Research Article: Use of Modern Contraception by the Poor Is Falling Behind

Date Published: February 6, 2007

Publisher: Public Library of Science

Author(s): Emmanuela Gakidou, Effy Vayena, Duff Gillespie

Abstract: BackgroundThe widespread increase in the use of contraception, due to multiple factors including improved access to modern contraception, is one of the most dramatic social transformations of the past fifty years. This study explores whether the global progress in the use of modern contraceptives has also benefited the poorest.Methods and FindingsDemographic and Health Surveys from 55 developing countries were analyzed using wealth indices that allow the identification of the absolute poor within each country. This article explores the macro level determinants of the differences in the use of modern contraceptives between the poor and the national averages of several countries. Despite increases in national averages, use of modern contraception by the absolute poor remains low. South and Southeast Asia have relatively high rates of modern contraception in the absolute poor, on average 17% higher than in Latin America. Over time the gaps in use persist and are increasing. Latin America exhibits significantly larger gaps in use between the poor and the averages, while gaps in sub-Saharan Africa are on average smaller by 15.8% and in Southeast Asia by 11.6%.ConclusionsThe secular trend of increasing rates of modern contraceptive use has not resulted in a decrease of the gap in use for those living in absolute poverty. Countries with large economic inequalities also exhibit large inequalities in modern contraceptive use. In addition to macro level factors that influence contraceptive use, such as economic development and provision of reproductive health services, there are strong regional variations, with sub-Saharan Africa exhibiting the lowest national rates of use, South and Southeast Asia the highest use among the poor, and Latin America the largest inequalities in use.

Partial Text: The use of safe and effective methods of contraception allows couples to determine the number and spacing of their pregnancies. Access to such methods was deemed a fundamental human right by the 1994 International Conference on Population and Development (ICPD)—a forum in which countries committed to work toward achieving the goal of universal access to reproductive health services, including access to effective contraceptives. Improving the use of effective contraception contributes to reducing the burden of reproductive ill health by decreasing mortality and morbidity of unwanted pregnancies [1,2]. Further, increasing contraceptive use reduces fertility, which, in turn, can play a crucial role in poverty reduction [3,4].

Average rates of use of modern contraceptive methods have increased over the past few decades in most developing countries. Our findings illustrate the differences in use by the poorest groups and how these differences relate to the estimated national average use.

Consistent with expected relationships for demand and access, the few studies undertaken to date with a focus on socioeconomic issues indicate that contraception rates are lower in poor countries and, within the limited set of countries analyzed, lower in poor women [21–25]. This study demonstrates that despite increases in national averages over time, the use of modern contraception by the absolute poor remains low, and the gaps in use across wealth quintiles persist and are increasing.



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