A new study by the Guttmacher Institute finds that within the developing world, the poorest countries are lagging far behind higher-income developing countries in meeting the demand for modern contraception. Between 2003 and 2012, the total number of women wanting to avoid pregnancy and in need of contraception increased from 716 million to 867 million, with growth concentrated among women in the 69 poorest countries where modern method use was already very low. The study, "Trends in Contraceptive Need and Use in Developing Countries in 2003, 2008, 2012: An Analysis of National Surveys" by Jacqueline E. Darroch and Susheela Singh, is published in the latest issue of The Lancet.

Roughly three-quarters (73%) of the 222 million women in developing countries who want to avoid a pregnancy but are not using a modern method now live in the poorest countries, compared with 67% in 2003. Furthermore, women in the poorest countries who want to avoid pregnancy are one-third as likely to be using a modern method as those living in higher-income developing countries.

The researchers found that between 2003 and 2012 in the developing world, overall modern contraceptive use increased from 71% to 74% among women wanting to avoid pregnancy, though rates varied greatly among subregions. Notable progress was made in Eastern Africa (31% to 46%), Southern Africa (75% to 83%), Southeast Asia (64% to 72%), Central America (71% to 77%) and South America (73% to 79%). In contrast, virtually no progress was made in the subregions with the lowest rates of use: in Middle Africa, contraceptive use increased only from 17% to 19% and in Western Africa, from 22% to 26%. Overall, in most subregions, modern contraceptive use grew more slowly between 2008 and 2012 than between 2003 and 2008.

Though the use of modern methods has risen in all regions over the last decade, far too many women still have an unmet need for such methods. Because of population growth and the growing desire for smaller families, the number of women with unmet need and the proportion of such women in the poorest developing countries are projected to increase even further.

"Unless the adequacy of family planning services improves more rapidly than it has in the past decade, the number of women with an unmet need for modern contraceptives will continue to rise, especially in the 69 poorest countries," said Jacqueline E. Darroch.

The authors also found that between 2003 and 2012, there was a shift away from sterilization (declining from 47% to 38% of all modern method use in developing countries) toward methods with higher failure rates, namely barrier methods (increasing from 7% to 13%) and injectables (from 6% to 9%). They argue that this trend calls for a greater focus on services that help women use reversible contraceptive methods consistently and correctly.

"In order to make substantial and sustainable progress, improving the quality of services must become a priority," noted Susheela Singh. "This includes providing adequate follow-up care, facilitating informed choice among methods, increasing public education and addressing the needs of young people for quality information and services."

"Trends in Contraceptive Need and Use in Developing Countries in 2003, 2008, 2012: An Analysis of National Surveys," by Jacqueline E. Darroch and Susheela Singh is currently available online and appears in a special theme issue of The Lancet published in advance of the 2013 Women Deliver conference. For a full copy of the article, please contact the journal directly.