Unmet Need For Contraception in African Women
By: Dr. Azuka Ezeike, MBBS, FWACS (Obstetrics and Gynaecology), MSc (Public Health), Freelance Medical Writer. Editorial and Medical review by the DLHA Team.
A group of African women seated at a health centre with their babies.
Highlights
- Around 25% of maternal deaths could be averted with the effective use of modern contraception.
- Many African countries report low contraceptive usage, directly correlating with high fertility and maternal mortality rates.
- Unmet need for contraception leads to increased risks for mothers and babies, including maternal deaths and under-five mortality.
- Lack of contraception contributes to educational limitations, economic disempowerment, and unsustainable population growth.
- Socio-cultural beliefs, gender dynamics, economic barriers, and healthcare system challenges hinder contraceptive use.
- Community advocacy, better access to services, and strong policy support are essential to addressing the unmet need for contraception
Introduction
Did you know that up to 25% of maternal deaths could be averted if all women wishing to avoid pregnancy could use modern methods of contraception?
Women with unmet need for contraception are those who are fertile and sexually active, who do not want any more children or want to delay the next child but are not using any method of contraception. [1] The concept is limited to women who are married or in consensual relationships.
Unmet need for contraception is an indicator that is used to evaluate the success of reproductive health programs. It helps to determine how a country's social condition and health system support women's intentions concerning the timing and the number of pregnancies. It shows the gap between a woman's reproductive intentions and her behaviour about family planning.
Most countries in Africa have low rates of contraceptive use. There is a direct relationship between the rate of contraceptive use and the high fertility rates, and maternal, newborn and child mortality rates recorded in these countries.
Statistics of Unmet Need for Contraception in Africa
According to the most recent data from the World Bank Group, the average percentage of African women aged 15-49 years using any form of family planning method is 33%. The figures are as high as 67% in Zimbabwe and as low as 4% and 7% in South Sudan and Somalia respectively. [2}
Data from the World Health Organization shows that in 2021, of the 1.9 billion women of reproductive age (15-49 years), 1.1 billion required family planning. Of them, 874 million used modern family methods, while up to 164 million had an unmet need for contraception. The numbers also revealed that approximately 65% of women of reproductive age worldwide used some form of family planning. Furthermore, as of 2022, only 58% of women in Sub-Saharan Africa had access to modern family planning methods. [3]
Every year, an estimated 74 million unintended pregnancies occur in developing regions, the great majority of which are among women using no contraception or a traditional method. [4]
According to the 2018 National Demographic Health Survey in Nigeria, only 17% of married women aged 15-49 years used a method of contraception while the unmet need for contraception among married women was 19%. [5]
Unmet need for contraception is usually higher in the uneducated, poor, rural dwellers when compared to the educated, better off and urban-dwelling women. [4]
Consequences of Unmet Need
Unmet need for contraception leads to too frequent and too many births. These could lead to:
The health risks can affect the mother, the baby or both.
To the mother
- Increased risk of anaemia and micronutrient deficiencies
- Risk of intimate partner violence and spousal neglect
To the baby
When births are not well-spaced and there are too many births, the children are not spared from the consequences. The health impact includes:
- Increased risk of under-five deaths
The socioeconomic effects of unmet needs for family planning extend beyond the individual to include the community and the nation. [3, 4] They include:
- Loss of educational opportunities
- Limitation of economic potential
- Unsustainable country population growth with pressure on natural resources
- Lack of economic development for the affected countries
Factors Contributing to Unmet Need for Contraception in Africa
The low contraceptive usage in Africa is due to several factors. These factors are linked to the traditional, cultural, social and economic climate in the continent. A study done in Ekiti state, Nigeria showed that the desire for more children, spousal disapproval and fear of side effects were the contributory factors to poor contraceptive use. [7]
I. Sociocultural/Religious Beliefs and Practices
- The number of children a man has in the African continent is considered a status symbol, thus multiple births are culturally encouraged.
- Children are also considered part of the workforce for farming and other related activities, hence the need to have as many as possible.
- There are also cultural misconceptions concerning some forms of family planning, such as permanent family planning methods.
- Misinformation about the side effects of family planning procedures dissuades some people from using family planning.
- Some religious sects forbid some types of contraception, resulting in a bias towards some methods of family planning.
II. Gender Dynamics
- The patriarchal nature of African society encourages imbalances in decision making and this may limit the ability of women to take reproductive health decisions.
- Spousal opposition to family planning is a major hindrance to contraception. [7]
- There is a widespread idea that family planning is for women, hence African males are hesitant to use family planning treatments such as condoms and vasectomy.
III. Economic and Educational Factors
Education and income are important social determinants of health. They lead to reduced access to family planning in the following ways:
- It reduces access to health literacy information and leads to reduced awareness of the available family planning methods.
- Lack of economic empowerment limits leads to the inability to access services especially where they have to be paid for. [8]
- Some African countries lack funds to provide free family planning services in the absence of donor funding.
