Over 8% Indian Women Have Unmet Contraceptive Needs, Most Common Mode Is Female Sterilisation: Study In Lancet

Female sterilisation is the most commonly used method in India, accounting for 62.2 per cent of all modes of sterilisation. The contraceptive prevalence rate (CPR) was 46.7 per cent in 2019.

Over 8% of Indian women of reproductive age had unmet contraceptive needs in 2019, according to a study published in The Lancet. Female sterilisation is the most commonly used method in India, accounting for 62.2 per cent of all modes of sterilisation.

In India, the contraceptive prevalence rate (CPR) was 46.7 per cent in 2019, which means that 46.7 per cent of all women of reproductive age (15-49 years) were using some form of contraception. In comparison, the global CPR was 51.9 per cent in 2019.

In the Lancet study, the contraceptive prevalence rate was defined as the "proportion of all women of reproductive age (15-49 years) who were currently using, or whose partner is using, at least one method of contraception". 

The modern contraceptive prevalence rate was defined as the "proportion of all women of reproductive age using modern contraceptive methods".

Female sterilisation accounted for 62.2 per cent of all contraceptive modes used in India. Male sterilisation accounted for 1.3 per cent, intrauterine devices for 3.3 per cent, and condoms for 13.9 per cent. In comparison, globally, female sterilisation accounted for only 26.6 per cent of all contraceptive modes used.

“In India, the larger proportion of women using female sterilisation is likely to be associated with incentives for sterilisation provided to some groups by the Indian Government,” the study said.

Unmet Needs

The study is the most comprehensive assessment of worldwide contraceptive need and use. It found that more than 160 million women and adolescents had unmet contraceptive needs in 2019. This happened despite major increases in use of contraceptives at a global level since 1970. 

The authors on the paper have mentioned estimates of worldwide contraceptive use, need and type continuously from 1970 to 2019 by country, age group, and marital status. 

Benefits Of Contraception

Women's social and economic empowerment and increased access to contraception are linked. Contraceptives also lead to better health outcomes for women. 

Increasing access to contraception is a key goal of international initiatives and a Sustainable Development Goal (SDG). 

Use of contraceptives can prevent unintended pregnancies, and as a result, maternal mortality and neonatal mortality are reduced. Neonatal mortality rate refers to the number of deaths in the first 28 completed days of life per 1,000 live births in a given year or some other period, according to the World Health Organization (WHO).

Contraception allows women to plan childbearing, and enables adolescents and women to remain in school, pursue higher studies, and work, leading to social and economic empowerment later in life.

Policymakers can tailor and make accessible types of contraception to the population in need by understanding which age groups have the most unmet need. Unmet need of contraceptives can be reduced by accommodating the preferences of women of different ages and marital statuses. 

Some permanent methods of contraception include female and male sterilisation. According to the study, permanent methods are more likely to be used by older women. Meanwhile, younger women and adolescents prefer using short-acting methods such as oral contraceptive pills or condoms. 

Which Women Were Defined As Requiring Contraception?

The authors analysed data from 1,162 self-reported representative surveys on women's contraceptive use, and produced national estimates of various family planning indicators through models. The family planning indicators include the proportion of women of reproductive age (15-49 years) using any contraceptive method, the rules of contraceptives in use, the proportion of women of reproductive age using modern methods, unmet need for any contraceptive method, and demand satisfied with modern methods. 

The authors defined women as needing contraception when they were married or if unmarried, sexually active, able to become pregnant and not wanting a child within two years, or if they were pregnant or had just given birth but would have preferred to delay or prevent their pregnancy. 

Rise In Use Of Modern Contraceptives Since 1970

There has been a significant shift from using less effective, traditional methods to using more effective, modern contraceptives, since 1970. Modern contraceptives include oral contraceptive pills, Intrauterine devices, and male and female sterilisation contraceptive methods. Despite this shift, there are some limitations.

