1. International Family Planning Conference
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. International Family Planning had been recently revitalized
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.

3. International family planning: Three Eras
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
Era One:
Priority Attention
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
Era Two:
Growing Neglect
Growing attention and partnerships
USAID funding and attention increased under GHI
DFID & BMGF exert leadership, sponsoring 1st ever Summit
Attention focused on high need/low income countries
Growing recognition of demographic/economic in addition to rights and health rationale
Era Three:
Revitalization

4. Total Fertility Rate (TFR)
High fertility correlates with low modern FP use
(the two maps are nearly perfect negative images of each other)
Modern Contraceptive Prevalence Rate (MCPR)
Total Fertility Rate (TFR)
No Data
No Data
1 - 19
Source: Population Reference Bureau. Population Data Sheet, 2011.

5. Modern contraceptive use worldwide has ↑ 6-fold over 50 years – and 20-fold in developing regions
2012
Developed
Countries
Developed
Countries
117 million women
86 million in More Developed Countries (MDCs)
31 million in Less Developed Countries (LDCs)
797 million women
152 million in MDCs
645 million in LDCs
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)
Source: ”Adding It Up,” Guttmacher, 2012; Bongaarts, Population and Development Review, 1984; World Contraceptive Use 2011, UN Population Division, 2011.

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

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

8. Use + Unmet need = Total demand for FP
24%
55%
Modern method use
Modern method use
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.

9. Unmet need for FP in Developing Countries: Key facts
867 million women want to avoid pregnancy
645 million using a modern method
99 million using traditional methods
123 million using no method
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”
Source: “Adding It Up”, Guttmacher, 2012.

10. Modern method use, unmet need for modern FP & proportion of demand being met, by region – Part 1
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 Countries
55%
645 M
19%
222 M
74%
Asia
62%
515 M
17%
141 M
79%
Eastern Asia
88%
267 M 3%
16 M
94%
Central Asia
52%
6 M
2 M
75%
South Asia
46%
163 M
24%
83 M
66%
Southeast Asia
56%
64 M
20%
25 M
72%
Western Asia
34%
14 M
35%
50%
Source: UN Department of Economic and Social Affairs, Population Division. World Contraceptive Use, Data for women married or in a union.

11. Modern method use, unmet need for modern FP & proportion of demand being met, by region – Part 2
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 (%)
Africa
25%
51 M
28%
59 M
46%
Northern Africa
45%
16 M
21%
8 M
67%
Southern Africa
58%
9 M
16%
2 M
82%
Eastern Africa
27%
17 M
32%
20 M
Western Africa 9%
7 M
30%
19 M
Middle Africa 7%
37%
10 M
17%
Latin America & Carib
66%
80 M
19%
23 M
78%
South America
70%
58 M
Central & Caribbean
61%
22 M
20%
76%
Source: UN Department of Economic and Social Affairs, Population Division. World Contraceptive Use, Data for women married or in a union.

12. At the country-level, variations are more wide-ranging
80%
70%
60%
50%
40%
30%
20%
10% 0%
Unmet Need
Trad Method
Modern Method
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
Source: DHS

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

14. London Summit commitments can reduce disparities
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
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

15. Thank you
“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