It is estimated by the Guttmacher Institute that 222 million women worldwide have an unmet need for modern contraception. Women of reproductive age (15 – 49) are considered to be in need of contraception if they are using contraceptives — modern or traditional — or are using no method but are married or are unmarried and sexually active (i.e., had had sex in the three months prior to being surveyed), are fecund and do not want a child soon (in the next two years) or at all; identify their current pregnancy as unintended; or are experiencing postpartum amenorrhea after an unintended pregnancy.
An unmet need may be because the woman cannot access contraception or because, even where it is formally available, take-up and use are limited by the degree of cultural acceptance, the level of female empowerment, affordability or problems with distribution. This means many people have much larger families than the global average, with some countries averaging five or six children per woman. In some places, high infant mortality rates can contribute to higher birth rates because women have more pregnancies to compensate.
Contraception is only one element of a general lack of reproductive health services. Half a million women die each year during pregnancy and childbirth — this is equivalent to four full jumbo jets crashing every day.
After a number of years of reduced international support, US funding of reproductive health programmes in developing countries has resumed. However, funding remains below the required level. One reason is that the necessary response to the AIDS crisis has resulted in the diversion of funds previously used for family planning and maternal health programmes.
In the developed world, while most couples have one, two or three children, unintended pregnancy still remains an issue, particularly in the US and UK. Government programmes have been instigated, such as promoting more reliable long-acting reversible contraceptives, but, as yet, results have been limited.
Access to reproductive health services, including contraception, is central to slowing, halting and reversing population growth. We fully endorse United Nations Millennium Development Goal 5b, which aims to achieve universal access to reproductive health services by 2015; however, this goal seems unlikely to be achieved. The UK government is a major contributor of funding to reproductive health programmes overseas, and several UK-based charities have longstanding records in the field, such as Marie Stopes International and the International Planned Parenthood Federation (IPPF). We support their work, and that of the United Nations Population Fund (UNFPA). We welcome the 2010 $40bn initiative by the UN to improve maternal and infant health, including reproductive health.
Reproductive healthcare in the UK
There has been some recent progress, but there remains much scope for improvement. The UK still has the highest teenage pregnancy rate in Europe. GPs have been encouraged to stress the advantages of long-acting, reversible contraceptives — ‘take and forget’ — such as implants, injections and intrauterine devices. There have also been moves to ease access to emergency contraception, liberalise guidelines on the advertising of reproductive health services and make sex and reproductive health education compulsory. These are part of a wider government strategy of improving sexual health, along with a long-standing campaign to reduce teenage pregnancies. We endorse these initiatives.
We call for:
- improvement in the way sex and relationships are taught in schools, preferably by trained teachers who are comfortable with the subject;
- lifting of all restrictions on the advertising of reproductive health products and services;
- making access to emergency contraception easier and more affordable; and
- making family planning a top health priority.
Read more about poor reproductive health.