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Family planning use and unmet need

Rebecca Best describes the unmet need for contraception and outlines the huge potential health benefits that could be realised if this need were met.
REBECCA BEST: I’m Becky Best, a midwife who has experience working clinically and in research in the UK and Sierra Leone. In this step we’re going to be talking about the importance of family planning and reproductive health. In the previous steps we learned that women with unmet needs are those able to become pregnant, are sexually active and do not want to become pregnant, but are not currently using any method of contraception or who are currently unintentionally pregnant. In this presentation, we will discuss why providing family planning services to prevent unintended pregnancies is a priority for preventing adverse health outcomes and discuss the benefits of meeting this need for contraception. First, let’s discuss what is happening globally.
As of 2017, there are 1.6 billion women of reproductive age living in developing regions. About half of them, 885 million women, want to avoid a pregnancy, but only around 3/4 of that subset of women, 671 million, are using modern contraceptives. So where does that leave us? 214 million women have an unmet need for modern contraception in developing regions. This includes 155 million who use no method of contraception and 59 million who rely on traditional methods. But why is this important? In 2017, an estimated 308,000 women in developing countries would die from pregnancy-related causes and 2.7 million babies will die in the first month of life.
Most of these deaths could be prevented with full access to certain vital services, including contraceptive care to help avoid unintended pregnancies and quality maternal and newborn health care to health mothers and newborns safely through pregnancy and delivery. One of the specific targets of the health Sustainable Development Goal, SDG3, is that by 2030, the world should ensure universal access to sexual and reproductive health care services, including for family planning, information and education, and the integration of reproductive health international strategies and programmes. This week we will focus on making every both wanted and delve into these in later weeks. We only have 10 years to achieve the SDGs.
So it’s important to note that in order to realise health benefits, we need to invest in both contraception as well as maternal and newborn health.
Let us first look at the progress we have made. Despite the growing number of women who want to avoid pregnancy, we have made steps to support women by meeting their contraception needs in the last decade. Here we see that there has been a decline in the number of women in developing regions with an unmet need for contraception, from 225 million women 2014 to 214 million women in 2017. This is largely being driven by increases in modern contraceptive use. So let’s take a look at what is happening globally. We see that despite progress being made, there are huge disparities in access to contraception, especially among the poorest women and in the poorest countries. This uneven progress is linked to unequal access.
The unintended pregnancy rate remains substantially higher in developing regions than in developed regions. The high unintended pregnancy rate in developing regions corresponds with a substantial unmet need for contraception in these parts of the world. We see here that the proportion of women who have an unmet need for modern contraception is highest in sub-Saharan Africa, at 21%. However the largest absolute number, 70 million women, live in southern Asia. Abortions that are unsafe are much higher in countries where laws are more restrictive. Women in low income countries are also most likely to have an unsafe abortion. Abortions rates have remained steady in developing regions, while declining in developed regions.
These large gaps also exist in regard to provision of essential and quality maternal health services, which we’ll discuss further next week when we discuss maternal health. Unmet need is closely linked to poorer health outcomes due to smaller spaces between births, increased family size, and increased number of abortions. Sexual and reproductive health services, which provide choice of method and appropriate counselling, are needed to help women avoid unintended pregnancies and to ensure healthy outcomes for those who do become pregnant. Not all women who do not want to get pregnant use effective methods. And to understand how to support women to access and use contraceptives, we must think about the reasons for non-use.
Understanding unmet need for contraception, not using contraception despite wanting to avoid pregnancy, is essential for effective family planning policies and programmes that aim to help women and couples to choose the number and timing of their children. Research has shown that women give a range of reasons for not using modern contraceptive methods. There are many factors responsible for not using contraception, despite wanting to avoid pregnancy, which predominantly fall into four categories. Concern about the side effects or health risks of contraceptive methods. That they are having sex infrequently or not at all. That they or others around them oppose contraception.
And, finally, the belief that contraception is not required or safe when breastfeeding, or they haven’t resumed menstruation after a birth, or both. This tells us that provision alone is not enough. Women need counselling, information, and a range of contraception methods to enable them to choose a method that works for them and that they are likely to be able to continue with or use effectively. The barriers to addressing unmet need go beyond contraception provision. Despite progress, gaps in meeting women’s needs still persist, especially among the poorest women and in the poorest countries.
Reducing barriers requires better quality of care within sexual and reproductive health care services, which address poor quality services, policy restrictions, and social and economic factors that prevent people from accessing and using needed services. As we saw in the previous slide, we need to address the urgent need for high quality contraception services, that offer a wide range of methods, and coupled with comprehensive counselling. It is important to involve men, key stakeholders, and community members in programmes to increase uptake and reduce stigma for women who choose to use services.
While there are many barriers, there are also great opportunities for improving health. If all unmet need for modern contraception was satisfied in developing regions, there would be approximately a 3/4 decline in unintended pregnancies, unplanned births, and induced abortions. As we have learned, there are 885 million women of reproductive, age 15 to 49 years, in developing regions who want to avoid a pregnancy, yet 214 million are not using a modern contraceptive method. Now, let’s discuss the potential health benefits that will be gained if all of these 214 million women started using an effective contraceptive method.
According to the Guttmacher Institute in 2017, if all unmet need for modern contraception was satisfied in developing regions, there would be approximately a 75% decline in unintended pregnancies, going from the current 89 million to 22 million per year. Unplanned births, from 30 million to 7 million per year. And induced abortions, from 48 million to 12 million per year. The health benefits of preventing unintended pregnancies would be substantial. Compared with the current situation, fully meeting the unmet need for modern contraception would result in an estimated 76,000 fewer maternal deaths each year.
Thinking about what we have learned, what do we need to do next? We have learned that there are many benefits for family planning, which go beyond mortality. But to realise these benefits, we require continued investments in health care programmes and policies in order to ensure that women and couples have access to contraceptives and family planning services. It is also crucial to make or keep safe abortion services available, since, even if the need for contraceptives is fully met, contraceptive methods occasionally fail and perfect use is unrealistic. Together these efforts are essential to helping women safely achieve their reproductive goals. Family planning is the most cost effective way of reducing maternal deaths.
Roughly every $1 spent on contraception services saves $2.20 in maternal and newborn care due to the decline in unintended pregnancies and safer birth spacing. Beyond health and cost benefits, contraception allows women to choose their family size and the timings of their births– increasing their education, career, and social opportunities. This has huge benefits for gender equality and consequently society as a whole.

We’ve determined that family planning has a range of benefits to health and beyond, but what if women can’t access the contraception they want or need?

In this step Rebecca Best will describe the unmet need for contraception and explore its causes, then outline the huge potential health benefits that could be realised if this need were met.

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