Progress in Modern Contraceptive Prevalence

In The Lancet Global Health, Saifuddin Ahmed and colleagues1 present the findings from their study in which they assessed the progress in modern contraceptive prevalence rates since the 2012 London Summit on Family Planning in some sub-Saharan African countries. This programme was launched by the Bill & Melinda Gates Foundation, the UK government, and other partners and laid the foundations for the Family Planning 2020 initiative, which aims to enable 120 million additional women to use modern contraceptive methods by 2020 (“120 by 20”) in the world’s 69 poorest countries. This goal will require increasing the pre-2012 annual growth rate of modern contraceptive prevalence rates from an estimated 0·7 to 1·4 percentage points.  They used data from 45 rounds of Performance Monitoring and Accountability 2020 surveys, all undertaken after 2012, to ascertain trends in modern contraceptive prevalence rates among women aged 15–49 years in nine settings in eight sub-Saharan African countries: Burkina Faso; Kinshasa, Democratic Republic of Congo; Ethiopia; Ghana; Kenya; Niamey, Niger; Kaduna, Nigeria; Lagos, Nigeria; and Uganda.

The overall weighted average annual rate of change in rates was 1·92 percentage points. A high rate of change was achieved in Burkina Faso, Ghana, Kaduna (Nigeria), Kinshasa (DR Congo) and Uganda; however, not in Ethiopia, Kenya, Lagos (Nigeria), or Niamey (Niger), which had non-significant changes of less than 1 percentage point. The information from this study correlates with data from WHO showing that many sub-Saharan African countries still present a high total fertility rate: almost 5·4 births per woman and a low modern contraceptive prevalence rate.

The importance of this study was to highlight the situation regarding changes in modern contraceptive prevalence rates in some sub-Saharan African countries. Provision of modern contraceptive methods is one of the main components of sustainable global development, poverty alleviation, environmentally safe sustainability, increased life expectancy, women empowerment, gender equality, and health promotion including the reduction of maternal morbidity, mortality, and unsafe abortion, and the improvement of child survival through birth spacing. However, it is also important to assess the reasons associated with the low achievements in contraceptive provision and the means to solve this enormous problem, e.g. low education, sexual violence and civil conflict. Contraceptive use empowers women and facilitates access to education, work outside the home, and engagement in family income.

An absence of health services and trained healthcare professionals poses a barrier to accessing modern contraceptives—mainly implants and intrauterine contraceptives (IUCs)—which require adequate facilities with infection prevention services, instruments for placement and removals, and commitment and expertise to follow-up women with side-effects. Additionally, provision of implants and IUC should be expanded or introduced in the immediate postpartum period. Working out logistics, decentralisation of services, mobilisation of the community, and provision of mobile services in rural areas are strategies among others to explore. There is no doubt that a great effort is needed, but family planning programmes are essential to support countries’ social and economic development and the wellbeing of women.

*Abstract of Comment published in Lancet Global Health 2019, May 17, 2019 by Luis Bahamondes, Alessandra Peloggia Department of Obstetrics and Gynaecology, University of Campinas Faculty of Medical Sciences, 13084-971 Campinas, SP, Brazil (LB, AP)

1 Ahmed S, Choi Y, Rimon JG, et al. Trends in contraceptive prevalence rates in sub-Saharan Africa since the 2012 London Summit on Family Planning: results from repeated cross-sectional surveys. Lancet Glob Health 2019; published online May 17. http://dx.doi.org/10.1016/S2214-109X(19)30200-1.