Contraception Family planning enables people to make informed choices about their sexual and reproductive health. fact sheet Key facts ` According to 2017 estimates, 214 million women of reproductive age in developing regions have an unmet need for modern contraception who would like to delay or stop childbearing but are not using any method of contraception. ` Use of modern contraceptives in 2017, prevented an estimated 308 million unintended pregnancies, and meeting all women’s need for these methods would avert an additional 67 million annually. ` About 15 million adolescents use a modern contraceptive method, while 23 million have an unmet need for modern contraception and are thus at elevated risk of unintended pregnancy. ` Some contraceptive methods help prevent the transmission of HIV and other sexually transmitted infections. ` Family planning offers a range of potential benefits that encompass economic development, maternal and child health, education, and women’s empowerment. ` Family planning, most fundamentally, advances human rights. It reinforces people’s rights to determine the number and spacing of their children. Family planning allows people to attain their desired number of children and determine the spacing of pregnancies. It is achieved through information, education and the use of contraceptive methods. Benefits of family planning and contraception Family planning is one of the most cost-effective investments a country can make in its future (1). Family planning offers a range of potential benefits that encompass economic development, maternal and child health, education, and women’s empowerment. In almost all regions of the world, contraceptives are used by the majority of women in the reproductive age range (15-49 years) who are married or in a union. Worldwide in 2017, 63 per cent of these women were using some form of contraception. Contraceptive use was above 70 per cent in Europe, Latin America and the Caribbean, and Northern America, while being below 25 per cent in Middle and Western Africa (2). Promotion of family planning – and ensuring access to preferred contraceptive methods for women, girls and couples – is essential to securing the well-being and autonomy of women, while supporting the health and development of communities. The United Nations (UN) estimates that for every US$1 spent on family planning, from US$2 to US$6 can be saved from the reduced numbers of people needing other public services, such as immunizations, health care, education, and sanitation (3) Preventing maternal morbidity and mortality Contraception has clear health benefits, since the prevention of unintended pregnancies results in a subsequent decrease in maternal morbidity and mortality . Family planning allows spacing of pregnancies, delaying pregnancies in young girls who are at increased risk of health problems and death from early childbearing, and preventing pregnancies among older women who also face increased risks. Family planning enables women who wish to limit the size of their families to do so. By reducing rates of unintended pregnancies, contraception also reduces the need for unsafe abortion. Family planning is a low-cost and effective way to save lives. Contraceptive supplies cost, on average, about US$1.55 per user annually in developing countries. Contraception has clear health benefits, since the prevention of unintended pregnancies results in a subsequent decrease in maternal morbidity and mortality. Family planning allows spacing of pregnancies, delaying pregnancies in young girls who are at increased risk of health problems and death from early childbearing, and preventing pregnancies among older women who also face increased risks. Family planning enables women who wish to limit the size of their families to do so. By reducing rates of unintended pregnancies, contraception also reduces the need for unsafe abortion. Family planning is a low- cost and effective way to save lives. The global community generally agrees that family planning prevents maternal deaths by: • Reducing the number of times a woman is exposed to the risks of pregnancy (4,5), • Helping women avoid unintended and closely spaced pregnancies—a study in Bangladesh found that very short pregnancy intervals are linked with 7 times increased risk of induced abortion (6) • Helping women avoid more than 4 births, or births after 35 years of age (4) Furthermore, if all unmet need for modern contraception were satisfied in developing regions, there would be approximately a three-quarters decline in unintended pregnancies (from the current 89 million to 22 million per year), unplanned births (from 30 million to seven million per year) and induced abortions (from 48 million to 12 million per year) (7). The health benefits of preventing unintended pregnancies would be substantial. Compared with the current situation, fully meeting the unmet need for modern contraception would result in an estimated 76,000 fewer maternal deaths each year (7). Reducing unsafe abortion from unintended pregnancies Around the world, unintended and unwanted pregnancies are common challenges that women and couples face. About 44% of all pregnancies worldwide are unintended, and some 56% of unintended pregnancies end in an induced