Despite the strong evidence that increasing contraceptive use accelerates development, 345 million of the 1.9 billion women aged between 15 and 49 in the world may be regularly exposed to the risks of sex without contraception. First, 226 million (18%) of all married and partnered women are in need of modern contraception, according to a recent study. Assuming 18% of the 665 million single women and girls also have an unmet need for modern contraception, the total pool of unprotected women in the world rises by 120 million to 345 million – close to 20% of all women aged 15 to 49 years.
Global contraceptive initiatives like Family Planning 2020, studies like the 2012 Lancet Family Planning Series and databases like World Contraceptive Use underestimate the size of the population of exposed women because they focus on married and partnered women. As a result, much less is known about the contraceptive status of unpartnered women and girls. It is highly likely that these women face both a higher demand for contraception and greater barriers to accessing it, due to the stigma of sex and pregnancy before marriage that remains in many countries. This places single women at a higher risk of unplanned pregnancy compared to their married and partnered peers. Assuming 18% unmet need for modern contraception among single women may be a significant underestimate.
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 four in 10 women will experience partner violence in their lifetimes, according to the World Health Organization (WHO). 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 almost all of the largest populations of unprotected women and girls are in Asia and Africa. India is home to an estimated 68 million women and girls with an unmet need for modern contraception, Pakistan to 15 million, Nigeria to 11 million, Indonesia to 10 million, the Philippines to 10 million, Bangladesh to eight million, the Democratic Republic of Congo to eight million, China to seven million and Ethiopia to seven million. The only non-Asia or African country in the top ten is the USA, home to seven million women and girls with an unmet need for modern contraception. Together, these countries account for 150 million (44%) of the estimated 345 million exposed women and girls.
Of special concern are the large populations of unprotected women and girls in the countries with extremely low modern contraceptive use (<25%), high fertility rates (more than five children per woman), and high adolescent birth rates (over 100 births per 1,000 15 to 19-year-old girls). In addition to Nigeria and the Democratic Republic of Congo, Niger, Somalia, Mali, Chad, Angola, Côte d’Ivoire and Cameroon fall into this category. Increasing modern contraceptive use in all of 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 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.