The Guttmacher Institute has released new, very promising, data in its 2017 iteration of Adding It Up: Investing in Contraception and Maternal and Newborn Health.[i] Namely, that despite the fact that the number of women of reproductive age (15-49) in the developing world continues to grow by an estimated 12 million every year, the number of women who have an unmet need for family planning in those regions has decreased from 225 million in 2014 to 214 million in 2017. Put a different way, because of an increase in women using modern contraceptive methods, the percentage of women in the developing world with an unmet need for family planning has declined from 15% to 13% in just three years—a commendable achievement on the part of international family planning efforts.
Opportunity for Further Progress
The fact that 214 million women still say that they don’t want to become pregnant in the next two years but are not using modern contraception means there’s still an obvious and straightforward opportunity to increase contraceptive prevalence and reduce fertility rates—without even addressing the preference for large families that exists in many less developed countries.
If the global donor community made a large enough investment in family planning, the benefits for women would be astounding. After all, the consequences of unintended pregnancies—especially in resource-poor settings—can be dire. More than 300,000 women lose their lives each year to pregnancy-related causes—47,000 of them from unsafe abortion. The Adding It Up authors estimate that meeting unmet need would reduce maternal deaths by 76,000 a year. That’s 76,000 women who could continue to be mothers, wives, daughters, sisters, aunts, friends, and members of the community—76,000 women who wouldn’t die because of pregnancies they didn’t want to experience in the first place.
It will probably come as no surprise that the highest proportion of women with unmet need reside in sub-Saharan Africa (21%), as that is the world region with the highest total fertility rate (4.75 children per woman). With one-fifth of women at risk of unintended pregnancy not using contraception, there’s no reason—besides development assistance falling short of need—that the fertility rate in sub-Saharan Africa can’t decline to a level commensurate with other developing regions.
For $6.3 billion a year, 671 million women in the developing world are currently using contraception—preventing 307 million unintended pregnancies each year. Doubling that investment to $11.9 billion (from all sources: developing country governments, development assistance, etc.) would cover the cost of providing contraceptive services to all women in the developing world who want them.[ii]
If all unmet need for modern contraception were satisfied in developing regions, each year:
- unintended pregnancies would decline from 89 million to 22 million,
- unplanned births would decline from 30 million to 7 million, and
- induced abortions would decline from 48 million to 13 million.
Unmet Need in the United States
There is no equivalent unmet need calculation for the United States, where 45% of pregnancies are unintended. Although the U.S. funds the Demographic and Health Surveys, the project that collects the data that allows researchers to calculate levels of unmet need in the countries that receive our foreign aid, neither the U.S. Census nor the American Health Surveys include questions about future pregnancy intentions.
In developing countries, an estimated 43% of pregnancies are unintended. With that being the case, could we assume that roughly 13% of American women have an unmet need for family planning as well? Or is the percentage of unintended pregnancies on par in the U.S. because of inconsistent or incorrect use of birth control? Without collecting the data, we can’t know.
What we do know is that voluntary use of modern contraception prevents unintended pregnancy, unsafe abortion, and maternal death. It’s an investment worthy of far more support than it currently receives—which is far more support than it will receive in the nearing years, at least from the United States, if Trump and his “pro-life” lackeys get their way. With his extreme Global Gag Rule, his elimination of aid to UNFPA, and his proposal to end all international family planning support, Donald Trump is telling those 214 million women with unmet need—and millions more who will lose their existing access to modern contraception—that “pro-life” doesn’t include their lives.
[i] Previous versions of the report were published in 2003, 2008, 2012, and 2014.
[ii] These cost figures were updated in accordance with a correction Guttmacher issued shortly after the report was published.