IV. Healthcare System Challenges
Challenges at the healthcare delivery system level limit access to family planning services. Some of the challenges include:
- Poor quality of service and availability of reproductive health services in most locations in Africa, especially in rural areas.
- Unavailability of trained health workers in many localities.
- Unavailability of modern family planning methods in some health facilities.
- User and provider bias against some family planning methods. [3]
- Stock out of family planning commodities.
- Inconvenient family planning clinic schedules. This limits access, especially for women who have to travel long distances to access care.
V. Policy and Governance
- Poor funding of reproductive health programs.
- Unavailability of national policies on family planning.
- Non-revision of existing policies in line with current realities.
- Poor implementation of family planning programmes.
- Poor monitoring and evaluation of family planning processes and programs
Strategies to Address Unmet Need for Contraception in Africa
I. Community-Based Interventions
- Community advocacy on the need for girl child education.
- Community education and outreach programs to increase awareness of the need for family planning and change any negative perception. A study done in Tanzania showed that the perceptions of the benefits, effectiveness, and safety of contraception increased the chances of contraceptive use in women. [9]
- Community and religious leaders are major stakeholders in issues relating to women. As major opinion leaders, they should be carried along in the drive to refute the myths and misconceptions about family planning.
II. Improving Access to Services
- Family planning services should be located very close to the people to minimize transportation barriers. [9]
- There should be an improved supply of family planning commodities to give women a wide range of contraceptive options.
- Contraceptive services should be provided at low or no cost to override the economic barriers.
- Provision of family planning requires some technical skills. Therefore there is a need for training and retraining of health care staff to enable them to provide high-quality services.
III. Policy and Advocacy
- Access to contraception is a fundamental human right, efforts to expand access to family planning services must be led from a rights-based perspective.
- There is a need for political will to implement evidence-based guidelines provided by the WHO and other relevant agencies.
- Strengthening and redesigning the national family planning policies and disseminating them to the grassroots (primary health care facilities and communities) is crucial. [10]
- Well-designed programs that would address the underlying factors for non-usage of contraception should be put in place. [4]
- Increased advocacy for women’s reproductive rights and health by governmental and non-governmental organisations.
- Data-driven solutions based on regular demographic and health surveys are needed to enable targeted interventions.
Conclusion
When women do not want to get pregnant but yet do not have access to contraception, the consequence is usually unwanted pregnancy. The disastrous consequence of an unwanted pregnancy goes beyond the individual. It extends to the community and nation. Stakeholders should mutually work together to support and implement effective strategies to reduce the unmet need for contraception. This would promote healthier outcomes for women and their families.
References:
1. World Health Organization. The Global Health Observatory. Indicator metadata registry list. Unmet need for family planning (%). [Internet, n.d.]. Cited 2024 Jul 4. Available from here.
2. World Bank Open Data. Demand for family planning satisfied by modern methods (% age of married women with demand for family planning (by country). [Internet, n.d.]. Cited 2024 Jul 4. Available from here.
3. World Health Organization. Family planning/contraception methods [Internet, 2023 Sept. 5]. Cited 2024 Jul 4. Available from here.
4. Sedgh G, Ashford LS, Hussain R. Unmet need for contraception in developing countries: examining women’s reasons for not using a method. (Internet. 2016 Jun 21] Cited 2024 Jul 5; Available from here.
5. National Population Commission (NPC) (Nigeria) and ICF, International. Nigeria Demographic and Health Survey, 2018. NDHS. National. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF International; [Internet 2019 October]. Cited 2024 Jul 5. Available from here.
6. Health Think Analytics. The effect of lack of family planning and factors hindering it in Nigeria. [Internet, n.d.]. Cited 2024 Jul 5. Available from here.
7. Durowade KA, Omokanye LO, Elegbede OE, Adetokunbo S, Olomofe CO, Ajiboye AD, et al. Barriers to contraceptive uptake among women of reproductive age in a semi-urban community of Ekiti state, southwest Nigeria. Ethiop J Health Sci [Internet]. 2017 Mar 27(2):121–8. Available from here.
8. Population Reference Bureau [Internet, 2012 March 28]. Cited 2024 Jul 5. Unmet need for contraception: fact sheet. Available from here.
9. Kraft JM, Serbanescu F, Schmitz MM, Mwanshemele Y, Ruiz C. AG, Maro G, et al. Factors associated with contraceptive use in sub-Saharan Africa. J Womens Health (Larchmt) [Internet]. 2022. 31(3):447–57. Available from here.
10. Agyekum AK, Adde KS, Aboagye RG, Salihu T, Seidu AA, Ahinkorah BO. Unmet need for contraception and its associated factors among women in Papua New Guinea: analysis from the demographic and health survey. Reproductive Health [Internet]. 2022. 19(1):113. Available from here.
Related:
Birth control pills in Nigeria: Common Myths and Misinformation
Why Family Planning Is Essential To Nigerian Women of Reproductive Age
Published: July 9, 2024
© 2024. Datelinehealth Africa Inc. All rights reserved.
Permission is given to copy, use and share content without alteration or modification and subject to source attribution.
