A Review of Literature on Global and Regional Contraception and Safe Abortion Trends (2015-2020)



Contraception and Abortion

Executive Summary

Contraception and safe abortion are key components of sexual and reproductive health and rights. They are essential and critical sexual and reproductive health services that save lives and provide women, girls and communities the chance to live a life of dignity and wellbeing. Despite wide evidence of the multiple health, socioeconomic and environmental benefits of contraception and safe abortion, access to services and supplies in these two areas remains an urgent public health issue in various parts of the world. As part of Share-Net’s Contraception and Abortion Community of Practice (CoP), this review seeks to inform practitioners, researchers, activists and policy-makers working around contraception, safe abortion and SRHR at large about current global and regional contraception and abortion trends, the major policy and financing dynamics around these areas for the 2015 – 2020 period. This report also has the goal of presenting promising practices and recommendations to increase and expand access and uptake of contraception and safe abortion.

Contraception and Abortion estimates and trends

  • As of 2019, there were 218 million women in developing regions with an unmet need for modern contraception, meaning that they want to prevent a pregnancy but are not using modern contraceptive methods. These women account for 77% of the 111 million unintended pregnancies occurring each year in developing regions.
  • Adolescent women account for 6% (14 million) of all women in reproductive age with an unmet need for modern methods.
  • An estimated 56 million abortions take place each year. Approximately 31 million are safe, 17 million less safe and 8 million least safe. Almost all less safe and least safe abortions (97%) take place in developing regions.

The policy and financing landscape around contraception and abortions services and supplies

Multiple actors and stakeholders shape and influence international policy and funding around contraception and safe abortion. The US is the single largest donor to family planning and contraceptive supplies and has a significant impact on the dynamics of this landscape. The reintroduction and radical expansion of the Global Gag Rule (GGR) in 2017 by the Trump-Pence administration is jeopardizing global progress around SRHR goal by cutting back the benefits from family planning and reproductive health programmes financed by the US. The 2015-2020 period has also seen a revival in the interest from donors in the areas of contraception and safe abortion. EU countries and Canada, for example, are taking the leading role in pushing for global progress and support towards sexual and reproductive global health targets. They have made commitments following pledges as part of initiatives such as the FP2020, the GFF and SheDecides, and have increased international policy focusing on SRH/FP. The European donor community has also been a prominent champion for the inclusion and monitoring of SRH/FP in the SDGs, especially within the framework of Universal Health Coverage (UHC). However, significant sustained efforts and resources are required to address current funding gaps and increase access to high-quality contraception and safe abortion services and supplies, especially for those who have the greatest needs.

The impact of the new Global Gag Rule: A disheartening outlook for sexual and reproductive health and rights

There is no evidence supporting the effectiveness of the GGR in decreasing abortion rates. Instead the GGR goes contrary to its stated purpose: by reducing access to contraception and family planning services, it then increases the number of unintended pregnancies and (unsafe) abortions. This harmful policy puts ideology before evidence, and rather than protecting life it endangers the right to health, well-being and bodily autonomy of millions across the world. The effects of this dangerous anti-abortion policy are far-reaching and they disproportionately impact women, girls and vulnerable, under-served populations who already face systematic barriers in accessing contraceptive and safe abortion care and other essential sexual and reproductive health services. Although it is still difficult to quantify the full impact of the current GGR, the literature indicates that adolescents, LGBTQI+ people and sex workers have been severely affected by the policy. Mainly, the GGR is aggravating existing barriers to access and increasing economic vulnerability, eroding safe spaces, disrupting SRH services and emboldening anti-SRHR, anti-LGBTQI+ and anti-sex work sentiment.

Future directions

The recommendations arising from this literature review of contraception and abortion are as follows:


  • Improve and expand data collection on adolescents, particularly young adolescents (10-14 years), as most of the literature only include information for married or older women.
  • Improve and expand data collection on abortion estimates. Current abortion data tends to be limited and estimates available have significant rates of underreporting and inaccuracy.
  • Continue monitoring, documenting and publishing the impact of the GGR.
  • Research new developments in contraceptive technologies that can expand contraceptive choices, thereby addressing many concerns that currently discourage people from using a method.


  • Addressing funding gaps through collaboration between national governments, NGOs, donors, and the individuals receiving care.
  • Mobilize political support in the US to permanently end the GGR through the Global HER Act.
  • For policy-makers and donor governments, avoid applying conditionalities on development funding for health, including counter-conditionalities intended to respond to the GGR.
  • Donor governments should include SRHR as part of their international aid policy and funding for UHC in developing countries. The mantra should be ‘there is no UHC without SRHR’”.


  • Advance advocacy and mobilization efforts to increase access to contraception and safe abortion by findings avenues to advocate in partnership with other initiatives, such as the Global Fund to Fights Aids, Tuberculosis and Malaria. This could be good approach to improve services and stigma reducing strategies for LGBTQI+ people.
  • Improve service delivery environment by prioritizing programmes that benefit under-served and vulnerable populations.
  • Within Share-Net, examine whether combined strategies and work from the different Communities of Practice (CoPs) are addressing contraceptive and safe abortion access for all, including strategies to ensure that the most vulnerable groups can access these services.


The year 2020 marks a critical time to take stock of progress and shortfalls towards achieving UHC and other health-related SDG targets by 2030. Sexual and reproductive health is a key element of UHC, and this of course includes access to contraception and safe abortion. Current trends show that despite significant progress, millions of women and girls across the world are still deprived from the right to decide whether and when to have children.

Addressing unmet needs and gaps in contraception and safe abortion services and supplies in a comprehensive and efficient manner can only be achieved through the implementation of diverse, creative and sustained strategies. These should include advocacy and research, investments and financial commitments, and collaboration between donors, governments and civil society organizations focusing on various SRHR areas and populations.

Civil society organisations, funders, researcher and activists need to continue their strategic, deliberate and nuanced approaches to build on the recent successes to continue challenging the barriers which impede women, girls and individuals to control and make informed decisions about their fertility, health and wellbeing. Contraception and safe abortion are essential and life-saving health care and are fundamental rights for all people. This should be the norm rather than the exception, for every person, in every corner of the world.

To read the full report, please click here


We have also developed an infographic with the main findings and takeaways from the research which you can find  here

General Information:

  • Corporate Author: Share-Net Netherlands
  • Publication Year: 2020
  • To be published on country nodes: The Netherlands
  • This item is about these countries: Global
  • Theme: Contraception and Abortion