Underuse of modern methods of contraception: underlying causes and consequent undesired pregnancies in 35 low- and middle-income countries

Posted by Share-Net NL on February 17, 2015 at 6:50 am

Every year, when 123 million women experience pregnancy as a harbinger of happiness, many of the remaining 87 million face it with dismay. The World Health Organization (WHO) reports that, after becoming pregnant without intention, many of these women are presented with a stark set of scenarios: risk of death, disability and lower educational and employment potential (WHO, 2005). Reducing the number of unintended pregnancies could avert 60% of maternal deaths and 57% of the child deaths (WHO, 2014). As undesired pregnancies affect poor and vulnerable populations disproportionately, access to essential contraceptive commodities remains a great concern to redress global inequity. Furthermore, many undesired pregnancies end in induced abortion (Cleland and Ali, 2004).

In 2000, 189 nations, by adopting the United Nations Millennium Declaration, pledged to free people from extreme poverty and multiple deprivations. From this declaration emerged eight Millennium Development Goals (MDGs) (United Nations, 2000). It was agreed that family planning contributes to sustainable development, health and well-being of mothers, their children and gender equity (Van Braeckel et al., 2012). In 2005, the Member States added ‘achieve universal access to reproductive health’ to MDG 5 (WHO, 2014); despite pledges, MDG-5 is the most off-track MDGof all (WHO, 2013a,b). Although contraceptive prevalence shows an upward trend and unmet needs show a downward trend globally, the absolute number of married women who either do not use contraception or who have an unmet need for family planning is projected to grow. This indicates that increased investment is necessary to meet the demand for contraceptive methods worldwide (Alkema et al., 2013; Darroch and Singh, 2013). To accelerate the achievement of MDG 5 by expanding access to contraceptives, global initiatives have been revitalized (e.g. Family Planning 2020, International Conference on Family Planning, ICPD beyond 2014), which aim to improve the political and funding climate. This intensified global momentum to expand access to contraceptives could be an opportunity for reproductive health programmes in resource-limited settings.

Method failure leading to pregnancy is common among reversible methods of contraception. During the first year of contraceptive use, 25–27% women stop using ‘calendar’ and ‘withdrawal’ methods due to unintended pregnancy, 15% stop using male condoms, 8% oral contraceptives, 3% injectable, 2% lactational amenorrhea method (LAM) and 0.2% intrauterine devices (IUDs) (Trussell, 2007). Women, especially those with low education, often switch to less-effective traditional methods of contraception (Ali and Cleland, 2010). This has slowed progress in attaining MDG 5(Ali et al., 2012).

This study quantifies the relationship between undesired pregnancies and contraception: effectiveness of modern methods (MM) of contraception compared with traditional methods, non-use of contraception and the underlying reasons for not using contraceptives. The study results aim to target actions to improve utilization of effective contraceptive methodologies.

Author: Saverio Bellizzi, Howard L. Sobel, Hiromi Obara, Marleen Temmerman
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