Understanding the Worldwide Contraception Crisis

In the richer parts of the world, contraception is often seen as a vital means of maintaining control over one’s life, but the prospect of an unwanted pregnancy isn’t, for most people and for the most part, a life-and-death issue. That’s not true for women in less developed parts of the world, though; there, as the authors of a new study in Human Reproduction point out, citing World Health Organization research, “after becoming pregnant without intention, many of these women are presented with a stark set of scenarios: risk of death, disability and lower educational and employment potential.” Their children also face heightened risks of dying at a very young age.

So it’s no wonder that researchers are trying to better understand why women in some places don’t have or use condoms. A team led by Saverio Bellizzi of the WHO looked at 49 surveys given to women in their most fertile years in “low- and middle-income countries between 2005 and 2012” to better get a sense of their contraception habits and access. Then they used statistical extrapolation to generate approximate numbers for all women and unplanned pregnancies in the countries covered.

The results are pretty shocking: “Fifteen million out of 16.7 million undesired pregnancies occurring annually in 35 countries could have been prevented with the optimal use of [modern methods] of contraception.”

Why didn’t they use condoms? As you can see by perusing this table, in the vast majority of cases it was not because of cost or access concerns, but because of misinformation or religious and/or partner pressure:

Of the total, 5559 (37.3%) did not use any contraceptive methods because of fear of side effects/health concerns; 2620 (17.6%) did not use it because they underestimated the risk of pregnancy; 3331 (22.4%) women indicated they or their partner’s opposition to contraception or religious prohibition as the reason; 1055 (7.1%) mentioned other related … reasons, such as the cost, which alone accounted for 2.4% of the total. Some 516 (2.4%) women were not aware of the availability and/or source of contraception and 1812 (12.1%) women indicated other reasons.

It’s important to note that respondents were only allowed to choose one primary reason for not using a condom — certainly there could be cases where multiple reasons factor in (“I don’t think condoms work, and I don’t know where to find them anyway”). But it’s still striking how much bigger of an impact social pressure and misinformation appear to have as compared to availability. There is a lot of work to be done in this area.