The percentage of married women or women in couples who use at least one contraceptive method has grown over the past two decades, from 55 percent in 1990 to 63 percent in 2010. But new projections suggest that the demand for modern contraception remains high: By 2015, 233 million women worldwide will have an unmet need for contraception, according to a United Nations study published Monday.
"The gains in contraceptive prevalence and the reduction in unmet need for family planning since 1990 are indeed significant," study author Dr. Ann Biddlecom, chief of the fertility and family planning section at the U.N. Population Division, told The Huffington Post. "But some parts of the world are still coping with high unmet need for family planning."
From 1990 to 2010, the unmet need for family planning -- or the percent of women who wish to postpone having a baby or avoid it altogether but who were not using any method of contraception -- dropped from 15 to 12 percent. The results of the contraception study -- based on numbers from available U.N. data on married or in-union women age 15 to 49, as well as mathematical modeling -- were published Monday in The Lancet. The study was conducted by researchers with the U.N. and the National University of Singapore.
The biggest gains in the percent of women using any form of contraception occurred in southern Asia as well as eastern, northern and southern Africa. However, in both central and western Africa, contraceptive use remained low: By 2010, fewer than one in five women used any method.
"The African region is often painted with a broad brush," Biddlecom said, noting that the study's results emphasize the very different paths followed by varied sections of the continent.
Overall, the new findings suggest there is a huge range in contraceptive use across the globe. In 2010, just 8 percent of married or cohabiting women in central Africa reported that they or their partner used a modern method of contraception, compared to more than 70 percent in parts of Asia, Europe and North America, including the U.S. Hormonal birth control pills, intrauterine devices, condoms, vaginal barrier methods, emergency contraception and male or female sterilization all constitute forms of "modern" contraception, while traditional forms include withdrawal and the rhythm method.
In an editorial accompanying the new study, John Cleland, a researcher in the department of population health at the University of London, wrote that the findings highlight the "glaring disparities" in contraceptive use around the world. Cleland, who did not work on the study but had reviewed it, argued that the expansion of community services in target areas is critical, but not more important than efforts to address hostility toward contraception as well as widespread perceptions that certain types of birth control can have adverse health effects.
The factors that limit the use of contraception vary from country to country, Dr. Daniel Grossman, vice president for research at Ibis Reproductive Health, a nonprofit focused on women's reproductive choices and health worldwide, told The Huffington Post. They include access barriers such as high costs and limited facilities offering family planning in a given area, in addition to women not knowing about the methods available to them, not liking those methods or facing opposition from their husbands and partners.
"Contraception is the single most cost-effective intervention that can reduce maternal mortality ... improve maternal and child health and help women and families achieve their desired family size," Grossman said.
Notably, the new study focused solely on women who are married or cohabiting, in part because they make up a large proportion of the women who are "at risk" for pregnancy and for whom decisions about contraceptive use are very relevant, Biddlecom explained. Additionally, in many areas -- particularly Asia and Africa -- surveys have been restricted to married women, although more data on unmarried, sexually active men and women is emerging.
"To extrapolate the study findings to unmarried women worldwide, you would have to assume that they make contraceptive use decisions in the same way as married women," Biddlecom said. "We'd rather not make [that] assumption and instead have plans to expand the model to include all relevant data on unmarried women."