The ability to control fertility is a woman’s most essential tool...

to influence the quality of her own life and the life of her child/ren. By giving women the freedom to determine if, when, and how many children they will have, contraception is a powerful tool to improve health, education, and employment, and increase investments in children. Nations also benefit when women are healthy and engaged in paid work, and when families can invest more in education. But of the estimated 2 billion women aged between 15 and 49 in the world, less than half (48%) are currently using modern contraception. This leaves more than 1 billion women unprotected. The subset of these 1 billion women who want to use modern contraception, and there are various estimates about the size of that pool, and even those who don't, are routinely exposed to the many risks of unprotected sex, including the health, education, and economic risks associated with pregnancy and high fertility rates.

As 70% of these unprotected women live in just 20 countries, including India, China, Pakistan, Nigeria, Indonesia, USA, Ethiopia, Bangladesh, the Philippines, Brazil, Russia, the Democratic Republic of Congo (DRC), Mexico, Egypt, Türkiye, Japan, Iran, Viet Nam, Tanzania, and Sudan, their ability to control their own fertility has implications for global economic and social development. Further, in the countries with extremely low (<20%) modern contraceptive use and high fertility rates (more than five children per woman), including Niger, Somalia, Chad, the DRC, CAR, Mali, Angola, Nigeria, and Burundi, increasing contraceptive use 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. Due to the “youth bulge” in many of these countries and the rising populations of young men with limited opportunities, increasing contraceptive use could also deliver a long-term peace and security dividend.

In recognition of the economic and social costs of high fertility to individual women, their families, and nations, countries should institute a new measure of women’s freedom to pursue their full potentials - the Child Dependency Ratio - the ratio of dependent children (<15 years) to women of working age (15 to 49 years). They should seek to achieve a Child Dependency Ratio of <1 by 2025 and <0.8 by 2030. This would assist high-population countries with low contraceptive coverage and high Child Dependency Ratios (e.g., India, Pakistan, Nigeria, Indonesia, the Philippines, the Democratic Republic of Congo, and Ethiopia) and also the smaller population countries struggling with extremely low rates of modern contraceptive use, high fertility rates, and high teen pregnancy rates, including Niger, Somalia, Chad, Mali, and Angola.

The United Nations (UN), its agencies, and development partners should include the Child Dependency Ratio as a specific indicator in the Sustainable Development Goals (SDGs), alongside the more traditional indicators of contraceptive prevalence, unmet need for modern contraception, and the fertility rate. The UN should also ensure that all of its member states and agencies understand that fertility control is central to women’s freedom to lead healthy, productive lives and to the economic and social development of nations, especially low-income nations with very high fertility and early marriage rates and very low levels of educational attainment among women and girls. The ultimate goal of the Child Dependency Ratio is to reduce fertility rates to the levels required for the achievement of the SDGs.

Updated January 2024