In the developing world, 222 million women would like to delay or avoid pregnancy, but are not using modern contraception. At the 2012 London Summit on Family Planning, the development community committed to reducing this unmet need for modern contraception by reaching 120 million women and girls from 69 of the world’s poorest countries with voluntary access to family planning information, contraceptives, and services by 2020, an agreement known as FP2020. In a recent study, Population Council researchers recommend a promising strategy for reducing unmet need for modern contraception. Rather than focusing solely on reaching women who have never used contraception, the researchers suggested providing better information and services to support women who already use contraceptives, and making it easier for those who previously used contraception to resume use.
Council researchers Anrudh K. Jain, Francis Obare, Saumya RamaRao, and Ian Askew analyzed Demographic and Health Survey (DHS) data compiled in 34 developing countries between 2005 and 2010. Twenty of these countries were in sub-Saharan Africa.
Drawing from the data, the authors estimated that among the 120 million women whom FP2020 seeks to reach are some 45 million women who once used contraceptives, but discontinued. Additionally, in the coming years, if current levels of contraceptive discontinuation continue, 49 million current contraceptive users would stop using contraceptives, even though they still wish to avoid pregnancy. Therefore, the researchers estimated that high contraceptive discontinuation in the past and present could leave up to 94 million (45 million + 49 million) women with unmet need. This study is the first to empirically estimate the potential contribution of high contraceptive discontinuation to current and future unmet need.
According to the authors, reducing unmet need could best be achieved in two ways. First, by supporting women and girls who are already using a modern contraceptive method with good information and services so that they can continue with their current method or switch to another modern method that better suits their needs. And second, by helping women and girls who once used, but no longer use, a modern contraceptive method to find and use a method that suits their needs.
“Engaging women who have used a method in the past or are using one now is likely to be the fastest and most cost effective way to reduce unmet need,” says Jain, “because these women have already evaluated potential advantages and overcome barriers to contraceptive use—including everything from cultural and social attitudes to out-of-pocket cost—and have made decisions in favor of family planning and adopted a method.”
Strategies to promote sustained and consistent contraceptive use
The authors identified three strategies for reducing contraceptive discontinuation, increasing switching to more effective methods, and increasing uptake by former users. One strategy is to expand the range of contraceptive methods available so that women have more options to choose from; this and other studies have shown that the more contraceptive methods that are available, the less likely a woman is to discontinue contraceptive use. The second strategy is to improve quality of care and provider–client interactions; studies have shown that women are more likely to continue using contraception and less likely to experience unintended pregnancy when they receive higher-quality counseling and care. The third proposed strategy focuses on improving the characteristics of contraceptive technologies available; this approach assumes that women will continue using their preferred method, or decide to return to it, if products are easier to use, well-tolerated, and more affordable.
“Focusing on encouraging past users with unmet need to resume use and supporting current users are essential in reducing unmet need in the future and reaching FP 2020 goals,” says Askew.
Jain, Anrudh K., Francis Obare, Saumya RamaRao, and Ian Askew. 2013. “Reducing unmet need by supporting women with met need,” International Perspectives on Sexual and Reproductive Health 39(3):133–141. DOI: 10.1363/3913313.