|Demand for family planning satisfied with modern methods among sexually active women in low- and middle-income countries: who is lagging behind?|
||Fernanda Ewerling , Cesar G. Victora, Anita Raj, Carolina V. N. Coll, Franciele Hellwig, and Aluisio J. D. Barros
||Reproductive Health, 15:42; DOI: https://doi.org/10.1186/s12978-018-0483-x
More than one region
||Background: Family planning is key for reducing unintended pregnancies and their health consequences and is
also associated with improvements in economic outcomes. Our objective was to identify groups of sexually active
women with extremely low demand for family planning satisfied with modern methods (mDFPS) in low- and
middle-income countries, at national and subnational levels to inform the improvement and expansion of
programmatic efforts to narrow the gaps in mDFPS coverage.
Methods: Analyses were based on Demographic and Health Survey and Multiple Indicator Cluster Survey data. The
most recent surveys carried out since 2000 in 77 countries were included in the analysis. We estimated mDFPS
among women aged 15–49 years. Subgroups with low coverage (mDFPS below 20%) were identified according to
marital status, wealth, age, education, literacy, area of residence (urban or rural), geographic region and religion.
Results: Overall, only 52.9% of the women with a demand for family planning were using a modern contraceptive
method, but coverage varied greatly. West & Central Africa showed the lowest coverage (32.9% mean mDFPS),
whereas South Asia and Latin America & the Caribbean had the highest coverage (approximately 70% mean
mDFPS). Some countries showed high reliance on traditional contraceptive methods, markedly those from Central
and Eastern Europe, and the Commonwealth of Independent States (CEE & CIS). Albania, Azerbaijan, Benin, Chad
and Congo Democratic Republic presented low mDFPS coverage (< 20%). The other countries had mDFPS above
20% at country-level, yet in many of these countries mDFPS coverage was low among women in the poorest
wealth quintiles, in the youngest age groups, with little education and living in rural areas. Coverage according to
marital status varied greatly: in Asia & Pacific and Latin America & the Caribbean mDFPS was higher among married
women; the opposite was found in West & Central Africa and CEE & CIS countries.
Conclusions: Almost half of the women in need were not using an effective family planning method. Subgroups
requiring special attention include women who are poor, uneducated/illiterate, young, and living in rural areas.
Efforts to increase mDFPS must address not only the supply side but also tackle the need to change social norms
that might inhibit uptake of contraception.
Keywords: Family planning, Contraception, Socioeconomic factors, Health equity