Despite the strong evidence that increasing contraceptive use accelerates development, an analysis of United Nations data reveals that as many as 40% of the 1.8 billion women aged between 15 and 49 in the world today may be regularly exposed to the risks of unprotected sex, including pregnancy. Currently an estimated 800 million married and partnered women aged between 15 and 49 use contraception. Of the remaining 1 billion, 225 million are married and partnered and in need of contraception. The remaining 775 million are single women and girls, the majority of whom are likely to be sexually active but who are not currently counted in official measures of demand for contraception. If we estimate that contraceptive use among these women and girls is 27% (half the global average of 55%), 570 million would be exposed increasing the total pool of unprotected women in the world to an estimated 791 million, or more than 40% of all women aged 15 to 49 years.
Because the focus of global contraceptive initiatives (e.g. Family Planning 2020), studies (e.g. 2012 Lancet Family Planning Series) and databases (e.g. World Contraceptive Use) is on married and cohabiting women, the official measures of contraceptive coverage overestimate prevalence and underestimate demand because they exclude a very large group of single women and girls from measurement. Much less is known about the contraceptive status of single women and girls but it is highly likely that in lower and middle income countries they face even greater barriers to using contraception and are at a higher risk of unplanned pregnancy compared to their married and partnered peers.
Further, single women and girls may be at greater risk of unwanted pregnancy from forced or coerced sex as rates of sexual violence are high in many low and middle income countries. According to the WHO, almost 4 in 10 women in Africa and South Asia will experience partner violence in their lifetimes, and a Lancet study from Swaziland found that 33% of girls experienced an incident of sexual violence before they reached 18 years of age. The US Centers for Disease Control and Prevention has found similarly high rates of forced sexual activity for girls in Kenya, Tanzania and Zimbabwe. We should not underestimate the pregnancy risks to women and girls in societies with low contraceptive use and high rates of sexual violence.
It is of great concern then, that the largest populations of unprotected women and girls live in lower and middle income countries, especially India, China, Pakistan, Nigeria, Indonesia, Brazil, Bangladesh, Mexico, and Ethiopia, home to an estimated 400 million exposed women and girls or half the global total. Of particular concern are the unprotected populations of women and girls in the countries with extremely low (<20%) modern contraceptive use, high fertility rates (more than 5 children per woman), high adolescent birth rates and low high school attendance rates for girls. Niger, Mali, Somalia, Chad, Burundi, Nigeria, Angola, the Democratic Republic of Congo, Uganda and Burkina Faso top the list and increasing modern contraceptive use in these countries could yield major national and regional development returns including increased economic growth, reductions in poverty and inequality, and improvements in maternal and child health and education.
Further, due to the “youth bulge” in many of these countries, increasing contraceptive use could also deliver a long-term “peace and security dividend”. By 2030 the number of young men (15 to 29 years) in many fragile countries will have increased dramatically including in Niger (99%), Mali (70%), Somalia (59%), Chad (61%), Burundi (55%), Nigeria (58%), Democratic Republic of Congo (50%), and Uganda (65%). The rising numbers of young men many of whom will come of age during period of rising unemployment and rapid urbanization, could become a potent force for conflict and insecurity.