Meeting Demand for Family Planning
Family planning programs play a key role in providing information and services that help people make informed reproductive choices and use contraception safely and effectively.
Meeting Current Needs
Worldwide in 1998, 570 million couples were using contraception, according to an estimate by the United Nations (225). Family planning programs are meeting current demand better by expanding the range of contraceptive choices, reaching more clients in rural areas, providing empathic counseling, and addressing the concerns of their clients (122,272).
Nonetheless, according to a study of 20 developing countries in 1990, an average of 22% of all births are unwanted (28). This estimate is probably low because many parents do not want to acknowledge that a child was unwanted (254). Also, of the estimated 182 million pregnancies each year in developing countries, some 66 million–about 36%–are unintended. About 36 million of these are estimated to end in abortion (see Figure, opposite). Almost half of these induced abortions are unsafe (9,243).
Meeting unmet need. Millions of people who might be interested in family planning are not being served at all. In developing countries over 100 million married women of reproductive age–one woman in every five outside China–are estimated to have an “unmet need” for family planning (189). Unmet need, which is estimated from survey data, refers to married women who say that they would prefer to avoid or postpone childbearing but who are not using any method of contraception (254). Many sexually active unmarried women probably have an unmet need as well (55).
There are many reasons for unmet need and for unintended pregnancies. For instance, women and men often worry about side effects of contraceptive use. Other women lack accurate information about reproductive health or access to appropriate services. Family planning programs could address most of these reasons (29, 189). Such an effort, however, will require more financial support and stronger leadership commitment to the importance of avoiding unintended childbearing.
Serving contraceptive users better also could reduce the number of unintended pregnancies substantially (108). Many unintended pregnancies result from contraceptive failures, which are often caused by inconsistent or incorrect use (14). Offering counseling and choices helps clients use contraception correctly and consistently.
Worldwide over 350 million couples–more than one-third of all couples–do not have access to a full range of modern family planning information and services, the United Nations Population Fund (UNFPA) has estimated (224). As programs make more contraceptive methods available, more people are able to find methods that meet their needs (122).
Meeting Rising Demand
In developing countries the percentage of married couples using contraception has risen substantially, from less than 10% in the 1960s to 55% in 1998, and it continues to rise (1 72,225). Family planning programs have played a key role in this increase by turning “latent demand”–people’s desire to space and limit births–into actual demand for contraceptive information and services (69). In most developing countries many people have been able to space and limit their births because–and sometimes only because–widely supported family planning programs have provided contraception and made it increasingly understood, accepted, and accessible.
As contraceptive use has spread, the average number of births per woman has declined. Each 15% increase in contraceptive prevalence results in approximately one less birth per woman on average (190). Reflecting people’s growing interest in having fewer children, the number of births in developing countries has fallen from over six children per woman in the 1960s to about three children today (179, 227).
Improving access and quality. Programs help people use contraception by maximizing access to good-quality services (142). Good-quality care makes contraception safer and more effective by: offering a range of methods; informing clients fully about them, including side effects; screening clients for medical eligibility; helping clients choose for themselves methods that suit their own circumstances; showing clients how to use methods properly; and supporting clients when they encounter problems or decide to switch methods (122).
As quality improves and more methods become available, more couples use contraception. For example, for each additional method that is widely available in a country, contraceptive prevalence–the percentage of married women using contraception–increases by an average 3.3 percentage points, according to data from Demographic and Health Surveys (DHS) in 44 countries (18, 189).
Given a range of contraceptive methods and other good-quality care, virtually any person can find a method that is safe and appropriate (219,263). When used appropriately and correctly, family planning methods pose almost no health risk. Using contraception typically is much safer than giving birth. The average lifetime risk of dying from maternal causes worldwide is 1 in 60 and much higher in many developing countries (267). Use of modern contraception is rarely a cause of death (91).
Nor does contraception cause undesired permanent infertility, as some people incorrectly believe. Male and female sterilization are the only contraceptive methods that result in permanent infertility–which is their purpose. All other methods are temporary, as they are intended to be, and fertility returns either immediately or within some months after discontinuation of use (263).
Some contraceptive methods have positive health benefits in addition to those of preventing pregnancy. For example, condoms protect men and women from sexually transmitted infections (STIs) including HIV/AIDS. Combined oral contraceptives can reduce a woman’s risk of developing cancers, anemia, benign breast disease, ectopic pregnancy, and pelvic inflammatory disease (PID) (91).
Using contraception outside marriage. Contraceptive use outside marriage has been increasing as people marry later and more remain unmarried (8). In sub-Saharan Africa, for example, an estimated 8 million unmarried women ages 15-44 use contraception, and in Latin America, 10 million. Worldwide, as many as 60% of all condoms are used outside marriage.
In sub-Saharan Africa contraceptive use is much higher among sexually active unmarried women, at 37%, than among married women, at 15%. In Latin America almost three-fourths of sexually active unmarried women use contraception compared with two-thirds of married women (275). In Asia data on contraceptive use among unmarried women or men are scarce.
Ensuring A Human Right
Increasingly, governments around the world are embracing the concept of reproductive rights. The concept is reflected in national laws and international agreements.
At the 1994 ICPD in Cairo, 179 countries agreed to the Program of Action, which states that everyone has the right to “the enjoyment of the highest attainable standard of physical and mental health” and the right “to decide freely and responsibly the number, spacing, and timing of their children and to have the information and means to do so” (224). The ICPD program of action urges:
States should take all appropriate measures to ensure, on a basis of
equality of men and women, universal access to health-care services,
including those related to reproductive health care, which includes family
planning and sexual health. Reproductive health care programmes should
provide the widest range of services without any form of coercion. (224)
For over 20 years family planning has been widely recognized as a human right. To make the right to reproductive health a reality, however, requires national commitment (171).
Measuring Potential Demand for Family Planning
Among Married Women Country Developing Country
% Using Contraception 55%
% with Unmet Need(*) 20%(**)
(*) Want to avoid pregnancy but not using contraception
(**) Excludes China. If China is included, unmet need in developing countries averages 13% instead of 20%.
RELATED ARTICLE: KEY POINTS
As more people want family planning, will support for family planning programs keep pace? Support is needed because:
(1) Millions of people use family planning. Millions more probably would do so with better information and services.
(2) Demand for family planning is rising. Couples today want fewer children, and using modern contraception to space and limit births is becoming the norm.
(3) Reproductive health is a human right but not yet a reality. All people should have access to reproductive health care and be able to make informed choices, plan their births, and avoid unintended pregnancies.3
COPYRIGHT 1999 Department of Health
COPYRIGHT 2008 Gale, Cengage Learning