1. Meet unmet demand for contraception

While much of the unmet demand for contraception has been met, much progress remains to be made in this area. In the article, "Population Policy Options..." in your assigned reading, Bongaarts estimates that future population growth could be diminished by ~ 1/3 by meeting remaining unmet demand for contraception. For example, it is estimated that 1 in 6 married women in developing nations outside China has unmet need for contraception (about 100 million women). The highest unmet need (about 25% of women) is in subSaharan Africa and some other regions on that continent. In subSaharan Africa, only about 26% of married women use any form of contraception at all, and in Ethiopia, 10% of women surveyed had never heard of contraception (ZPG Reporter fall '07).

Why is there unmet need? Many reasons, including lack of money for supplies and for travel to obtain the supplies, pressures from spouses and families to have many children, inconvenience, fear of side effects, religious beliefs, lack of information about available methods, and lack of access to family planning resources.

This unmet demand results in many unplanned births and also in a huge number of abortions. For example, in 2002, it was estimated that, worldwide, about one out of four births (25%) was unplanned, and, because many of these terminate in abortions, unplanned pregnancies lead to about 25 million abortions per year!

While the proportion of women using contraception has increased in developing countries over recent decades, there are now more women (in an absolute sense, rather than as a proportion) NOT using contraception than there were three decdes ago simply because population has grown so much over that time.

It was estimated in 2001 that, if all unmet demands for contraception in lesser developed countries could be met, with the developed nations paying about 2/3 of the costs, as they agreed to do in the last UN Conference on Population, it would cost about $3 billion per year. That sounds huge, but it translates into a cost per developed-world taxpayer of about the equivalent of one can of soda every 6 months. (This estimate according to the book, "Beyond Six Billion: Forecasting the World's Poplation" edited by J. Bongaarts and R.A. Buato, National Academy Press.)

Consider this also; in 2002, the UN estimated that, by 2015, contraceptive needs in developing countries would increase by over 40%, largely because of the increases in the number of women of reproductive age that will populate these areas. If we have so much unmet demand already, it is hard to fathom how the increase in demand will be met.

NEEDS IN THE US:

Lest we assume that unmet need for contraception exists only in lesser developed nations, the organization "Zero Population Growth" and the Alan Guttmacher Institute estimate that 60% of all pregnancies in the US are unplanned [I have read 50% elsewhere.]. These unplanned pregnancies translate into ~ 3.6 million unplanned pregnancies per year in the US. Of these, ~43% result in births, ~44% are aborted, and ~13% miscarry, resulting in ~1.5 million children born each year in the US as result of unintended pregnancies, and about that many abortions per year as well. Figures from the 2012 ZPG Reporter source cited above indicate that, between 1982 and 2010, only 63% of births in the US were intended [note this figure is for births, not for pregnancies], while 23% of births were "mistimed" and 14% were unwanted. As you can imagine, these statisics vary widely depending on a woman's economic status and level of education. Clearly, better access to and education about contraception are needed here in the US as well as in 3rd world countries. These rates of unplanned -- and teen -- pregnancies in the U.S. are about twice as high as rates in other developed nations.

A program in a Baltimore, MD highschool demonstrated the importance of access to contraception. The program made condoms and other forms of contraception available for free to students and saw the pregnancy rate drop by 30% in 28 months! (ZPG Reporter, fall '07).

As a counter example, the state of Texas received about twice as much Federal funding as any other state for "abstinence only" education, yet had the highest rate of repeat births to teens of any state (24% of teens who had already had one baby have another in TX, compared to a national average for repeat births of 20%) [ZPG Reporter Dec. '07).

The Guttmacher Institute estimates that 75-80% of all teen pregnancies in the US are unplanned; in 2012 [October], the ZPG Reporter cited that this figure for teen pregnancies was 77%, consistent with the Guttmacher's estimate. However, a piece of good news here -- the teen birth rate in the US in 2011 was at an all-time low of 31.3 births per 1,000 girls; this is over a 44% decrease since the early 1990's!. That rate,however, remains as much as nine times that of other industrialized countries [ZPG Reporter March 2013].) In the US, ~ 22% of women < 20 years old have babies, while ~ 33% of women that age become pregnant (the difference in those percentages is basically because of abortions...). For comparison, in Sweden, only ~ 4% of women 20 years old or younger are mothers; in Canada, the percentage is ~ 11%.

Another positive sign, however, is that the average age of new mothers in the US as of 2009 was 25 years, whereas in 1970, that age was 21.4 years. (The average across other developed nations as of 2009 was 29 years...) (ZPG Reporter 10/09)

Until recently, virtually all health insurance plans in the US covered costs of prenatal care and childbirth, and most also covered sterilization and abortion, but a much smaller fraction covered costs of contraception. As of 2003, it was estimated that only 15% of health insurance plans in the US covered all five FDA-approved prescription contraceptives the pill, diaphragm, IUD, Norplant, and Depo-provera) and only 50% covered any method at all (ZPG Reporter, fall '03). Also, oddly enough, many insurance companies offered coverage for the drug "Viagra," as a treatment for impotence, while not necessarily covering costs of contraception. By fall 2003, however, 21 states in the U.S. had passed "contraceptive equality laws," which require that all insurance providers that cover prescription drugs also cover all FDA-approved contraceptive devices and drugs. Oregon passed such a law in 2007, joining the ~ 1/2 of US states with such laws. The Alan Guttmacher Institute estimates that adding contraceptive coverage to the average health plan would cost employers about $2.00 per employee per month; it seems that this cost would rapidly be recouped when unplanned pregnancies and their complications are avoided.

The Obama administration, however, as part of the health care overhaul, created a requirement that all FDA-approved forms of birth control must be covered by health insurance providers with no co-pay. This was slated to become effective Jan 1, 2013. (Medicaid, the health insurance program for low income people, already did cover costs for contraception.) Some alternative arrangement is likely for religious-based health insurance providers.

(To move to the next section in these notes (on decreasing demand for large families), click the box at the bottom of the page labeled ">>." To return to the previous section on trends in the developing world, click the box labeled "<<" and to return to the master directory for the BI301 web site, click the box labeled "CONTENTS.")

This page maintained by Patricia Muir at Oregon State University. Last updated Nov. 15, 2013.

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