abortion (8). An estimated 56 million induced abortions took place annually in 2010-14, which translates to an annual abortion rate of 35 abortions for every 1000 women aged 15-44 years (9). Family planning can prevent many of these tragic deaths by reducing the number of unintended pregnancies with a higher risk of pregnancy complications and unsafe abortions. Reducing newborn and infant mortality Contraception can prevent closely spaced and ill- timed pregnancies and births, which contribute to some of the world’s highest infant mortality rates. Closely spaced births result in higher infant mortality: international survey data show that babies born less than two years after their next oldest brother or sister are twice as likely to die in the first year, as those born after an interval of three years. Infants of mothers who die as a result of giving birth also have a greater risk of death and poor health. Providing all pregnant women and their infants with the level of maternal and newborn health care recommended by the World Health Organization would reduce maternal deaths by 64%, to 112,000 per year, assuming no change in contraceptive use or in the number of unintended pregnancies. Newborn deaths would drop by 76%, to 655,000 (7). If full care for all pregnant women and newborns were combined with full provision of modern contraception to women who want to avoid pregnancy, maternal deaths would drop from 308,000 to 84,000 per year, and newborn deaths would drop from 2.7 million to 538,000 per year (7). Helping to prevent HIV/AIDS Contraception reduces the risk of unintended pregnancies among women living with HIV, resulting in fewer infected babies and orphans. In addition, male and female condoms provide dual protection against unintended pregnancies and against STIs including HIV. While approximately 1 in 4 women in sub-Saharan Africa has an unmet need for family planning, studies have shown that women living with HIV have higher unmet need for family planning and reproductive health services than the general population, in part due to lack of investment in integrated family planning and HIV services (10). Another recent study found that if the needs of women with HIV for modern contraceptive methods and antiretroviral medication were both fully met, HIV transmission from mothers to newborns would be nearly eliminated—reduced by 93% annually (11). Empowering people and enhancing education Family planning and contraception enables people to make informed choices about their sexual and reproductive health, and creates an opportunity for women for enhanced education and participation in society, including paid employment. Family planning can help women and girls, especially those who have become mothers, stay in school, become literate, learn a trade, start a business, or otherwise achieve their educational and employment goals. Early and unintended pregnancy can be both a cause and a consequence of dropping out of school (12). Reducing adolescent pregnancies Preventing unintended pregnancy is essential to improving adolescents’ sexual and reproductive health and their social and economic well-being (13). Pregnant adolescents are more likely to have preterm and low birth-weight babies. Babies born to adolescents have higher rates of neonatal mortality. Many adolescent girls who become pregnant have to leave school. This has long-term implications for them as individuals, their families and communities (14). Contributes to Economic Growth Rapid fertility decline, which is linked to increased family planning use, lowers the ratio of dependents to income earners. This results in a higher proportion of wage earners and leads to national savings. With supportive socioeconomic policies and attention to equity, countries can then experience a “demographic dividend” of rapid economic growth. Estimates indicate that the demographic dividend effect of family planning is most pronounced in countries with current high fertility, where rates of return on economic productivity and potential lifetime earnings from improved availability and uptake of contraception could exceed 8% of GDP by 2035 (15). Who provides contraception? It is important that contraceptive methods are widely available and easily accessible to anyone who is sexually active, including adolescents Midwives are trained to provide (where authorized) locally available and culturally acceptable contraceptive methods. Other trained health workers, for example community health workers, also provide counseling and some methods, such as pills and condoms. For methods such as sterilization, women and men need to be referred to a clinician. WHO has identified which cadre of lower and midlevel health workers can provide contraceptive services safely and effectively, through task shifting and task sharing as part of its Guideline on optimizing the roles of health workers. Global unmet need for contraception As of 2017, 1.6 billion women of reproductive age (15–49) live in developing regions. About half of them (885 million women) want to avoid a pregnancy; of this subset of women, about three-quarters (671 million) are using modern contraceptives (7). The proportion of women who have an unmet need for modern contraception is highest in Sub-Saharan Africa (21%), while the largest absolute number (70 million women) live in Southern Asia. Together, Sub- Saharan Africa and Southern Asia account for 39% of all women in developing regions who want to avoid pregnancy and 57% of women with an unmet need for modern contraception (7). Reasons for this include: • limited access to contraception, particularly among young people, poorer segments of populations, or unmarried people; • limited choice of methods; For more information, please contact: Department of Reproductive Health and Research World Health Organization Avenue Appia 20, CH-1211 Geneva 27, Switzerland E-mail: reproductivehealth@who.int www.who.int/reproductivehealth WHO/RHR/14.07 Rev.1 © World Health Organization 2019. Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence. • fear or experience of side-effects; • cultural or religious opposition; • poor quality of available services; • gender-based barriers. The unmet need for contraception remains too high. This inequality is fueled by both a growing population, and a shortage of services. WHO response Achieving universal access and the realization of sexual and reproductive health services will be essential to fulfil the pledge of the 2030 Agenda for Sustainable Development that “no one will be left behind” (2). It will require intensified support for contraceptive services, including through the implementation of effective government policies and programmes. WHO is working to promote family planning and contraception by producing evidence-based guidelines on safety and service delivery of contraceptive methods and on ensuring human rights in contraceptive programmes, and by developing quality standards and providing pre-qualification of contraceptive commodities. WHO further assists countries to adapt and implement these tools to strengthen contraceptive policies and programmes. Additionally, WHO participates in developing new contraceptive technologies to and leads and conducts implementation research for expanding access to and strengthening delivery contraceptive information and services. References 1. Starbird E, Norton M, Marcus R. Investing in family planning: key to achieving the sustainable development goals. Glob Health Sci Pract. 2016;4(2):191-210. http:// dx.doi.org/10.9745/GHSP-D-15-00374 2. United Nations, Department of Economic and Social Affairs, Population Division (2017). World Family Planning 2017 - Highlights (ST/ESA/SER.A/414). 3. UN Population Division. 2009. “What Would It Take to Accelerate Fertility Decline in the Least Developed Countries?” Policy Brief 2009/1, United Nations, New York. 4. Stover J, Ross J. How increased contraceptive use has reduced maternal mortality Matern Child Health J. 2010;14(5):687–695. doi:10.1007/s10995-009-0505-y. pmid:19644742 5. Cleland J, Conde-Agudelo A, Peterson H, Ross J, Tsui A. Contraception and health. Lancet. 2012;380(9837):149– 156. doi:10.1016/S0140-6736(12)60609-6. pmid:22784533 6. DaVanzo J, Hale L, Razzaque A, Rahman M. Effects of interpregnancy interval and outcome of the preceding pregnancy on pregnancy outcomes in Matlab, Bangladesh. BJOG. 2007;114(9):1079–1087. doi:10.1111/j.1471- 0528.2007.01338.x. 7. Darroch JE, Sully E. Adding It Up: Investing in Contraception and Maternal and Newborn Health, 2017. New York. Guttmacher Institute, 2017. 8. Bearak J Popinchalk A Alema A Sedgh G. Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model. Lancet. 2018; 6: e380-e389 9. Sedgh G Bearak J Singh S et al. Special tabulations of updated data from Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends. Lancet. 2016; 388: 258-267 10. Petruny T, Minichiello SN, McDowell M, Wilcher R. Meeting the contraceptive needs of key populations affected by HIV in Asia: an unfinished agenda. AIDS Res Treat. 2012;2012:792649. doi:10.1155/2012/792649. pmid:22991656 11. Singh S, Darroch J, Ashford L. Adding it up: the costs and benefits of investing in sexual and reproductive health 2014. New York: Guttmacher Institute; 2014. 12. United Nations Educational, Scientific and Cultural Organization (UNESCO). Developing an education sector response to early and unintended pregnancy. Paris (France): UNESCO; 2014. Available from: http://unesdoc. unesco.org/images/0023/002305/230510E.pdf 13. Jacqueline E. Darroch, Vanessa Woog, Akinrinola Bankoleand, Lori S. Ashford. Adding It Up: Costs and Benefits of Meeting the Contraceptive Needs of Adolescents, New York: Guttmacher Institute, 2016, https://www.guttmacher.org/report/adding-it-meeting- contraceptive-needs-of-adolescents. 14. United Nations Population Fund (UNFPA) [Internet]. New York: UNFPA. Population and poverty; 2014. Available from: http://www.unfpa.org/resources/population-and- poverty 15. Stenberg K, Axelson H, Sheehan P, Anderson I, Gülmezoglu AM, Temmerman M, et al. Study Group for the Global Investment Framework for Women’s Children’s Health. Advancing social and economic development by investing in women’s and children’s health: a new Global Investment Framework. Lancet. 2014;383(9925):1333–1354.
