Many women in developing countries wish to avoid pregnancy, but do not use contraceptives. The usual advocacy angle is that most of these women lack access, but a new study shows that the reasons are more varied. In fact, only 5 percent of women across 52 countries cited access as the reason for not using contraceptives. The problem is lack of information and options.
Half of the women included in the analysis said that they were not using contraceptives because of health concerns and infrequent sex with their partners. Other reasons include it being too soon since giving birth (either still breastfeeding or not menstruating) and opposition to birth control. Conversely, few women said that lack of access, lack of awareness or cost were reasons for non-use.
“Regardless of the level of unmet need or contraceptive use in a country, concerns about side effects and health risks of methods are common…these concerns are also a common reason for discontinuation of use among women who wish to avoid pregnancy,” according to the analysis by the Guttmacher Institute. “Attention must be paid to whether the quality of services provided is effective.”
Infrequent sex is an oft-used reason for not using birth control, especially among unmarried women. That raises the concern that women perceive that the chances of pregnancy are low, so they don’t feel like it is necessary to use contraceptives. The analysis points to a 2012 survey of U.S. women who were not using a contraceptive method. About one-third of those women said that they did not think they could get pregnant. Such views may be emerging in developing countries, raising the risk of unintended pregnancies.
The data are based on information gathered between 2005 and 2014 from demographic and health surveys collected in 32 African countries, 13 Asian countries and seven from Latin America and the Caribbean. All countries had data on why married women used contraceptives, and 31 countries also had data for unmarried women.
Breastfeeding and lack of menstruation was the leading reason for married women in 12 countries. However, 11 of the countries were in Africa, where women tend to breastfeed longer than the global average. Considering the high fertility rate in many African countries, Guttmacher analysts said there is more evidence pointing to the fact that women are underestimating the chances they can get pregnant.
There are other differences among regions and countries, but the recommendations show that there are more similarities. The authors said that more support and information is vital. Half of the married women who said infrequent sex was the reason for eschewing contraceptives also said they had sex in the past three months. Counseling to note the risk of pregnancy could help. And it would also benefit the women who said that health risks were a concern. They could learn about alternative methods that will not negatively impact their health.
“Providers should ensure that all women – married and unmarried – are able to choose from a wide range of contraceptive options so that they can select a method that best suits their needs. It is equally crucial that women are given the opportunity to switch methods if the first contraceptive they try doesn’t end up working for them,” said Gilda Sedgh, lead author, in a release.
At a fundamental level, the information shows the need for a shift in the way family planning in developing countries is discussed. Access is a major problem globally, but it is not all that significant of a reason for lack of contraceptive use. More options and better information can help more women avoid unwanted pregnancies.