Increasing women’s access to modern contraceptive methods alone will not satisfy their unmet need for contraception, according to "Reasons for Contraceptive Nonuse Among Women Having Unmet Need for Contraception in Developing Countries," a new study by Gilda Sedgh and Rubina Hussain of the Guttmacher Institute. The most common reasons married women give for not using a contraceptive method—despite wanting to avoid a pregnancy—have less to do with whether they can obtain contraceptives and much more to do with concerns about possible health risks and side effects or their belief that they don’t have sex frequently enough to warrant using a method.
Among married women who were not using contraceptives, on average 4-8% of those in Asia, Africa and Latin America attributed their non-use to lack of access. However, in a few countries, lack of access was a significant barrier. This reason for nonuse was cited by 18–23% of women in Benin, Cameroon, Congo-Brazzaville, Côte d’Ivoire and Guinea, and by 17% of women in the Philippines (more than twice the proportion of women in any other Asian country).
The researchers found that 23–28% of married women in all three regions who had an unmet need for contraception said they were not using a method because they had experienced or were worried about side effects or health risks. These concerns were especially prevalent in Southeastern Asia (36%) and Eastern Africa (32%). Concerns about side effects and health risks were significantly more common in countries with high levels of unmet need than in countries with the lowest levels of unmet need.
The study, which analyzed data from the most recent Demographic and Health Surveys of 51 developing countries, found that approximately one-third of married women seeking to avoid pregnancy in Latin America and Asia and one-fifth of such women in Africa reported that infrequent sex was a primary reason for nonuse. In Asia, nonuse for this reason is becoming more common and was especially prevalent in Nepal (73%) and Bangladesh (58%). The authors suggest that an increase in the number of couples who live apart because of labor migration might help explain this phenomenon.
"There is a pressing need to further strengthen family planning services to ensure that they provide women with counseling on their risk of pregnancy, with information on possible side effects and health risks of specific methods, and with a wide range of methods to choose from," said Sedgh. "The findings also highlight the need for investment in new technologies that better address the concerns and needs of women—including methods with fewer side effects that are easily used by women who have sex infrequently."
A substantial number of women across the developing world (an average of 14–19% in the three regions) reported that they were not using contraceptives because they had recently given birth or were breast-feeding. Exclusive breast-feeding is considered an effective method of contraception if the woman has given birth within the last six months and has not resumed her menstrual cycle. However, in 43 of the countries studied, fewer than half of the women who cited breast-feeding as their reason for nonuse met these conditions.
"These findings come at a critical moment, as the international community and national governments increasingly recognize that meeting women’s contraceptive needs not only promotes their health and well-being, but also enhances gender equity, reduces poverty and strengthens societies," said Susan Cohen, Acting Vice President for Public Policy at the Guttmacher Institute. "The study provides key insights from women themselves that should guide future investments, policies and programs to enable more women to meet their childbearing goals and more countries to meet their development goals."
"Reasons for Contraceptive Nonuse among Women Having Unmet Need for Contraception in Developing Countries," by Gilda Sedgh et al., is currently available online in a special issue of Studies in Family Planning.