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Posted at 08:34 AM ET, 07/11/2012

World Population Day: Can women find birth control if they want it?

Around the world, 222 million women would like to avoid or delay pregnancy but lack access to contraception, according to the United Nations Population Fund. That number is one reason the UNFPA chose “reproductive health” as the theme for this year’s World Population Day.

Birth control “is a very controversial issue because very often people relate this to population control,” said Edilberto Loaiza, senior monitoring and evaluation adviser in the UNFPA. “But many women are being denied the right to decide freely when and how many children to have. That’s what it is about.”
A woman stands on the porch outside of the Centro Clinico Diagnostico in Jimani, Dominican Republic. ( Lauren Gilger - WALTER CRONKITE SCHOOL OF JOURNALISM)

Contraception was a popular item on the development agenda throughout the 1970s and 1980s. But it fell out of favor in the 1990s, when epidemiologists began to fear that AIDS would kill a catastrophic number of people, particularly in Africa, according John Bongaarts, vice president of the Population Council.

“But that didn’t happen,” Bongaarts explained. “In fact, the population of Africa continues to grow rapidly.”

And now, contraception is back in vogue as a potential way to ease environmental concerns, such as dwindling natural resources, especially in poor countries. Economic incentives also play a role, Bongaarts said, because fewer young children mean fewer schools and hospitals to build.

Providing contraceptive care in the developing world costs $4 billion annually and saves $5.6 billion in maternal and newborn health costs, according to a recent report released by the Guttmacher Institute and UNFPA. And a new study published by the Lancet this week found that contraceptive use prevents more than 270,000 maternal deaths from childbirth each year.

The report said it would cost another $4.1 billion per year to provide birth control to all in the developing world who want it. That investment would produce savings of $5.7 billion, the report said. It would slash the number of unintended pregnancies from 80 million to 26 million, reduce the number of abortions performed by 26 million, cut pregnancy-related deaths by 79,000 and eliminate 1.1 million infant deaths.

In time for a Summit on Family Planning in London this week, the Bill and Melinda Gates foundation unveiled a grant of hundreds of millions of dollars to improve access to contraception in the developing world.

“This is our moment in time to say this is a priority and we need to fund it,” Gates told Reuters.

Although more women are using contraception worldwide, the rate of increase is slowing, experts say. Each year between 2008 and 2012, 10 million more women began using so-called “modern” contraceptives, defined by the UNFP as virtually any birth control method other than withdrawal or the rhythm method. For the previous four years, the increase in the number of women using birth control was approximately 20 million per year, according to the UNFPA report.

Contraceptive use rose by 6 percent in Southeast Asia and 7 percent in Eastern Africa, but there was little change in other parts of Africa.

Although women in poorer countries are less likely to have access to contraception, there are some developing nations that saw gains in contraceptive use since 2000. The prevalence of birth control has increased rapidly in Rwanda, Malawi and Ethiopia, for example, but has remained essentially stagnant in India and Zimbabwe.


(Screenshot: UNFPA)

The common denominator for increasing contraceptive use appears to be government buy-in for family planning programs, according to Bongaarts.

“The president of Uganda wants more Ugandans,” he said. “In places like Nigeria, there’s a rivalry between ethnic groups, so it’s hard to get a family planning program going.”

By comparison, health workers in countries like Ethiopia go door to door in villages and offer pills or birth control shots to women, Bongaarts said.

It also helps to have plenty of foreign donors.

“I was in Rwanda a few years ago, and what surprised me was the presence of the U.S. government there,” Loaiza said. “There were U.S. clinics in many areas, and they had clear targets in contraceptive use. If you had the same thing in other countries, you might get a similar result.”

***

Here is a regional breakdown of countries with the highest and lowest number of women aged 15-49 who are married or in committed relationships who use a modern method of contraception, according to a 2011 UNFPA spreadsheet:

 

Africa:

Highest: South Africa -- 60 percent

Lowest: Somalia -- 1.2 percent

 

Asia:

Highest: China, 84 percent

Lowest: Azerbaijan, 13.2 percent

 

Europe:

Highest: U.K., 84 percent

Lowest: Macedonia, 9.8 percent

 

Latin America:

Highest: Brazil, 77 percent

Lowest: Haiti, 24 percent

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By  |  08:34 AM ET, 07/11/2012

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