Globally, the proportion of women of reproductive age using modern contraception increased from 28 per cent in 1970 to 48 per cent in 2019. 

In 1970, the demand satisfaction rate was 55 per cent. This increased to 79 per cent in 2019. 

A total of 1.2 billion women needed contraception in 2019. Of these, 163 million women who were not using contraception at that time were considered to have a need for contraception in 2019, the study said.

In a statement released by The Lancet, Dr Annie Haakenstad, one of the authors on the paper, said although there have been excellent strides in contraceptive ability since the 1970s at a global level, there is still a long way to go to ensure that every woman and adolescent girl can benefit from the economic and social empowerment contraceptives can offer. She added that the results indicate that where a woman lives in the world and their age still significantly impacts their use of contraception.

The Findings

Different regions across different countries had varied availability of contraceptives in 2019. 

The use of modern contraceptives was highest in southeast Asia, East Asia and Oceania. In these regions, 65 per cent of the women who needed contraception used contraceptives. Of these, the demand of 90 per cent was satisfied. 

Meanwhile, sub-Saharan Africa had the lowest use of modern contraceptives. Only 24 per cent of the women who needed contraception were able to use contraceptives. The demands of 52 per cent of these women were satisfied.

In South Sudan, the level of modern contraceptive use was two per cent, the lowest for any country. Norway had the highest level of modern contraceptive use (88 per cent). 

In 2019, South Sudan, Central African Republic, and Vanuatu were the countries where unmet need was the highest. In South Sudan, 35 per cent of the women requiring contraception had unmet needs. 

The proportions of women with unmet needs in Central African Republic and Vanuatu were 29 per cent and 28 per cent, respectively. 

The goal of the Family Planning 2020 Initiative (FP2020) was to increase the number of women using modern contraception by 120 million between 2012 and 2020 in 69 priority countries. Between 2012 and 2019, the number of women using contraception in the 69 countries, excluding Western Sahara, increased by 69 million, the study estimated. This left the initiative 51 million short of reaching its goal.

Women and adolescents belonging to the age groups of 15 to 19 years and 20 to 24 years have the lowest rates of demand satisfied globally, the study found. The demand satisfaction rates in women and adolescents are 65 per cent and 72 per cent respectively. 

Women aged 15 to 24 comprise 16 per cent of total need. The same age group comprises 27 per cent of unmet need. 

As many as 43 million young women and adolescents worldwide did not have access to contraceptives they required in 2019. 

In Latin America and the Caribbean, female sterilisation and oral contraceptives were dominant in 2019. Meanwhile, in high-income countries, oral contraceptive pills and condoms were dominant.

The contraceptive methods common in Europe, eastern Europe and Central Asia were intrauterine devices and condoms. 

In South Asia, female sterilisation accounted for more than half of all contraceptive use. 

More than half of women in 28 countries preferred female sterilisation over other contraceptive methods. This indicates that there may be a limited availability of options for contraceptives in these areas. 

What Do The Authors Say?

Dr Haakenstad explained that the study draws attention towards young women being overrepresented among those who cannot access contraception when they need it. She added that these are the women who stand most to gain from contraceptive use because delaying having children can help women stay in school or get other training opportunities and to enter and maintain paid employment. All this can lead to social and economic benefits throughout a woman's lifetime. This is also an essential driver towards greater gender equity, she further said. 

To some extent, the location determines the types of contraceptive methods in use. The dominance of single contraceptive methods could indicate a lack of suitable choices for women and adolescent girls. 

Professor Rafael Lozano, one of the authors on the paper, said the study highlights that not only should contraception be available to all women, but also suitable choices of contraceptives. 

Limitations

The authors noted some limitations to their study, including the fact that the criteria used to identify women requiring contraception may not capture certain women in need. These include the women who underreport sexual activity due to social stigma, women who are not satisfied with their current method of contraception, and women who are not sexually active because they lack contraception.