The What-nots, Why-nots, and So-whats of Contraceptive Use, Method Mix and Unmet Need

Scott Radloff, PhD Bill & Melinda Gates Institute for Population and Reproductive Health

International Family Planning Conference Ababa, Ethiopia, November 15, 2013

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Presentation Themes

International Family Planning had been recently revitalized

In 50 years, contraceptive use has dramatically increased…

…but not uniformly in pace …or in method mix by subregions …unmet need varies substantially across subregions and countries …as well as across socioeconomic strata.

FP2020 offers the promise of addressing disparities in access... …as it reduces unmet need …for the benefit of women’s health, child health …and for the well-being of families, communities, and nations.

International family planning: Three Eras

Era Two: 1996-2008Growing Neglect

Era One: 1965-1995Priority Attention

Era Three: 2009-2020Revitalization

Dramatic growth in donor attention and funding UNFPA established, regular international conferences held Early policies/commitment/resources in LAC, Asia, North Africa By early 1990s, country graduation began Demographic and health rationale primary

Donors attention shifts to other health priorities Increased use of basket funding approaches Greater disparity between middle/low income countries USAID funding declines from 1995 peak Rights and health rationale become primary

Growing attention and partnerships USAID funding and attention increased under GHI DFID & BMGF exert leadership, sponsoring 1st ever Summit Attention focused on high need/low income countries Growing recognition of demographic/economic in addition to rights

and health rationale

High fertility correlates with low modern FP use (the two maps are nearly perfect negative images of each other)

Total Fertility Rate (TFR)Modern Contraceptive Prevalence Rate (MCPR)

No Data

1.9 - 2.5

4.4 - 7.4

2.6 - 4.11 - 1.8No Data

20 - 41

61 - 86

42 - 601 - 19

Source: Population Reference Bureau. Population Data Sheet, 2011.

117 million women 86 million in More Developed Countries (MDCs)

31 million in Less Developed Countries (LDCs)

Source: ”Adding It Up,” Guttmacher, 2012; Bongaarts, Population and Development Review, 1984; World Contraceptive Use 2011, UN Population Division, 2011.

Modern contraceptive use worldwide has ↑ 6-fold over 50 years – and 20-fold in developing regions

Developed Countries

797 million women 152 million in MDCs

645 million in LDCs

Developed Countries

1960-652012

Drivers of expanded contraceptive use: Demand for smaller families + healthy timing/spacing of pregnancies Improved access to family planning services Wider range, safer, more effective and affordable method choice Population growth (from 3 to 7 billion)

World

Source: World Contraceptive Use 2011, UN Population Division, 2011.

CPR = 63%LAPM share of all modern method use = 57%TFR = 2.4

Worldwide, there is a wide range of method use…

…and there is a wide variation across and within regions.

Contraceptive method mix differs dramatically by subregion

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MCPR = 70%LARC/PM share = 46%TFR = 2.1

MCPR = 54%LARC/PM share = 31%TFR = 1.5

MCPR = 52%LARC/PM share = 83%TFR = 2.7

MCPR = 23%LARC/PM share = 13%TFR = 5.1

Source: World Contraceptive Use 2011, UN Population Division, 2011.

Use + Unmet need = Total demand for FP

Total Demand for Modern Contra-ception, Worldwide

Note: Unmet need is an indicator to track achievement of Millennium Development Goal 5, improving maternal health.

Source: UN Population Division, 2012; World Contraceptive Use, 2011. Data for women married or in union.

Total Demand for Modern Contra-ception, Least Developed Countries

24%

55%

unmet need unmet

need

Modern method useModern

method use

• Many reasons for unmet need – Complex (e.g., access barriers; fear of side effects; partner opposition)

More than just a “supply” issue

Rises with growing demand, i.e., in part is a marker of “success”

• 867 million women want to avoid pregnancy 645 million using a modern method

99 million using traditional methods

123 million using no method

Unmet need for FP in Developing Countries: Key facts

Source: “Adding It Up”, Guttmacher, 2012.

