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The What-nots, Why-nots, and So-whats of Contraceptive Use, Method Mix and Unmet Need Scott Radloff, PhD Bill & Melinda Gates Institute for Population.

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Presentation on theme: "The What-nots, Why-nots, and So-whats of Contraceptive Use, Method Mix and Unmet Need Scott Radloff, PhD Bill & Melinda Gates Institute for Population."— Presentation transcript:

1 The What-nots, Why-nots, and So-whats of Contraceptive Use, Method Mix and Unmet Need Scott Radloff, PhD Bill & Melinda Gates Institute for Population and Reproductive Health International Family Planning Conference Ababa, Ethiopia, November 15, 2013

2 Presentation Themes  International Family Planning had been recently revitalized  In 50 years, contraceptive use has dramatically increased…  …but not uniformly in pace  …or in method mix by subregions  …unmet need varies substantially across subregions and countries  …as well as across socioeconomic strata.  FP2020 offers the promise of addressing disparities in access...  …as it reduces unmet need  …for the benefit of women’s health, child health  …and for the well-being of families, communities, and nations. 2

3 International family planning: Three Eras Era Two: Growing Neglect Era One: Priority Attention Era Three: Revitalization  Dramatic growth in donor attention and funding  UNFPA established, regular international conferences held  Early policies/commitment/resources in LAC, Asia, North Africa  By early 1990s, country graduation began  Demographic and health rationale primary  Donors attention shifts to other health priorities  Increased use of basket funding approaches  Greater disparity between middle/low income countries  USAID funding declines from 1995 peak  Rights and health rationale become primary  Growing attention and partnerships  USAID funding and attention increased under GHI  DFID & BMGF exert leadership, sponsoring 1 st ever Summit  Attention focused on high need/low income countries  Growing recognition of demographic/economic in addition to rights and health rationale

4 High fertility correlates with low modern FP use (the two maps are nearly perfect negative images of each other) Total Fertility Rate (TFR) Modern Contraceptive Prevalence Rate (MCPR) No Data No Data Source: Population Reference Bureau. Population Data Sheet, 2011.

5 117 million women 86 million in More Developed Countries (MDCs) 31 million in Less Developed Countries (LDCs) Source: ”Adding It Up,” Guttmacher, 2012; Bongaarts, Population and Development Review, 1984; World Contraceptive Use 2011, UN Population Division, Modern contraceptive use worldwide has ↑ 6-fold over 50 years – and 20-fold in developing regions Developed Countries 797 million women 152 million in MDCs 645 million in LDCs Developed Countries Drivers of expanded contraceptive use:  Demand for smaller families + healthy timing/spacing of pregnancies  Improved access to family planning services  Wider range, safer, more effective and affordable method choice  Population growth (from 3 to 7 billion)

6 World Source: World Contraceptive Use 2011, UN Population Division, CPR = 63% LAPM share of all modern method use = 57% TFR = 2.4 Worldwide, there is a wide range of method use… …and there is a wide variation across and within regions.

7 Contraceptive method mix differs dramatically by subregion 7 MCPR = 70% LARC/PM share = 46% TFR = 2.1 MCPR = 54% LARC/PM share = 31% TFR = 1.5 MCPR = 52% LARC/PM share = 83% TFR = 2.7 MCPR = 23% LARC/PM share = 13% TFR = 5.1 Source: World Contraceptive Use 2011, UN Population Division, 2011.

8 Use + Unmet need = Total demand for FP Note: Unmet need is an indicator to track achievement of Millennium Development Goal 5, improving maternal health. Source: UN Population Division, 2012; World Contraceptive Use, Data for women married or in union. 24% 55% unmet need Modern method use

9 Many reasons for unmet need –  Complex (e.g., access barriers; fear of side effects; partner opposition)  More than just a “supply” issue  Rises with growing demand, i.e., in part is a marker of “success” Many reasons for unmet need –  Complex (e.g., access barriers; fear of side effects; partner opposition)  More than just a “supply” issue  Rises with growing demand, i.e., in part is a marker of “success” 867 million women want to avoid pregnancy  645 million using a modern method  99 million using traditional methods  123 million using no method 867 million women want to avoid pregnancy  645 million using a modern method  99 million using traditional methods  123 million using no method Unmet need for FP in Developing Countries: Key facts Source: “Adding It Up”, Guttmacher, 2012.

10 REGION Modern Method Use (MCPR) Women Using Modern FP (millions) Unmet Need Modern FP (%) Women with Unmet Need for Modern FP (millions) Proportion of Total Demand Being Met (%) Developing Countries55%645 M19%222 M74% Asia62%515 M17%141 M79% Eastern Asia88%267 M3%16 M94% Central Asia52%6 M19%2 M75% South Asia46%163 M 24%83 M66% Southeast Asia56%64 M20%25 M72% Western Asia34%14 M35%14 M50% Source: UN Department of Economic and Social Affairs, Population Division. World Contraceptive Use, Data for women married or in a union. Modern method use, unmet need for modern FP & proportion of demand being met, by region – Part 1

11 REGION Modern Method Use (MCPR) Women Using Modern FP (millions) Unmet Need Modern FP (%) Women with Unmet Need for Modern FP (millions) Proportion of Total Demand Being Met (%) Africa25%51 M28%59 M46% Northern Africa45%16 M21%8 M67% Southern Africa58%9 M16%2 M82% Eastern Africa27%17 M 32%20 M46% Western Africa9%7 M30%19 M27% Middle Africa7%2 M37%10 M17% Latin America & Carib66%80 M19%23 M78% South America70%58 M17%16 M78% Central & Caribbean61%22 M20%7 M76% Source: UN Department of Economic and Social Affairs, Population Division. World Contraceptive Use, Data for women married or in a union. Modern method use, unmet need for modern FP & proportion of demand being met, by region – Part 2

12 At the country-level, variations are more wide-ranging Modern contraceptive use ranges widely, from 5-57 percent. In most countries, less than half the demand for modern FP is being met. For every woman using modern FP, one to five women have unmet need. Modern contraceptive use ranges widely, from 5-57 percent. In most countries, less than half the demand for modern FP is being met. For every woman using modern FP, one to five women have unmet need. Source: DHS 80% 70% 60% 50% 40% 30% 20% 10% 0% Source: DHS

13 Contraceptive use in Africa much lower among poorest quintile Source: Demographic and Health Surveys. Adapted and updated from L. Dougherty, “Healthy Timing and Spacing of Pregnancy,” Knowledge Management Services Project Poorest quintile Wealthiest quintile

14 London Summit commitments can reduce disparities Source: Global Population Assistance Report , 1994 (for period), UNFPA; Financial Resource Flows for Population Activities in 2009 ( data adjusted to align with GPAR categorization), UNFPA; data for estimated drawing upon London FP Summit, 2012 commitments. “Adding It Up,” Guttmacher, 2012 FP2020 goal of extending family planning to 120 million new users Translates to: 14 million fewer abortions 43,000 fewer maternal deaths 600,000 fewer infant deaths As well as many other family, community, and national benefits Key to meeting 8 MDGs

15 Thank you 15 “Family Planning 2020 (FP2020) is a global partnership that supports the rights of women and girls to decide, freely and for themselves, whether, when, and how many children they want to have. FP2020 works with governments, civil society, multi-lateral organizations, donors, the private sector, and the research and development community to enable 120 million more women and girls to use contraceptives by 2020.” -- FP2020 website


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