Contraception Family planning enables people to make informed choices about their sexual and reproductive health. fact sheet Key facts ` An estimated 222 million women in developing countries would like to delay or stop childbearing but are not using any method of contraception. ` Contraceptive use prevented 218 million unintended pregnancies in developing countries in 2012, and, averting 55 million unplanned births, 138 million abortions (of which 40 million are unsafe), 25 million miscarriages and 118,000 maternal deaths. ` Some family contraceptive methods help prevent the transmission of HIV and other sexually transmitted infections. ` Programmes should ensure that the contraceptive needs of such vulnerable groups as adolescent women, poor women and rural women are met and that inequities in information and access are reduced. ` Family planning reinforces people’s rights to determine the number and spacing of their children. Family planning allows people to attain their desired number of children and determine the spacing of pregnancies. It is achieved through information, education and the use of contraceptive methods. Benefits of family planning and contraception Promotion of family planning – and ensuring access to preferred contraceptive methods for women, girls and couples – is essential to securing the well-being and autonomy of women, while supporting the health and development of communities. Preventing maternal morbidity and mortality Contraception has clear health benefits, since the prevention of unintended pregnancies results in a subsequent decrease in maternal morbidity and mortality . Family planning allows spacing of pregnancies, delaying pregnancies in young girls who are at increased risk of health problems and death from early childbearing, and preventing pregnancies among older women who also face increased risks. Family planning enables women who wish to limit the size of their families to do so. By reducing rates of unintended pregnancies, contraception also reduces the need for unsafe abortion. Family planning is a low-cost and effective way to save lives. Contraceptive supplies cost, on average, about US$1.55 per user annually in developing countries. Reducing unsafe abortion from unintended pregnancies An estimated 20 million unsafe abortions take place each year— resulting in 67,000 deaths annually, mostly in developing countries. Family planning can prevent many of these tragic deaths by reducing the number of unintended pregnancies with a higher risk of pregnancy complications and unsafe abortions. Reducing infant mortality Contraception can prevent closely spaced and ill- timed pregnancies and births, which contribute to some of the world’s highest infant mortality rates. Closely spaced births result in higher infant mortality: international survey data show that babies born less than two years after their next oldest brother or sister are twice as likely to die in the first year, as those born after an interval of three years. Infants of mothers who die as a result of giving birth also have a greater risk of death and poor health. Helping to prevent HIV/AIDS Contraception reduces the risk of unintended pregnancies among women living with HIV, resulting in fewer infected babies and orphans. In addition, male and female condoms provide dual protection against unintended pregnancies and against STIs including HIV. Contraception is an effective approach to reducing costs associated with HIV/AIDS: Savings are estimated at US$25 at HIV/AIDS care and treatment facilities, for every dollar spent on family planning. Contraceptive use prevents more than 577,000 unintended pregnancies to HIV-infected women each year in sub-Saharan Africa; if all women in the region who did not wish to get pregnant used contraception, another 533,000 (additional) unintended pregnancies to HIV-positive women could be averted annually. Empowering people and enhancing education Family planning and contraception enables people to make informed choices about their sexual and reproductive health, and creates an opportunity for women for enhanced education and participation in society, including paid employment. Additionally, having smaller families allows parents to invest more in each child. Children with fewer siblings tend to stay in school longer than those with many siblings. Reducing adolescent pregnancies Pregnant adolescents are more likely to have preterm and low birth-weight babies. Babies born to adolescents have higher rates of neonatal mortality. Many adolescent girls who become pregnant have to leave school. This has long-term implications for them as individuals, their families and communities. Slowing population growth Family planning is key to slowing unsustainable population growth and the resulting negative impacts on the economy, environment, and national and regional development efforts Who provides contraception? It is important that contraceptive methods are widely available and easily accessible to anyone who is sexually active, including adolescents Midwives are trained to provide (where authorised) locally available and culturally acceptable contraceptive methods. Other trained health workers, for example community health workers, also provide counseling and some methods, such as pills and condoms. For methods such as sterilization, women and men need to be referred to a clinician. WHO has identified which cadre of lower and mid- level health workers can provide contraceptive services safely and effectively, through