The unmet need for social context in family planning

New evidence on the relationship between sexual health and social context finds a strong association between gender equality, education and family planning

Twenty-five years ago, two global events – the International Conference on Population and Development and the Fourth World Conference on Women in Beijing – formally recognized that women’s health and reproductive choices cannot be separated from the social context of their lives.

Now, researchers have created a dataset which brings together national surveys from 74 countries, representing 3 million women. For the first time, it allows them to describe trends in demand/use of modern contraceptives alongside social and economic indicators.

The data is published in The Lancet Global Health and is authored by the London School of Hygiene & Tropical Medicine and the World Health Organization.

It shows that, over time, women are more likely to have their demand for modern contraception met in countries where gender equality and their educational opportunities improve.

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Gender equality and education increases access to modern contraception

Trends in sexual activity and demand for use and use of modern contraceptive methods in 74 countries: a retrospective analysis of nationally representative surveys finds that met need for modern contraception is strongly correlated with positive shifts in social structures.
For every 0.1-point increase in a country’s gender development index, it found a 6.7% rise in women who were sexually active and did not want to conceive. Of those women, an additional 13.5% used modern methods to prevent a pregnancy.

Expectations of every girl’s right to education also made a difference. Each extra year in schooling is linked to an increase of 2.3% in demand, and a 4.7% increase in use of modern contraceptive methods.

“This study shows how every woman must negotiate her reproductive autonomy within the social framework in which she lives, responding to barriers and opportunities as they emerge,” says Dr Lale Say, one of the authors of the study and Unit Head at WHO and HRP.

“Gender equality is both a precondition and a driving force for securing women’s reproductive health and rights – as well as the sustainable development targets, which are our best chance for delivering health and well-being for all.”

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Global trends reveal new challenges in family planning

Overall, the data reinforce global trends: more time spent sexually-active and single, postponement of parenthood, and the near-universal desire for smaller families.

The study also highlights where action is needed at country-level to avoid family planning services falling behind demand.

Out of the 74 countries analyzed, 42 showed an increase in demand for contraception. Only 37 countries show an increase in use of a modern method to prevent pregnancy.

Although unmet need for contraception declined in 34 countries, it increased in 14 countries. Significantly more progress is needed, and faster, to ensure each girl and woman is able to access the sexual and reproductive health services she needs.

Barriers and solutions to reproductive health and rights

Gender equality can affect contraceptive use in many ways. From the personal and political degree to which women are free to choose their sexual activity, to accessing family planning services it can also shape any power imbalances within personal relationships. This study supports recent efforts by WHO to adopt a broader, integrated concept of sexual and reproductive health – and to translate it into a framework for policy and practice.

The authors argue that family planning targets in the 2030 Agenda for Sustainable Development will not be met without a profound shift: from focus on ‘access to contraception’, to broader aspects of sexual health and social context.

Since reproductive health and women’s empowerment are intertwined, trends in contraceptive use can also reveal progress towards another global target: progress towards gender equality.