SEATTLE — The Guttmacher Institute analyzes women’s access to contraception as well as pregnancy and delivery care globally. Despite a significant increase in past decades, its 2017 report identifies shortcomings in contraceptive use in developing countries. Redressing these has the potential to improve the health and living standards of women and children and reduce population growth.
According to the Guttmacher Institute, 214 million women need contraception. These needs remain unmet in developing countries in 2017. Although they want to avoid pregnancies, these women do not have access to modern methods of contraception. Effective methods include hormone injection, sterilization, intrauterine devices and condoms. More than 150 million women do not use any form of contraception; the remaining 59 million rely on traditional methods such as coitus interruptus or the rhythm method.
Using the so-called rhythm method, couples abstain or use condoms during the woman’s estimated fertile days. When used commonly, these methods are only 73 and 75 percent effective respectively according to the World Health Organization (WHO). The Guttmacher Insitute also does not consider postpartum amenorrhea to be a modern method of contraception.
The most cited reason among the women for not using modern contraception was their fear of health risks or side effects (26 percent), followed by infrequent or no sex (24 percent) and opposition by the women themselves or others (23 percent). Twenty percent of women cited postpartum amenorrhea or breastfeeding. Only 5 percent of the women stated that they lacked access to contraception. High costs and unawareness of methods were cited by 3 percent.
The World Health Organization supports universal access to contraception due to its wide-ranging benefits. Allowing women to determine the number of their children reduces pregnancy-related health risks. The number of maternal and newborn deaths is reduced, as well as unintended pregnancies and unsafe abortions. Contraception is also crucial for the prevention of the spread of HIV; it reduces the number of unintended pregnancies with infected babies and – in the case of condoms – prevents contagion with STIs among sexual partners.
Reduced family sizes also have positive effects on women’s and children’s education and living standards. Adolescent girls are more likely to stay in school longer when they don’t have to drop out due to pregnancies. When family sizes and the number of children can be controlled, parents are able to invest more in each child, and can each attain a better education.
Contraception, according to the U.N. Population Fund (UNFPA), empowers women, not only through increased education but also because of their increased autonomy in the household and improved earning power.
Jagdish Upadhyay from the UNFPA says: “If by 2030 the average family size is just one child fewer, then by 2030 the world population is estimated to be approximately 8 billion rather than 9 billion.” The WHO also states that access to contraception “is key to slowing unsustainable population growth and the resulting negative impacts on the economy, environment, and national and regional development efforts.”
According to the U.N. Department of Economic and Social Affairs Population Division, the use of contraceptives has increased significantly globally in the past decades, especially in Asia, the Caribbean and Latin America. In sub-Saharan Africa, contraceptive use has increased at a slower pace. This trend is expected to continue. In 2015, U.N. member states committed to ensuring universal access to sexual and reproductive healthcare services by 2030 in the Sustainable Development Goals.
The Guttmacher report suggests that, due to a variety of barriers, improving access to contraception will also require a variety of measures that address “policy restrictions, poor-quality services, and social and economic factors that prevent people from obtaining or using needed services.” Accurate counseling and accessibility of a wider range of methods can reduce barriers like the fear of side effects and the misbelief that infrequent sex prevents pregnancies. Investing in these strategies will be worthwhile and cost-effective, the report argues, as every dollar spent on contraception in developing countries saves $2.30 in maternal and newborn healthcare.
– Lena Riebl