A reproductive revolution is spreading across much of the developing world. Use of effective contraception has risen rapidly, and fertility has been falling. But there is still a long way to go. More than one woman in every five wants to avoid pregnancy but is not using contraception.
That was the lead introduction in a Population Reports issue on “The Reproductive Revolution” from December 1992—more than 20 years ago.
Jump ahead to March 12, 2013, and a headline for a Lancet Commentary about an article appearing in the journal on contraceptive prevalence rates and unmet need for family planning reads: “The contraceptive revolution: focused efforts are still needed.”
The article (by Leontine Alkema, Vladimira Kantorova, Clare Menozzib, and Ann Biddlecom) and commentary (by John Cleland and Iqbal H. Shah) present detailed information about trends between 1990 and 2010 with projections to 2015 and reveal there is a long way to go to reach the Millennium Development Goal of achieving “universal access to reproductive health” by 2015. Although worldwide contraceptive prevalence rates increased during this 20-year period from 55% to 63%, and unmet need decreased from 15% to 12%, the authors write:
A young mother awaits health care at a clinic in Jos, Nigeria, amongst a crowd that has flocked to the newly established program.
© 2000 Liz Gilbert, Courtesy of Photoshare
- The absolute number of married women who either use contraception or who have an unmet need for family planning is projected to grow from 900 million in 2010 to 962 million in 2015, and will increase in most developing countries.
- Unmet need for modern methods will jump from 221,000 in 2010 to 233,000 by 2015.
- In 2010, an estimated 146 million married women (or those in a union) (aged 15-49) had an unmet need for family planning.
- In 2010, contraceptive prevalence was less than 20% (one woman in five) in 23 countries (all in Africa), and
- Unmet need exceeded 30% in 15 countries—12 of which are in Africa.
- Unmet need is particularly problematic in western and central Africa. For example, in Nigeria, the most populated country in sub-Saharan Africa, contraceptive prevalence has risen from 7% to only 14% in 20 years and unmet need has remained static at 21%.
- Of greatest concern are the Sahelian countries of Chad, Mali, Mauritania, and Niger, where the combined population is projected to increase threefold, from 45.6 million in 2010 to 131.9 million in 2050, which presents an impossible burden for fragile ecosystems.