task shifting and task sharing as part of its Guideline on optimizing the roles of health workers to attain Millennium Development Goals (MDG) 4 and 5. Contraceptive use Contraceptive use has increased in many parts of the world, especially in Asia and Latin America, but continues to be low in sub-Saharan Africa. Globally, use of modern contraception has risen from 48% in 1990 to 57% in 2012. Regionally, the proportion of women aged 15–49 reporting use of a modern contraceptive method has risen minimally or plateaued between 2008 and 2012. In Africa it went from 24% to 27%, in Asia and Latin America and the Caribbean it has remained at 61%, and 67% respectively. There is significant variation among countries in these regions. Use of contraception by men makes up a relatively small subset of the above prevalence rates. The modern contraceptive methods for men are limited to male condoms and sterilization (vasectomy). Global unmet need for contraception An estimated 222 million women in developing countries would like to delay or stop childbearing but are not using any method of contraception. Reasons for this include: • limited access to contraception, particularly among young people, poorer segments of populations, or unmarried people; • limited choice of methods; • fear or experience of side-effects; • cultural or religious opposition; • poor quality of available services; • gender-based barriers. The unmet need for contraception remains too high. This inequiality is fueled by both a growing population, and a shortage of services. In Africa, 53% of women of reproductive age have an unmet need for modern contraception. In Asia, and Latin America and the Caribbean – regions with relatively high contraceptive prevalence – the levels of unmet need are 21% and 22%, respectively. WHO response WHO is working to promote family planning and contraception by producing evidence-based guidelines on safety and service delivery of contraceptive methods and on ensuring human rights in contraceptive programmes, and by developing quality standards and providing pre-qualification of contraceptive commodities. WHO further assists countries to adapt and implement these tools to strengthen contraceptive policies and programmes. Additionally, WHO participates in developing new contraceptive technologies to and leads and conducts implementation research for expanding access to and strengthening delivery contraceptive information and services. References Singh S and Darroch JE, Adding It Up: Costs and Benefits of Contraceptive Services—Estimates for 2012, New York: Guttmacher Institute and United Nations Population Fund (UNFPA), 2012, http://www. guttmacher.org/pubs/AIU-2012-estimates.pdf Cates W. Family Planning: the essential link to achieving all eight Millennium Development Goals. Contraception 2010;81(6):460-61. Martine Collumbien, Makeda Gerressu, and John Cleland, “Non-Use and Use of Ineffective Methods of Contraception,” in Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors (Geneva: World Health Organization, 2004): 1255-1320. Heidi W. Reynolds, M.J. Steiner, and Willard Cates Jr., “Contraception’s Proved Potential to Fight HIV,” Sexually Transmitted Infections 81 (2005): 184. Ruth Levine et al., “Contraception,” in Disease Control Priorities in Developing Countries, 2d ed., ed. Dean T. Jamison et al. (New York: The World Bank and Oxford University Press, 2006): 1082. Save the Children, State of the World’s Mothers 2004: Children Having Children, accessed online at www. savethechildren.org Photo: UNAIDS WHO/RHR/14.07 © World Health Organization 2014 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO web site (www.who.int/about/licensing/copyright_form/en/index.html). All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published materi- al is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. For more information, please contact: Department of Reproductive Health and Research World Health Organization Avenue Appia 20, CH-1211 Geneva 27, Switzerland E-mail: reproductivehealth@who.int www.who.int/reproductivehealth References Singh S and Darroch JE, Adding It Up: Costs and Benefits of Contraceptive Services—Estimates for 2012, New York: Guttmacher Institute and United Nations Population Fund (UNFPA), 2012, http://www.guttmacher.org/ pubs/AIU-2012-estimates.pdf Cates W. Family Planning: the essential link to achieving all eight Millennium Development Goals. Contraception 2010;81(6):460-61. Martine Collumbien, Makeda Gerressu, and John Cleland, “Non-Use and Use of Ineffective Methods of Contraception,” in Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors (Geneva: World Health Organization, 2004): 1255-1320. Heidi W. Reynolds, M.J. Steiner, and Willard Cates Jr., “Contraception’s Proved Potential to Fight HIV,” Sexually Transmitted Infections 81 (2005): 184. Ruth Levine et al., “Contraception,” in Disease Control Priorities in Developing Countries, 2d ed., ed. Dean T. Jamison et al. (New York: The World Bank and Oxford University Press, 2006): 1082. Save the Children, State of the World’s Mothers 2004: Children Having Children, accessed online at www. savethechildren.org
