New Study Reveals Increasing Unmet Need for Family Planning in the World’s Poorest Countries

Elizabeth Futrell

JHU∙CCP | Technical Writer

A new study by the Guttmacher Institute and the United Nations Population Fund (UNFPA) reveals that the efforts of global family planning programs fall far short of what is needed to effectively address unmet need for family planning in the developing world. The authors of Adding it Up: Costs and Benefits of Contraceptive Services—Estimates for 2012 estimate that the level of unmet need for contraception—defined as the number of fecund, sexually active women who wish to avoid pregnancy but are not using modern contraception—fell only slightly from 226 million in 2008 to 222 million in 2012. Alarmingly, in the world’s 69 poorest countries—home to 73% of all women with unmet need—the number of women with unmet need for contraception has actually increased from 153 million to 162 million since 2008.

Woman Unmet Need 1

A smiling woman in Stone Town, Zanzibar, Tanzania.  © 2011 Arturo Sanabria, Courtesy of Photoshare

While the number of women in the developing world using modern contraceptive methods rose from 603 million to 645 million between 2008 and 2012, a closer look at these numbers reveals that more than half of this increase is due simply to population growth rather than to a higher contraceptive prevalence rate (CPR). CPR increased more noticeably during this time period in Eastern Africa (from 20% to 27%) and Southeast Asia (from 50% to 56%) than in Western Africa and Middle Africa, where little change was observed and fewer than 10% of married women currently use modern contraceptive methods.

Yet across the world, governments, donors, multilateral organizations, NGOs, and many others are working tirelessly to improve access to family planning services for people who want to space or limit future pregnancies. Global conferences and summits are being held to bolster funding, highlight cutting-edge research, and share best practices for ensuring that people who want to use modern contraceptive methods—particularly those in low-resource settings with limited access to health services—receive quality family planning services. Innovative service delivery models like community-based access to injectables and family planning and HIV services integration are allowing more women to access their preferred contraceptive methods. And new twists on existing contraceptive methods such as Sino-implant (II)® Implants and depo-subQ in UnijectTM are being developed to meet the diverse needs of women around the world.

Given these efforts, why are so many women’s needs for contraception still unmet? Among the many barriers to family planning are affordability, access, cultural preferences for larger families, misinformation or fears about contraceptive methods and their side effects, and funding shortages. The world saw less financial and political support for family planning programming over the past two decades than it did in previous years for a number of reasons. In many parts of the world, funding that would have been allocated to family planning was instead dedicated to HIV/AIDS. In some countries, family planning was stigmatized by coercive population control measures such as forced sterilization. In other places, cultural and religious beliefs have eroded support for modern contraceptive use. For example, in 2002, the conservative Bush administration withdrew U.S. funding from the United Nations Population Fund (UNFPA), which was only recently reinstated by the Obama administration.

Woman Unmet Need 2

A woman in Stone Town, Zanzibar, Tanzania. © 2011 Arturo Sanabria, Courtesy of Photoshare.

As a result of these and other barriers to family planning, 80 million unintended pregnancies will occur in the developing world this year. Of these pregnancies, 30 million will end in unplanned birth, 40 million in abortion, and 10 million in miscarriage. Nearly 300,000 women in developing countries will die from pregnancy-related causes this year; nearly one-third of these pregnancies will have been unintended.

Filling the current unmet need for family planning would result in notable economic and environmental benefits, which will be reviewed in a new series in The Lancet, whose July 2012 publication will coincide with the London Summit on Family Planning. In addition, there would be

  • 54 million fewer unintended pregnancies
  • 26 million fewer abortions (including 16 million fewer unsafe abortions)
  • 7 million fewer miscarriages
  • 79,000 fewer pregnancy-related maternal deaths
  • 1.1 million fewer infant deaths

Meeting this unmet need will require the removal of cultural, geographic, economic, social, educational, physical, and political barriers. But if we fail to meet this need for family planning, we will need to address a multitude of resulting health, social, environmental, and economic challenges.

For a detailed analysis, read the full report: Adding it Up: Costs and Benefits of Contraceptive Services—Estimates for 2012.

For a summary of key findings, read the two-page brief: Costs and Benefits of Investing in Contraceptive Services in the Developing World.



Thanks for a clear discussion of unmet need for FP.  I'd like to add a footnote to point out that this need is not static at 222 million women.  Unmet need is going to soar as the population bulge of adolescents reaches age 18. Forty percent of the total populations in Malawi and Rwanda, for example, are less than 15 years old.  We need to focus on reaching adolescents now if we are to reduce unmet need in the future.

Adrienne, that's an excellent point. Earlier this month, the Interagency Youth Working Group (IYWG) published a post on their blog, Half the World, titled Myths and Truths: Family Planning for Girls. This post sheds light on the real situations and contraceptive needs of adolescents, including very young adolescent girls ages 10-14. The author also discusses some of the misconceptions around, and barriers to, access to family planning services for adolescents.

The IYWG is also hosting an online discussion forum today, February 28, titled Girl Centered Programming: What Are We Really Doing? The purpose of this e-forum is to discuss the importance of a multisectoral approach that includes sexual and reproductive health as well as other components to improve outcomes among adolescent girls as well as to share and exchange knowledge across countries to inform and transform practice in this area.

Please consider joining the discussion!