Trends in sexual activity and demand for and use of modern contraceptive methods in 74 countries: a retrospective analysis of nationally representative surveys

Abstract

Background A quarter of a century ago, two global events-the International Conference on Population and Development in Cairo, and the Fourth World Conference on Women in Beijing-placed gender equality and reproductive health and rights at the centre of the development agenda. Progress towards these goals has been slower than hoped. We used survey data and national-level indicators of social determinants from 74 countries to examine change in satisfaction of contraceptive need from a contextual perspective. Methods We searched for individual-level data from repeated nationally representative surveys that included information on sexual and reproductive health, and created a single dataset by harmonising data from each survey to a standard data specification. We described the relative timings of sexual initiation, first union (cohabitation or marriage), and first birth and used logistic regression to show the change in prevalence of sexual activity, demand for contraception, and modern contraceptive use. We used linear regression to examine country-level associations between the gender development index and the expected length of time in education for women and the three outcomes: sexual activity, demand for contraception, and modern contraceptive use. We used principal component analysis to describe countries using a combination of social-structural and behavioural indicators and assessed how well the components explained countrylevel variation in the proportion of women using contraception with fractional logistic regression. Findings In 34 of the 74 countries examined, proportions of all women who were sexually active, not wanting to conceive, and not using a modern contraceptive method decreased over time. Proportions of women who had been sexually active in the past year changed over time in 43 countries, with increases in 30 countries; demand for contraception increased in 42 countries, and use of a modern method of contraception increased in 37 countries. Increases over time in met need for contraception were correlated with increases in gender equality and with women's time in education. Regression analysis on the principal components showed that country-level variation in met contraceptive need was largely explained by a single component that combined behavioural and social-contextual variables. Interpretation Progress towards satisfying demand for contraception should take account of the changing context in which it is practised. To remove the remaining barriers, policy responses-and therefore research priorities-could require a stronger focus on social-structural determinants and broader aspects of sexual health. Funding UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.

Demand and Supply Side Factors Associated with the Use of Contraceptive Methods in Pakistan: A Contemplative Study of Demographic and Health Surveys, 1990-2018

“…A higher prevalence of contraceptive measures is found among women who have more knowledge, awareness, and media exposure (41)(42). Our ndings are consistent with these studies as those women (aged who have greater media exposure have more knowledge about contraceptive measures, and among them the use of contraceptives measures is also more likely (48). Ethnicity is also signi cantly associated with ever-use of contraceptive measures (43).…”

Non-use of Contraceptive Methods Among Married: Analysis of the 2018 Guinea Demographic and Health Survey

“…In our ndings, compared with adolescent married ever users aged 15-19 years old, married women aged [25][26][27][28][29][30][31][32][33][34], and 45-49 years old who were ever users had greater odds of not currently using a modern FP method. This nding corroborates the data from the Population Reference Bureau, which revealed that the reasons for not using the FP method among married individuals varied according to age.…”

“…The ndings from this study suggest that addressing unmet FP need is crucial to increasing the use of contraceptive methods among speci c groups of women who are exposed to the risk of pregnancy. Although a recent study in 78 countries showed that gender equality and education increase access to modern contraceptive methods [27], it is important to note that adapted and targeted strategies according to the speci c categories of women could yield a more sustainable increase in the demand for contraceptives.…”

Patchy progress on the ICPD: are we asking the right questions?

“…4 Using an in-depth retrospective regression and principal component analysis, Emma Slaymaker and colleagues have provided harmonised nationally available data from 74 countries to evaluate progress on the ICPD agenda using a broader social context than just contraceptive targets, including life events such as age of sexual initiation, first union (cohabitation or marriage), and first birth; sexual behaviour; and social and economic indicators, such as gross domestic product (GDP) per capita, indices of gender development and inequality, and female and male expected years of education. 5 This study provides useful insights by using a comprehensive approach, underscoring continuing societal changes that affect the length of time after sexual initiation to first union and first birth, which can lead to additional time using modern methods of contraception. Although only at the national level, data on sexual activity, demand for contraception, and use of contraception were correlated with the gender development index and expected years of education for females in the 67 countries with data available.…”