Contraception Family planning enables people to make informed choices about their sexual and reproductive health. fact sheet Key facts ` An estimated 222 million women in developing countries would like to delay or stop childbearing but are not using any method of contraception. ` Contraceptive use prevented 218 million unintended pregnancies in developing countries in 2012, and, averting 55 million unplanned births, 138 million abortions (of which 40 million are unsafe), 25 million miscarriages and 118,000 maternal deaths. ` Some family contraceptive methods help prevent the transmission of HIV and other sexually transmitted infections. ` Programmes should ensure that the contraceptive needs of such vulnerable groups as adolescent women, poor women and rural women are met and that inequities in information and access are reduced. ` Family planning reinforces people’s rights to determine the number and spacing of their children. Family planning allows people to attain their desired number of children and determine the spacing of pregnancies. It is achieved through information, education and the use of contraceptive methods. Benefits of family planning and contraception Promotion of family planning – and ensuring access to preferred contraceptive methods for women, girls and couples – is essential to securing the well-being and autonomy of women, while supporting the health and development of communities. Preventing maternal morbidity and mortality Contraception has clear health benefits, since the prevention of unintended pregnancies results in a subsequent decrease in maternal morbidity and mortality . Family planning allows spacing of pregnancies, delaying pregnancies in young girls who are at increased risk of health problems and death from early childbearing, and preventing pregnancies among older women who also face increased risks. Family planning enables women who wish to limit the size of their families to do so. By reducing rates of unintended pregnancies, contraception also reduces the need for unsafe abortion. Family planning is a low-cost and effective way to save lives. Contraceptive supplies cost, on average, about US$1.55 per user annually in developing countries. Reducing unsafe abortion from unintended pregnancies An estimated 20 million unsafe abortions take place each year— resulting in 67,000 deaths annually, mostly in developing countries. Family planning can prevent many of these tragic deaths by reducing the number of unintended pregnancies with a higher risk of pregnancy complications and unsafe abortions. Reducing infant mortality Contraception can prevent closely spaced and ill- timed pregnancies and births, which contribute to some of the world’s highest infant mortality rates. Closely spaced births result in higher infant mortality: international survey data show that babies born less than two years after their next oldest brother or sister are twice as likely to die in the first year, as those born after an interval of three years. Infants of mothers who die as a result of giving birth also have a greater risk of death and poor health. Helping to prevent HIV/AIDS Contraception reduces the risk of unintended pregnancies among women living with HIV, resulting in fewer infected babies and orphans. In addition, male and female condoms provide dual protection against unintended pregnancies and against STIs including HIV. Contraception is an effective approach to reducing costs associated with HIV/AIDS: Savings are estimated at US$25 at HIV/AIDS care and treatment facilities, for every dollar spent on family planning. Contraceptive use prevents more than 577,000 unintended pregnancies to HIV-infected women each year in sub-Saharan Africa; if all women in the region who did not wish to get pregnant used contraception, another 533,000 (additional) unintended pregnancies to HIV-positive women could be averted annually. Empowering people and enhancing education Family planning and contraception enables people to make informed choices about their sexual and reproductive health, and creates an opportunity for women for enhanced education and participation in society, including paid employment. Additionally, having smaller families allows parents to invest more in each child. Children with fewer siblings tend to stay in school longer than those with many siblings. Reducing adolescent pregnancies Pregnant adolescents are more likely to have preterm and low birth-weight babies. Babies born to adolescents have higher rates of neonatal mortality. Many adolescent girls who become pregnant have to leave school. This has long-term implications for them as individuals, their families and communities. Slowing population growth Family planning is key to slowing unsustainable population growth and the resulting negative impacts on the economy, environment, and national and regional development efforts Who provides contraception? It is important that contraceptive methods are widely available and easily accessible to anyone who is sexually active, including adolescents Midwives are trained to provide (where authorised) locally available and culturally acceptable contraceptive methods. Other trained health workers, for example community health workers, also provide counseling and some methods, such as pills and condoms. For methods such as sterilization, women and men need to be referred to a clinician. WHO has