Estimating progress towards meeting women’s contraceptive needs in 185 countries: A Bayesian hierarchical modelling study

Autoři: Vladimíra Kantorová aff001;  Mark C. Wheldon aff001;  Philipp Ueffing aff001;  Aisha N. Z. Dasgupta aff001
Působiště autorů: Population Division, Department of Economic and Social Affairs, United Nations, New York, New York, United States of America aff001
Vyšlo v časopise: Estimating progress towards meeting women’s contraceptive needs in 185 countries: A Bayesian hierarchical modelling study. PLoS Med 17(2): e32767. doi:10.1371/journal.pmed.1003026
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003026



Expanding access to contraception and ensuring that need for family planning is satisfied are essential for achieving universal access to reproductive healthcare services, as called for in the 2030 Agenda for Sustainable Development. Monitoring progress towards these outcomes is well established for women of reproductive age (15–49 years) who are married or in a union (MWRA). For those who are not, limited data and variability in data sources and indicator definitions make monitoring challenging. To our knowledge, this study is the first to provide data and harmonised estimates that enable monitoring for all women of reproductive age (15–49 years) (WRA), including unmarried women (UWRA). We seek to quantify the gaps that remain in meeting family-planning needs among all WRA.

Methods and findings

In a systematic analysis, we compiled a comprehensive dataset of family-planning indicators among WRA from 1,247 nationally representative surveys. We used a Bayesian hierarchical model with country-specific time trends to estimate these indicators, with 95% uncertainty intervals (UIs), for 185 countries. We produced estimates from 1990 to 2019 and projections from 2019 to 2030 of contraceptive prevalence and unmet need for family planning among MWRA, UWRA, and all WRA, taking into account the changing proportions that were married or in a union. The model accounted for differences in the prevalence of sexual activity among UWRA across countries.

Among 1.9 billion WRA in 2019, 1.11 billion (95% UI 1.07–1.16) have need for family planning; of those, 842 million (95% UI 800–893) use modern contraception, and 270 million (95% UI 246–301) have unmet need for modern methods. Globally, UWRA represented 15.7% (95% UI 13.4%–19.4%) of all modern contraceptive users and 16.0% (95% UI 12.9%–22.1%) of women with unmet need for modern methods in 2019. The proportion of the need for family planning satisfied by modern methods, Sustainable Development Goals (SDG) indicator 3.7.1, was 75.7% (95% UI 73.2%–78.0%) globally, yet less than half of the need for family planning was met in Middle and Western Africa. Projections to 2030 indicate an increase in the number of women with need for family planning to 1.19 billion (95% UI 1.13–1.26) and in the number of women using modern contraception to 918 million (95% UI 840–1,001).

The main limitations of the study are as follows: (i) the uncertainty surrounding estimates for countries with little or no data is large; and (ii) although some adjustments were made, underreporting of contraceptive use and needs is likely, especially among UWRA.


In this study, we observed that large gaps remain in meeting family-planning needs. The projected increase in the number of women with need for family planning will create challenges to expand family-planning services fast enough to fulfil the growing need. Monitoring of family-planning indicators for all women, not just MWRA, is essential for accurately monitoring progress towards universal access to sexual and reproductive healthcare services—including family planning—by 2030 in the SDG era with its emphasis on ‘leaving no one behind.’

Klíčová slova:

Africa – Asia – Contraceptives – Europe – Female contraception – Human families – Male contraception – Pregnancy


1. United Nations. Report of the International Conference on Population and Development, Cairo, 5–13 September 1994. New York (NY): United Nations; 1994. Sales No. E.95.XIII.18.

2. United Nations General Assembly. Transforming Our World: The 2030 Agenda for Sustainable Development. Resolution adopted by the General Assembly on 25 September 2015 (A/RES/70/1). New York (NY): United Nations; 2015. [cited 22 Jan 2020].

3. Every Woman Every Child. The Global Strategy for Women’s, Children’s and Adolescents Health (2016–2030). New York (NY): Every Woman Every Child; 2015. [cited 22 Jan 2020].

4. Brown W, Druce N, Bunting J, Radloff S, Koroma D, Gupta S, et al. Developing the “120 by 20” Goal for the Global FP2020 Initiative. Stud Fam Plann. 2014;45: 73–84. doi: 10.1111/j.1728-4465.2014.00377.x 24615576

5. United Nations, Department of Economic and Social Affairs, Population Division. World Contraceptive Use 2019. New York (NY): United Nations; 2019. [cited 22 Jan 2020].

6. United Nations, Department of Economic and Social Affairs, Population Division. World Family Planning 2017 Highlights. New York (NY): United Nations; 2017. [cited 22 Jan 2020].

7. United Nations. The Sustainable Development Goals report 2018. New York (NY): United Nations; 2018.

8. Cahill N, Sonneveldt E, Stover J, Weinberger M, Williamson J, Wei C, et al. 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. Lancet. 2017; 391: 870–882. doi: 10.1016/S0140-6736(17)33104-5 29217374

9. FP2020. FP2020: Catalyzing Collaboration 2017–2018. Washington (DC): Family Planning 2020; 2018.

10. Mauldin WP, Segal SJ. Prevalence of contraceptive use: Trends and issues. Stud Fam Plann. 1988; 19: 335–353. 3232164

11. United Nations, Department of Economic and Social Affairs, Population Division. Levels and trends of contraceptive use as assessed in 1998. New York (NY): United Nations; 2001.