REGION

Modern Method

Use (MCPR)

Women Using

Modern FP (millions)

Unmet Need

Modern FP (%)

Women with Unmet Need for

Modern FP (millions)

Proportion of Total Demand Being Met

(%)Developing Countries 55% 645 M 19% 222 M 74%

Asia 62% 515 M 17% 141 M 79%

Eastern Asia 88% 267 M 3% 16 M 94%

Central Asia 52% 6 M 19% 2 M 75%

South Asia 46% 163 M 24% 83 M 66%

Southeast Asia 56% 64 M 20% 25 M 72%

Western Asia 34% 14 M 35% 14 M 50%

Source: UN Department of Economic and Social Affairs, Population Division. World Contraceptive Use, 2011. Data for women married or in a union.

Modern method use, unmet need for modern FP & proportion of demand being met, by region – Part 1

REGION

Modern Method

Use (MCPR)

Women Using

Modern FP (millions)

Unmet Need

Modern FP (%)

Women with Unmet Need for

Modern FP (millions)

Proportion of Total Demand Being Met

(%)Africa 25% 51 M 28% 59 M 46%

Northern Africa 45% 16 M 21% 8 M 67%

Southern Africa 58% 9 M 16% 2 M 82%

Eastern Africa 27% 17 M 32% 20 M 46%

Western Africa 9% 7 M 30% 19 M 27%

Middle Africa 7% 2 M 37% 10 M 17%

Latin America & Carib 66% 80 M 19% 23 M 78%

South America 70% 58 M 17% 16 M 78%

Central & Caribbean 61% 22 M 20% 7 M 76%

Source: UN Department of Economic and Social Affairs, Population Division. World Contraceptive Use, 2011. Data for women married or in a union.

Modern method use, unmet need for modern FP & proportion of demand being met, by region – Part 2

Niger 2

006

Guinea 2005

DR Congo 2007

Sierra

Leone 2

008

Mali 2006

Nigeria

2008

Mozambique 2

010

Seneg

al 2010

Ghana 2

008

Uganda 2011

Ethiopia

2011

Tanzan

ia 2010

Kenya

2008/9

Malawi 2

010

Rwanda 2

010

Zimbab

we 2010/1

1

Mar

ried

wom

en

At the country-level, variations are more wide-ranging

• Modern contraceptive use ranges widely, from 5-57 percent.• In most countries, less than half the demand for modern FP is being met. • For every woman using modern FP, one to five women have unmet need.

Source: DHS

80%

70%

60%

50%

40%

30%

20%

10%

0%

Source: DHS

Unmet Need

Trad Method

Modern Method

Contraceptive use in Africa much lower among poorest quintile

2.8

1311.6

16.9

3.4

17.6

34.9

2.8 2.5

38.5

2.9

19.2

7.2

30.6

14.9

48.2

20.6

47.9

17.1

36.4

48.4

16.4

22.3

49.6

22

37.7 37.9

48.3

0

10

20

30

40

50

60

Poorest Richest

Perc

ent

Source: Demographic and Health Surveys.

Adapted and updated from L. Dougherty, “Healthy Timing and Spacing of Pregnancy,” Knowledge Management Services Project

Poorest quintile Wealthiest quintile

London Summit commitments can reduce disparities

1950s 1960s 1970s 1980s 1990s 2000s 2010s -

2,000

4,000

6,000

8,000

10,000

12,000

14,000

23 955

4,419 5,037

8,456 6,988

12,194

International Family Planning Assistance by Decade: Current Dollars

$ M

illio

ns

Source:  Global Population Assistance Report 1982-1989, 1994 (for 1950-1995 period), UNFPA; Financial Resource Flows for Population Activities in 2009 (1996-2008 data adjusted to align with GPAR categorization), UNFPA; data for 2009-2019 estimated drawing upon London FP Summit, 2012 commitments. “Adding It Up,” Guttmacher, 2012

FP2020 goal of extending family planning to 120 million new users Translates to:

14 million fewer abortions 43,000 fewer maternal deaths 600,000 fewer infant deaths

As well as many other family, community, and national benefits Key to meeting 8 MDGs

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Thank you

“Family Planning 2020 (FP2020) is a global partnership that supports the rights of women and girls to decide, freely and for themselves, whether, when, and how many children they want to have. FP2020 works with governments, civil society, multi-lateral organizations, donors, the private sector, and the research and development community to enable 120 million more women and girls to use contraceptives by 2020.” -- FP2020 website