportion of the need for family planning satisfied by modern methods, Sustainable Development Goals (SDG) indicator 3.7.1, was 75.7% (95% UI 73.2%–78.0%) globally, yet less than half of the need for family planning was met in Middle and Western Africa. Projections to 2030 indicate an increase in the number of women with need for family planning to 1.19 billion (95% UI 1.13–1.26) and in the number of women using modern contraception to 918 million (95% UI 840–1,001).

The main limitations of the study are as follows: (i) the uncertainty surrounding estimates for countries with little or no data is large; and (ii) although some adjustments were made, underreporting of contraceptive use and needs is likely, especially among UWRA.

Conclusions

In this study, we observed that large gaps remain in meeting family-planning needs. The projected increase in the number of women with need for family planning will create challenges to expand family-planning services fast enough to fulfil the growing need. Monitoring of family-planning indicators for all women, not just MWRA, is essential for accurately monitoring progress towards universal access to sexual and reproductive healthcare services—including family planning—by 2030 in the SDG era with its emphasis on ‘leaving no one behind.’

Abstract

In a Bayesian hierarchical modelling study, Vladimira Kantorova and colleagues estimate progress towards meeting women’s contraceptive needs in 185 countries.

Author summary

Why was this study done?

• Increasing availability of modern contraception has permitted greater opportunities for individual choice and responsible decision-making in matters of reproduction.

• Global, regional, and national annual estimates of contraceptive prevalence, unmet need for family planning, and the proportion of need for family planning satisfied by modern methods have previously been available only for married or in-union women of reproductive age (15–49 years) (MWRA).

• We sought to provide estimates of these family-planning indicators for all women of reproductive age (15–49 years) (WRA), including unmarried women (UWRA), that could be used for global monitoring of the proportion of WRA who have their need for family planning satisfied with modern methods (Sustainable Development Goals [SDG] indicator 3.7.1.)

What did the researchers do and find?

• We compiled data on contraceptive use and needs from 1,247 nationally representative surveys and produced harmonised annual estimates and projections that allow monitoring for all WRA, including UWRA.

• Among the 1.9 billion WRA worldwide in 2019, 1.1 billion have demand for family planning; of these, 842 million are using modern contraception, and 270 million have an unmet need for modern methods.

• UWRA account for an increasing share of users of modern contraceptive methods globally (15.7% in 2019 up from 12.1% in 2000), driven in part by an increase in contraceptive use among UWRA and an increase in the proportion of women who are unmarried.

• In 43 countries, of which 32 are low-income countries, less than half of the need for family planning is met by modern methods.

What do these findings mean?

• Annual estimates of key family-planning indicators among all women and by marital status, including the degree of uncertainty around them, provide the global health and development community with better tools for monitoring progress in the era of the SDG and other family-planning initiatives.

• Although contraceptive use has increased, the progress has been uneven between countries, and large gaps remain in meeting family-planning needs. These gaps should be met by family-planning programmes that enable couples and individuals to decide freely and responsibly the number and spacing of their children, as well as have the information and means to do so.