Despite the strong evidence that increasing contraceptive use accelerates development, more than one half (52%) of the world’s 2 billion women aged between 15 and 49 are not using modern contraception. For the subset of women who are seeking to get pregnant, who are pregnant, or who have recently delivered, this is not a problem. But for the rest, lack of contraceptive protection means exposure to the risks of sex without contraception – unplanned pregnancy.
Estimates vary as to the size of the pool of women who want to use modern contraception but who currently don’t. Most of these estimates underestimate the need by focusing only on married and partnered women or women in low- and middle-income countries (e.g., the Guttmacher Institute‘s estimate of 218 million women in need of modern contraception), or they rely on self-reported survey data that only counts women who have been sexually active in the past four weeks (e.g., a recent Global Burden of Disease modeling exercise estimated 163 million in need of modern contraception).
As a result, global contraceptive access initiatives like Family Planning 2030, studies like the 2012 Lancet Family Planning Series, and databases like World Contraceptive Use have struggled to come to terms with the size of the pool of women and girls who want to use modern contraception. Too little is known about the contraceptive status and preferences of single women and girls. It is highly likely that these women face an even higher demand for contraception and greater barriers to accessing it – and even to self-reporting their need – due to the stigma of sex and pregnancy before marriage in many countries. This places single women at a higher risk of unplanned pregnancy compared to their married and partnered peers.
Single women and girls may also be at greater risk of unwanted pregnancy from forced or coerced sex. Rates of sexual violence are high across all regions, but especially in Africa and South Asia where more than one in three women will experience partner violence in their lifetimes, according to new estimates from the World Health Organization (WHO). And in these regions, one-third of girls will experience an incident of sexual violence before they reach 18 years of age, according to the Violence Against Children surveys supported by the Together for Girls initiative. We should not underestimate the pregnancy risks to girls and single women 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 are in Asia and Africa. India is home to 216 million women and girls who are not using modern contraception, China to 69 million, Pakistan to 50 million, Indonesia to 41 million, Bangladesh to 27 million, the Philippines to 23 million, and Viet Nam 14 million. The largest populations of unprotected women across Africa are in Nigeria (50 million), Ethiopia (23 million), Democratic Republic of Congo (19 million), Tanzania (12 million), and Sudan (11 million). Other countries in the top 20 include the USA, home to 31 million women and girls not using
modern contraception, Brazil (22 million), Russia (19 million), Mexico (17 million), Egypt (17 million), and Türkiye (14 million), Iran (14 million), and Japan (13 million). Together, these 20 countries account for 700 million (68%) of the estimated 1 billion unprotected women and girls.
Of special concern are the large populations of unprotected women and girls in the countries with extremely low modern contraceptive use (<20%) and high fertility rates (more than five children per woman). In addition to the Democratic Republic of Congo mentioned above, Niger, Central African Republic, Somalia, Chad, and Mali all record ratios above 2. In these countries, increasing modern 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.
Further, due to the “youth bulge” in many of these countries increasing modern contraceptive use could also deliver a long-term “peace and security dividend.” By 2030 the number of young men (15 to 29 years) will have increased by more than 50% in most of the central and west African countries. The rising numbers of young men, many of whom will come of age during a period of high unemployment and rapid urbanization, could become a potent force for conflict and insecurity.