“In 2010, 146 million (130-166 million) women worldwide aged 15-49 years who were married or in a union had an unmet need for family planning. 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 (876-922 million) in 2010 to 962 million (927-992 million) in 2015, and will increase in most developing countries.
Interpretation: Trends in contraceptive prevalence and unmet need for family planning, and the projected growth in the number of potential contraceptive users indicate that increased investment is necessary to meet demand for contraceptive methods and improve reproductive health worldwide.”
Seven in 10 women with unmet need in the three regions cite reasons for nonuse that could be rectified with appropriate methods: Twenty-three percent are concerned about health risks or method side effects; 21% have sex infrequently; 17% are postpartum or breast-feeding; and 10% face opposition from their partners or others.
In these three regions, the typical woman with reasons for unmet need that could be addressed with appropriate methods is married, is 25 or older, has at least one child and lives in a rural area.
In the short term, women and couples need more information about pregnancy risk and contraceptive methods, as well as better access to high-quality contraceptive services and supplies.
In the medium term, adaptations of current methods can make these contraceptives more acceptable and easier to use.
Investment in longer-term work is needed to discover and develop new modes of contraceptive action that do not cause systemic side effects, can be used on demand, and do not require partner participation or knowledge.
Overcoming method-related reasons for nonuse of modern contraceptives could reduce unintended pregnancy and its consequences by as much as 59% in these regions.
Our findings suggest that access to services that provide a range of methods from which to choose, and information and counseling to help women select and effectively use an appropriate method, can be critical in helping women having unmet need overcome obstacles to contraceptive use
I’d also note that because demand for contraception tends to increase with better education, we would expect demand to increase over time. If supply does not increase to meet this demand, then unmet need will increase.
Thanks, Matt. Sorry I was heading out earlier so didn’t have time to elaborate as much as I would have liked. When I say unmet need for contraception (UMC) is low, I meant proportionally—by 2010 it was just over 10%, and I would guess is significantly lower still now. Of course, 10% globally is still a lot of people, but these are presumably the hardest people to reach and it is not clear how cost-effective doing so would be—moreover, it seems clear that even if we did manage to reach those 10%, the abortion rate would hardly decline by that much—so it is a pretty limited strategy for reducing abortions, if it is effective at all.
Regarding the second paper, table 5 indicates that only 8% of women with UMC globally lacked access (including because of cost). Table 3 in the third paper shows similar. So it still seems that only a very small proportion of women globally—perhaps 1% in 2010 - have a UMC because of lack of access to contraception.
There probably are interventions which could increase contraceptive uptake—but I don’t think they are by any means simple, and they are not generally solving lack of access per se. The access is there, even if the relevant education or empowerment of women is not. As indicated in the rest of my previous post, even if this were solved, it is still not clear to me that it would reduce abortions, given the counterbalancing effects contraception promotion has on sexual behaviour and desired family size. It seems particularly doubtful that it would reduce abortions by a large amount.
You are right that as education increases, desired family size generally falls, and contraception demand will grow. But I don’t see that there is a significant risk of contraception supply failing anytime soon. Even under the Mexico City Policy, which was widely held to significantly impede access to contraception, contraceptive use in the affected countries (turquoise—unaffected countries in orange) rapidly increased:
This, I suppose, is relevant to the EA discourse on neglectedness—with the emphasis on contraception in international development circles, it seems unlikely that slightly trimmed down support for it is going to significantly impede it or significantly increase abortion rates. But I confess I am only really on the peripheries of EA so I might be outdated with the neglectedness stuff.
The final 3 links seem to suggest the opposite of what you’re claiming (though I guess it depends what you mean by ‘low’):
Firstly, “for low unmet need for contraception in developing countries: https://pubmed.ncbi.nlm.nih.gov/23489750/″
From the abstract of that paper:
2. Secondly “And for low proportion of unmet need attributable to lack of access: https://www.guttmacher.org/sites/default/files/pdfs/pubs/Contraceptive-Technologies.pdf″
From the Highlights section of that paper:
3. Thirdly: https://pubmed.ncbi.nlm.nih.gov/24931073/
I’d also note that because demand for contraception tends to increase with better education, we would expect demand to increase over time. If supply does not increase to meet this demand, then unmet need will increase.
Thanks, Matt. Sorry I was heading out earlier so didn’t have time to elaborate as much as I would have liked. When I say unmet need for contraception (UMC) is low, I meant proportionally—by 2010 it was just over 10%, and I would guess is significantly lower still now. Of course, 10% globally is still a lot of people, but these are presumably the hardest people to reach and it is not clear how cost-effective doing so would be—moreover, it seems clear that even if we did manage to reach those 10%, the abortion rate would hardly decline by that much—so it is a pretty limited strategy for reducing abortions, if it is effective at all.
Regarding the second paper, table 5 indicates that only 8% of women with UMC globally lacked access (including because of cost). Table 3 in the third paper shows similar. So it still seems that only a very small proportion of women globally—perhaps 1% in 2010 - have a UMC because of lack of access to contraception.
There probably are interventions which could increase contraceptive uptake—but I don’t think they are by any means simple, and they are not generally solving lack of access per se. The access is there, even if the relevant education or empowerment of women is not. As indicated in the rest of my previous post, even if this were solved, it is still not clear to me that it would reduce abortions, given the counterbalancing effects contraception promotion has on sexual behaviour and desired family size. It seems particularly doubtful that it would reduce abortions by a large amount.
You are right that as education increases, desired family size generally falls, and contraception demand will grow. But I don’t see that there is a significant risk of contraception supply failing anytime soon. Even under the Mexico City Policy, which was widely held to significantly impede access to contraception, contraceptive use in the affected countries (turquoise—unaffected countries in orange) rapidly increased:
This, I suppose, is relevant to the EA discourse on neglectedness—with the emphasis on contraception in international development circles, it seems unlikely that slightly trimmed down support for it is going to significantly impede it or significantly increase abortion rates. But I confess I am only really on the peripheries of EA so I might be outdated with the neglectedness stuff.
Interesting points! Thanks for taking the time to respond and clarify.