Modern contraceptive use, unmet need, and demand satisfied among women of reproductive age who are married or in a union in the focus countries of the Family Planning 2020 initiative: a systematic analysis using the Family Planning Estimation Tool

Abstract

Background: The London Summit on Family Planning in 2012 inspired the Family Planning 2020 (FP2020) initiative and the 120×20 goal of having an additional 120 million women and adolescent girls become users of modern contraceptives in 69 of the world's poorest countries by the year 2020. Working towards achieving 120 × 20 is crucial for ultimately achieving the Sustainable Development Goals of universal access and satisfying demand for reproductive health. Thus, a performance assessment is required to determine countries' progress.

Methods: An updated version of the Family Planning Estimation Tool (FPET) was used to construct estimates and projections of the modern contraceptive prevalence rate (mCPR), unmet need for, and demand satisfied with modern methods of contraception among women of reproductive age who are married or in a union in the focus countries of the FP2020 initiative. We assessed current levels of family planning indicators and changes between 2012 and 2017. A counterfactual analysis was used to assess if recent levels of mCPR exceeded pre-FP2020 expectations.

Findings: In 2017, the mCPR among women of reproductive age who are married or in a union in the FP2020 focus countries was 45·7% (95% uncertainty interval [UI] 42·4-49·1), unmet need for modern methods was 21·6% (19·7-23·9), and the demand satisfied with modern methods was 67·9% (64·4-71·1). Between 2012 and 2017 the number of women of reproductive age who are married or in a union who use modern methods increased by 28·8 million (95% UI 5·8-52·5). At the regional level, Asia has seen the mCPR among women of reproductive age who are married or in a union grow from 51·0% (95% UI 48·5-53·4) to 51·8% (47·3-56·5) between 2012 and 2017, which is slow growth, particularly when compared with a change from 23·9% (22·9-25·0) to 28·5% (26·8-30·2) across Africa. At the country level, based on a counterfactual analysis, we found that 61% of the countries that have made a commitment to FP2020 exceeded pre-FP2020 expectations for modern contraceptive use. Country success stories include rapid increases in Kenya, Mozambique, Malawi, Lesotho, Sierra Leone, Liberia, and Chad relative to what was expected in 2012.

Interpretation: Whereas the estimate of additional users up to 2017 for women of reproductive age who are married or in a union would suggest that the 120 × 20 goal for all women is overly ambitious, the aggregate outcomes mask the diversity in progress at the country level. We identified countries with accelerated progress, that provide inspiration and guidance on how to increase the use of family planning and inform future efforts, especially in countries where progress has been poor.

Funding: The Bill & Melinda Gates Foundation, through grant support to the University of Massachusetts Amherst and Avenir Health.

Figure 1

2017 estimates for family planning indicators Median estimates of (A) modern contraceptive prevalence, (B) unmet need for, and (C) demand satisfied with modern methods in 2017 for 68 Family Planning 2020 countries.

Figure 2

Aggregate estimates for 2012–17 of family planning indicators Percentage of women of reproductive age who are married or in a union (A) who use (mCPR), (B) have an unmet need for, or (C) have demand satisfied with, modern methods of contraception. Estimates and 95% uncertainty intervals are shown for all Family Planning 2020 countries combined and for the country subregions. mCPR=modern contraceptive prevalence.

Figure 3

Changes in family planning indicators between 2012 and 2017 Estimated changes in (A) modern contraceptive prevalence (mCPR), (B) unmet need for, and (C) demand satisfied with modern methods between 2012 and 2017 for 47 Family Planning 2020 countries that have data after 2012. Horizontal lines are the 95% uncertainty intervals. Countries are ordered by decreasing point estimate. The red line indicates 0 percentage point change.

Figure 4

Attainment probabilities for modern contraceptive prevalence (mCPR) estimates in the most recent observation year for countries that made a commitment or not to FP2020 Results are for countries that had data available after 2012.