Women in the poorest countries of the developing world have unmet demands for reliable modern contraception, such as condoms and contraceptive pills, a recent study finds. Between 2003 and 2012, the total number of women avoiding pregnancy in need of contraception increased from 716 million to 867 million, with growth concentrated the 69 poorest countries.

Funded in part by the Bill and Melinda Gates Foundation, the new study by Guttmacher Institute's Jacqueline E. Darroch and Susheela Singh is published in the latest issue of The Lancet. Information on trends in contraceptive use is necessary to monitor progress toward the United Nation's Millennium Development Goal 5, which calls for universal access to contraceptive services. This study estimated trends in contraceptive use and unmet need in developing countries in 2003, 2008, and 2012.

"In order to make substantial and sustainable progress, improving the quality of services must become a priority," stated Singh. "This includes providing adequate follow-up care, facilitating informed choice among methods, increasing public education and addressing the needs of young people for quality information and services."

Methods identified as modern include sterilization, intrauterine devices, implants, injectable drugs, contraceptive pill, male condom, or other supply methods such as vaginal spermicides. These methods are considered more reliable and have less risk of unintended pregnancy than other more traditional methods, such as withdrawal or periodic abstinence.

The picture is not entirely bleak. Researchers found that between 2003 and 2012, modern contraceptive use in the developing world increased from 71 percent to 74 percent among women avoiding pregnancy, with rates varying greatly within sub-regions. Notable progress was made in Eastern Africa (31 percent to 46 percent), Southern Africa (75 percent to 83 percent), Southeast Asia (64 percent to 72 percent), Central America (71 percent to 77 percent) and South America (73 percent to 79 percent).

By comparison, virtually no progress was made in the sub-regions with the lowest rates of use: in Middle Africa, contraceptive use increased only from 17 percent to 19 percent and in Western Africa, from 22 percent to 26 percent. Overall, in most sub-regions, modern contraceptive use grew more slowly between 2008 and 2012 than between 2003 and 2008.

Though the use of modern methods has risen in all regions over the last decade, far too many women have no access to such methods. Roughly three-quarters of the 222 million women in developing countries who are avoiding pregnancy and lacking modern methods live in the poorest countries, compared with 67 percent in 2003. Women in the poorest countries who want to avoid pregnancy are one-third as likely to be using a modern method as those living in higher-income developing countries.

Because of a growing desire for smaller families — as well as rising population figures — the number of women with unmet need and the proportion of such women in the poorest developing countries are projected to increase even further.

"Unless the adequacy of family planning services improves more rapidly than it has in the past decade, the number of women with an unmet need for modern contraceptives will continue to rise, especially in the 69 poorest countries," said Darroch.

In addition, the authors found that between 2003 and 2012, women shifted away from choosing sterilization (declining from 47 percent to 38 percent of all modern method use in developing countries) toward methods with higher failure rates, namely barrier methods (increasing from 7 percent to 13 percent) and injectables (from 6 percent to 9 percent). They argue that this trend calls for availability of services that help women use reversible contraceptive methods consistently and correctly.

Source: Darroch, J.E. Singh, S. Trends in Contraceptive Need and Use in Developing Countries in 2003, 2008, 2012: An Analysis of National Surveys. The Lancet. 2013.