identified which cadre of lower and mid- level health workers can provide contraceptive services safely and effectively, through task shifting and task sharing as part of its Guideline on optimizing the roles of health workers to attain Millennium Development Goals (MDG) 4 and 5. Contraceptive use Contraceptive use has increased in many parts of the world, especially in Asia and Latin America, but continues to be low in sub-Saharan Africa. Globally, use of modern contraception has risen from 48% in 1990 to 57% in 2012. Regionally, the proportion of women aged 15–49 reporting use of a modern contraceptive method has risen minimally or plateaued between 2008 and 2012. In Africa it went from 24% to 27%, in Asia and Latin America and the Caribbean it has remained at 61%, and 67% respectively. There is significant variation among countries in these regions. Use of contraception by men makes up a relatively small subset of the above prevalence rates. The modern contraceptive methods for men are limited to male condoms and sterilization (vasectomy). Global unmet need for contraception An estimated 222 million women in developing countries would like to delay or stop childbearing but are not using any method of contraception. Reasons for this include: • limited access to contraception, particularly among young people, poorer segments of populations, or unmarried people; • limited choice of methods; • fear or experience of side-effects; • cultural or religious opposition; • poor quality of available services; • gender-based barriers. The unmet need for contraception remains too high. This inequiality is fueled by both a growing population, and a shortage of services. In Africa, 53% of women of reproductive age have an unmet need for modern contraception. In Asia, and Latin America and the Caribbean – regions with relatively high contraceptive prevalence – the levels of unmet need are 21% and 22%, respectively. WHO response WHO is working to promote family planning and contraception by producing evidence-based guidelines on safety and service delivery of contraceptive methods and on ensuring human rights in contraceptive programmes, and by developing quality standards and providing pre-qualification of contraceptive commodities. WHO further assists countries to adapt and implement these tools to strengthen contraceptive policies and programmes. Additionally, WHO participates in developing new contraceptive technologies to and leads and conducts implementation research for expanding access to and strengthening delivery contraceptive information and services. References Singh S and Darroch JE, Adding It Up: Costs and Benefits of Contraceptive Services—Estimates for 2012, New York: Guttmacher Institute and United Nations Population Fund (UNFPA), 2012, http://www. guttmacher.org/pubs/AIU-2012-estimates.pdf Cates W. Family Planning: the essential link to achieving all eight Millennium Development Goals. Contraception 2010;81(6):460-61. Martine Collumbien, Makeda Gerressu, and John Cleland, “Non-Use and Use of Ineffective Methods of Contraception,” in Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors (Geneva: World Health Organization, 2004): 1255-1320. Heidi W. Reynolds, M.J. Steiner, and Willard Cates Jr., “Contraception’s Proved Potential to Fight HIV,” Sexually Transmitted Infections 81 (2005): 184. Ruth Levine et al., “Contraception,” in Disease Control Priorities in Developing Countries, 2d ed., ed. Dean T. Jamison et al. (New York: The World Bank and Oxford University Press, 2006): 1082. Save the Children, State of the World’s Mothers 2004: Children Having Children, accessed online at www. savethechildren.org Photo: UNAIDS WHO/RHR/14.07 © World Health Organization 2014 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO web site (www.who.int/about/licensing/copyright_form/en/index.html). All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published materi- al is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. For more information, please contact: Department of Reproductive Health and Research World Health Organization Avenue Appia 20, CH-1211 Geneva 27, Switzerland E-mail: reproductivehealth@who.int www.who.int/reproductivehealth References Singh S and Darroch JE, Adding It Up: Costs and Benefits of Contraceptive Services—Estimates for 2012, New York: Guttmacher Institute and United Nations Population Fund (UNFPA), 2012, http://www.guttmacher.org/ pubs/AIU-2012-estimates.pdf Cates W. Family Planning: the essential link to achieving all eight Millennium Development Goals. Contraception 2010;81(6):460-61. Martine Collumbien, Makeda Gerressu, and John Cleland, “Non-Use and Use of Ineffective Methods of Contraception,” in Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors (Geneva: World Health Organization, 2004): 1255-1320. Heidi W. Reynolds, M.J. Steiner, and Willard Cates Jr., “Contraception’s Proved Potential to Fight HIV,” Sexually Transmitted Infections 81 (2005): 184. Ruth Levine et al., “Contraception,” in Disease Control Priorities in Developing Countries, 2d ed., ed. Dean T. Jamison et al. (New York: The World Bank and Oxford University Press, 2006): 1082. Save the Children, State of the World’s Mothers 2004: Children Having Children, accessed online at www. savethechildren.org