The access to contraception around the world : situational analysis and current challenges

The universal accessibility to sexual and reproductive rights is one of the targets of the Sustainable Development Goals (SDGs). The 6th target of SDG 5 aims to "ensure universal access to sexual and reproductive health care and the ability of people to exercise their reproductive rights". This target follows on from the Programme of Action adopted at the International Conference on Population and Development in Cairo in 1994, and the Beijing Platform for Action adopted in 1995. Both recognize the importance of promoting universal access to sexual health services.

However, according to the World Health Organization, 164 million women of childbearing age did not have access to the contraception they needed in 2021.

On the one hand, access to contraception guarantees everyone the right to freely dispose of their body. Secondly, it helps reduce the risks of an unwanted pregnancy. In fact, by reducing the need for unsafe abortions and preventing maternal illness, contraception contributes directly to lowering the maternal mortality rate.

Despite the importance of the right to contraception in achieving health-related SDG 3, as well as gender equality SDG 5, there are still several reasons that prevent women from a free access to contraception.

Access to contraception around the world : milestones and key figures

• Among the 1.9 billion women of childbearing age (between 15 and 49) in the world in 2021 :

• 9% have unmet contraceptive needs
• 270 million women lack access to modern family planning methods.

• In 2022, 874 million women worldwide, which equals 77.5% of women of childbearing age, use a modern contraceptive method, up 10 percentage points on 1990 (67%).
• Every year, 74 million women living in low- and middle-income countries become pregnant as a result of accidental causes.

Access to modern contraception is limited by several factors

• Limited access to sexual health services: by 2030, an additional 70 million women should be using a modern contraceptive method. However, access to and use of contraception remain linked to socio-economic and territorial inequalities. Indeed, the place of residence and the household’s standard of living either encourage or, on the contrary, hinder the use of contraceptive methods.

• Socio-economic factors: underprivileged populations living on the outskirts of cities and in shantytowns are generally far from family planning services. As a result, young women on low incomes experience disproportionately high rates of unwanted pregnancy, notably because of the economic costs of contraception. In the least developed countries, 15% of women have unmet need for family planning compared with 7% of women in more developed areas. Every year, 74 million women living in low- and middle-income countries become pregnant accidentally. As a result, 25 million unsafe abortions and 39,000 maternal deaths occur each year, according to the WHO.
• Geographical disparities and lack of family planning services: Inequalities in access to contraception are compounded by geographical disparities. For example, the proportion of unmet need for family planning on the African continent is 25%, compared with 13% in South-East Asia, 10% in Europe, 8% in the Americas and 4% in the Western Pacific.
• Poor quality of services: the access to affordable family planning services is crucial in order to achieve the Sustainable Development Goals Agenda. According to a WHO study in the Philippines, only 3% of women seeking to delay or limit pregnancy received contraceptive advice during their recent visits to health facilities. This leads to over 600,000 unsafe abortions in the Philippines every year.
• Impact of the Covid-19 pandemic on the access to family planning : the Covid-19 pandemic has caused major disruption to the availability and access to contraception, safe abortion, services for victims of gender-based violence and screening for HIV and sexually transmitted infections.

• Obstacles to contraceptive use: social intercourse within couples, social stigma and beliefs are all factors that hinder contraceptive use. Moreover, the level of education and sexual health education are essential to achieve the 7th of SDG 3, i.e. "universal access to sexual and reproductive health-care services, including family planning, information and education".

• Gender and Couple Relationships: the fear of disagreement with the spouse can lead some women to avoid family planning centers. According to the Demographic and Health Surveys led in 34 countries since 2015, 14% of married women that are not using contraception report that it is mainly their husband’s decision.
• Social stigmatization: in countries where contraception is a taboo subject, unmarried women are less likely to seek contraception out of fear of being marginalized. On the other hand, men who come with their wives to family planning services may be negatively perceived as being dominated by their wives, and may be embarrassed to be in so-called "feminine" places.
• Religious considerations: Religious beliefs can govern people’s daily practices and influence whether or not they use contraceptives. Some religions effectively condemn the use of modern contraceptives and may promote the idea that these methods are the cause of disease and infidelity.
• The level of education: low levels of education can lead to unwanted pregnancies. Evidence from sub-Saharan Africa confirms that lack of knowledge or misinformation is a barrier to contraceptive use, according to a recent study published in The European Journal of Contraception & Reproductive Health Care.
• Fear of side effects: According to a WHO study led in 36 countries, 2/3 of sexually active women who want to delay or limit childbearing have stopped using contraception out of fear of health problems and underestimating the risk of pregnancy. A survey by the Guttmacher Institute reveals that in 52 countries, a quarter of women do not use contraception for fear of side effects, such as infertility or depression.