Women Deliver: Contraception access for all women

Photo by irina slutskyThe benefits of contraceptive use include preventing unintended pregnancies and reducing the number of abortions. Contraceptive use enables couples to have the number of children they want and can care for, can reduce the transmission of HIV, helps reduce pressure on scarce natural resources and can improve educational and employment opportunities for women and their children. These improvements in turn contribute to reducing poverty and galvanizing economic growth.

Increased contraceptive use contributes towards two of the United Nations Millennium Development Goals – reducing maternal mortality and reversing the spread of HIV/AIDS – which contribute directly or indirectly to achieving all eight goals.

Two trends will likely drive up demand for contraceptives in the future. First, the number of women of reproductive age (15–49) will increase by 10% between 2007 and 2015 and by another 8% between 2015 and 2025. Second, contraceptive needs are expected to rise as increasing numbers of women want to have smaller families. As a result, increased investment in contraceptive services will become even more crucial.

Levels of unmet need for contraception vary greatly among subgroups of women both at the regional level and within countries. Women who are young, uneducated, poor or living in rural areas are generally at high risk of having an unintended pregnancy.

Historical trends show that educated, urban and financially better-off women have begun to want smaller families and therefore have needed contraceptives earlier than their less educated and poorer peers. Thus, educated, urban and better-off women may experience unmet need first, when their desire to have fewer children outpaces their access to and use of contraceptives. Eventually, the demand for contraceptives rises among women in poor and rural areas, as well, usually leading to an increase in unmet need in these groups.

Nearly everywhere, unmet need is higher among women living in rural areas than among those in urban areas. In many countries, unmet need is also higher among less educated women than more educated women, and among poor women compared with better-off women.

Of the 818 million women who want to avoid pregnancy, 43% rely on a reversible method (such as IUDs, pills, injectables, implants, condoms or vaginal methods), and 31% have had a tubal ligation or have a partner who has had a vasectomy (female sterilizations outnumber male sterilizations by 10 to one). Women who want to delay a birth may have different contraceptive needs compared with women who want to stop childbearing altogether. For example, sterilization is appropriate to the latter group but not the former.

If unmet need for modern methods were fully satisfied, an additional 53 million unintended pregnancies would be averted each year, resulting in 22 million fewer unplanned births, 25 million fewer induced abortions and seven million fewer miscarriages. The immediate health benefits of averting these unintended pregnancies would be substantial. Each year, an additional 150,000 women’s lives would be saved and 640,000 newborn deaths would be averted.

It is recommended that women are provided with the full range of contraceptive methods, along with counseling, to help them obtain a method that best suits their needs and to understand and manage any side effects. Other recommendations include:

    * Ensure that follow-up services are available so that women can switch methods as needed.
    * Make contraceptive services and supplies available and accessible to all women, giving special attention to women with the greatest unmet need, including rural women, adolescents, poor and marginalized women including HIV positive women.
    * Use outreach services to educate women about their risks and needs.
    * Provide young women and men with comprehensive and age-appropriate sex education in schools.
    * Provide public education and information to men and communities to promote more positive attitudes about contraception.
    * Improve contraceptive technologies through research and development, to help meet the need for methods that can be used in low-resource settings and that are accompanied by minimal side effects.

Efforts to meet the demand for contraceptives will have a tremendous impact on the health and well-being of women and their families, and on progress toward meeting the Millennium Development Goals.

Such progress is only possible, however, if national and international donor agencies, as well as developing and developed country governments, make the necessary investments to make modern contraceptives accessible to all women who need them.

Ishdeep Kohli-CNS

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