12. Ross JA, Winfrey WL. Unmet Need for Contraception in the Developing World and the Former Soviet Union: An Updated Estimate. Int Fam Plan Perspect. 2002;28: 138.

13. Guttmacher Institute. Adding It Up: Investing in Contraception and Maternal and Newborn Health, 2017. New York (NY); The Institute: 2017.

14. GBD 2016 SDG Collaborators. Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016. Lancet. 2017; 390: 1423–1459. doi: 10.1016/S0140-6736(17)32336-X 28916366

15. Ewerling F, Victora CG, Raj A, Coll CVN, Hellwig F, Barros AJD. Demand for family planning satisfied with modern methods among sexually active women in low- and middle-income countries: who is lagging behind? Reprod Health. 2018;15: 42. doi: 10.1186/s12978-018-0483-x 29510682

16. Ponce de Leon RG, Ewerling F, Serruya SJ, Silveira MF, Sanhueza A, Moazzam A, et al. Contraceptive use in Latin America and the Caribbean with a focus on long-acting reversible contraceptives: prevalence and inequalities in 23 countries. Lancet Glob Health. 2019;7: e227–e235. doi: 10.1016/S2214-109X(18)30481-9 30683240

17. Wheldon MC, Kantorová V, Ueffing P and Dasgupta ANZ. Methods for estimating and projecting key family planning indicators among all women of reproductive age. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2018. Technical Paper No. 2. [cited 22 Jan 2020].

18. Alkema L, Kantorová V, Menozzi C, Biddlecom A. “National, regional, and global rates and trends in contraceptive prevalence and unmet need for family planning between 1990 and 2015: a systematic and comprehensive analysis,” Lancet 2013. 381: 1642–1652. doi: 10.1016/S0140-6736(12)62204-1 23489750

19. Bradley SEK, Croft TN, Fishel JD, Westoff CF. Revising unmet need for family planning. DHS Analytical Studies No. 25. Calverton (MD): ICF International; 2012.

20. Casterline JB, editor. Diffusion processes and fertility transition: selected perspectives. Washington (D.C.): National Academy Press; 2001.

21. Marchetti C, Meyer PS, Ausubel JH. Human population dynamics revisited with the logistic model: How much can be modeled and predicted? Technol Forecast Soc Change. 1996;52: 1–30. doi: 10.1016/0040-1625(96)00001-7 12292026

22. Gelman A, Carlin JB, Stern HS, Dunson DB, Vehtari A, Rubin DB. Bayesian Data Analysis. 3rd ed. Boca Raton (FL): Chapman & Hall/CRC; 2013.

23. Gelfand AE, Smith AFM. Sampling-Based Approaches to Calculating Marginal Densities. J Am Stat Assoc. 1990;85: 398–409.

24. Plummer, M. JAGS: A program for analysis of Bayesian graphical models using Gibbs sampling. In: Hornik K, Leisch F, Zeileis A, editors. Proceedings of the 3rd International Workshop on Distributed Statistical Computing (DSC 2003); 2003 Mar 20–22; Vienna, Austria.

25. R Development Core Team. R: A Language and Environment for Statistical Computing. Vienna (Austria): R Foundation for Statistical Computing; 2018.

26. United Nations, Department of Economic and Social Affairs, Population Division. Estimates and Projections of Women of Reproductive Age Who Are Married or in a Union: 2018 Revision. New York (NY): United Nations; 2018. [cited 22 Jan 2020].

27. United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects 2017. New York (NY): United Nations; 2017.

28. Stevens GA, Alkema L, Black RE, Boerma JT, Collins GS, Ezzati M, et al. Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement. PLoS Med. 2016;13: e1002056. doi: 10.1371/journal.pmed.1002056 27351744

29. Dasgupta A, Ueffing P, Kantorová V. Sexual Activity by Marital Status and Age: A Comparative Perspective. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017. Technical Paper No. 11. [cited 22 Jan 2020].

30. Kantorová V, New JR, Biddlecom A, Alkema L. Setting Ambitious yet Achievable Targets Using Probabilistic Projections: Meeting Demand for Family Planning. Stud Fam Plann. 2017;48: 223–233. doi: 10.1111/sifp.12025 28518405

31. New JR, Cahill N, Stover J, Gupta YP, Alkema L. Levels and trends in contraceptive prevalence, unmet need, and demand for family planning for 29 states and union territories in India: a modelling study using the Family Planning Estimation Tool. Lancet Glob Health. 2017;5: e350–e358. doi: 10.1016/S2214-109X(17)30033-5 28193400

32. Ahmed S, Li Q, Liu L, Tsui AO. Maternal deaths averted by contraceptive use: an analysis of 172 countries. Lancet. 2012;380: 111–125. doi: 10.1016/S0140-6736(12)60478-4 22784531

33. Bearak J, Popinchalk A, Alkema L, Sedgh G. Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model. Lancet Glob Health. 2018;6: e380–e389. doi: 10.1016/S2214-109X(18)30029-9 29519649

34. Sedgh G, Bearak J, Singh S, Bankole A, Popinchalk A, Ganatra B, et al. Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends. Lancet. 2016;388: 258–267. doi: 10.1016/S0140-6736(16)30380-4 27179755

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PLOS Medicine

2020 Číslo 2

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