Modern methods of birth control are increasingly prevalent, but demand outpaces their distribution.
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Worldwide access to all forms of birth control has generally increased since 1990, but needs are nowhere near met. By 2015, according to new data published by the United Nations Population division in The Lancet, 233 million women who wish to put off or prevent childbirth will not have the resources to do so -- the study only looked at married women, not men or sexually active, single men and women.
That lack of contraception may actual become more of a problem is not immediately apparent. Unmet need for contraception among married women worldwide actually decreased between 1990 and 2010, from 15 to 12 percent. And the prevalence of modern methods of contraception increased, from 55 to 63 percent.
The twist is that "need" is a subjective measure, interpreted as a woman's desire not to have a child within the next two years. As contraception becomes more prevalent, it also becomes more desired. As social norms regarding family planning change, unmet need actually increases, because more women decide they want to put off or stop having more children. In commentary accompanying the article, for example, it is pointed out that:
...the most marked increase in use, from 12 percent to 33 percent, has taken place in eastern Africa, largely because of greater government commitment and improved community-based services. However, unmet need in this subregion has decreased only modestly, from 30 percent in 1990 to 26 percent in 2010, indicating that increased need, stemming from sharp reductions in desired numbers of children, has almost matched increased use.
The study's authors developed a statistical model that accounts for this effect, and that they believe more realistically estimates the growing demand than past efforts to do so. Population growth, too, is factored into their analysis.
In the developing world, the authors project that an estimated 834 married women will wish to prevent or delay childbirth; 204 million will either have access to no contraception or will rely on "traditional" methods, like withdrawal or periodic abstinence. The unmet need in the developed world will comprise of 29 million women.
In some countries, the initial push for increased access and education has yet to come. In Africa, 23 countries still had less than 20 percent prevalence of contraception by 2010, and in 12 African countries, as well as in Yemen, Haiti, and Samoa, unmet need was over 30 percent. And the need for contraception among unmarried, sexually active women has yet to be systematically analyzed, but will likely contribute to demand.
The full study, "National, regional, and global rates and trends in contraceptive prevalence and unmet need for family planning between 1990 and 2015: a systematic and comprehensive analysis," is published in The Lancet.