While much of the unmet demand for contraception has been met, much progress remains to be made in this area. In the article, "Population Policy Options..." in your assigned reading, Bongaarts estimates that future population growth could be diminished by ~ 1/3 by meeting remaining unmet demand for contraception. For example, it is estimated that 1 in 6 married women in developing nations outside China has unmet need for contraception (about 100 million women). The highest unmet need (about 25% of women) is in subSaharan Africa and some other regions on that continent. In subSaharan Africa, only about 21 % of married women use any form of contraception at all, and in Ethiopia, 10% of women surveyed had never heard of contraception (ZPG Reporter fall '07).
Why is there unmet need? Many reasons, including lack of money for supplies and for travel to obtain the supplies, pressures from spouses and families to have many children, inconvenience or side effects, lack of information about available methods, and lack of access to family planning resources.
This unmet demand results in many unplanned births and also in a huge number of abortions. For example, in 2002, it was estimated that about one out of four births (25%) was unplanned, and, because many of these terminate in abortions, unplanned pregnancies lead to about 25 million abortions per year!
While the proportion of women using contraception has increased in developing countries over recent decades, there are now more women (in an absolute sense, rather than as a proportion) NOT using contraception than there were three decdes ago simply because population has grown so much over that time.
It was estimated in 2001 that, if all unmet demands for contraception in lesser developed countries could be met, with the developed nations paying about 2/3 of the costs, as they agreed to do in the last UN Conference on Population, it would cost about $3 billion per year. That sounds huge, but it translates into a cost per developed-world taxpayer of about the equivalent of one can of Coca cola every 6 months. (This estimate according to the book, "Beyond Six Billion: Forecasting the World's Poplation" edited by J. Bongaarts and R.A. Buato, National Academy Press.)
Consider this also; in 2002, the UN estimated that, by 2015, contraceptive needs in developing countries will increase by over 40%, largely because of the increases in the number of women of reproductive age that will populate these areas. If we have so much unmet demand already, it is hard to fathom how the increase in demand will be met.
NEEDS IN THE US:
Lest we assume that unmet need for contraception exists only in lesser developed nations, the organization "Zero Population Growth" and the Alan Guttmacher Institute estimate that 60% of all pregnancies in the US are unplanned [I have read 50% elsewhere.]. (They estimate that 75-80% of all teen pregnancies in the US are unplanned.) This translates into 3.6 million unplanned pregnancies per year in the US. Of these, 43% result in births, 44% are aborted, and 13% miscarry, resulting in 1.5 million children born each year in the US as result of unintended pregnancies, and about that many abortions per year as well. Either of these are more than the number of legal + illegal immigrants combined! Clearly, better access to and education about contraception are needed here in the US as well as in 3rd world countries. These rates of unplanned -- and teen -- pregnancies in the U.S. are about twice as high as rates in other developed nations.
A program in a Baltimore, MD highschool demonstrated the importance of access to contraception. The program made condoms and other forms of contraception available for free to students and saw the pregnancy rate drop by 30% in 28 months! (ZPG Reporter, fall '07).
As a counter example, the state of Texas receives about twice as much Federal funding as any other state for "abstinence only" education, yet has the highest rate of repeat births to teens of any state (24% of teens who have already had one baby have another in TX, compared to a national average for repeat births of 20%) [ZPG Reporter Dec. '07).
In the US, there are ~ 400,000 births to teen mothers per year (2006 ZPG Reporter). THE US has the highest rate of teen pregnancy of any developed nation; in the US ~ 22% of women < 20 years old have babies, while ~ 33% of women that age become pregnant (the difference in those percentages is basically because of abortions...). For comparison, in Sweden, only ~ 4% of women 20 years old or younger are mothers; in Canada, the percentage is ~ 11%.
It is curious that virtually all health insurance plans in the US cover costs of prenatal care and childbirth, and most also cover sterilization and abortion, but a much smaller fraction cover costs of contraception. As of 2003, it was estimated that only 15% of health insurance plans in the US covered all five FDA-approved prescription contraceptives the pill, diaphragm, IUD, Norplant, and Depo-provera) and only 50% covered any method at all (ZPG Reporter, fall '03). Also, oddly enough, many insurance companies offer coverage for the drug "Viagra," as a treatment for impotence, while not necessarily covering costs of contraception. By fall 2003, however, 21 states in the U.S. had passed "contraceptive equality laws," which require that all insurance providers that cover prescription drugs also cover all FDA-approved contraceptive devices and drugs. Oregon passed such a law in 2007, jlining the ~ 1/2 of US states with such laws. The Alan Guttmacher Institute estimates that adding contraceptive coverage to the average health plan would cost employers about $2.00 per employee per month; it seems that this cost would rapidly be recouped when unplanned pregnancies and their complications are avoided.
As of fall 2003, 21 states had "contraceptive equity laws" which require that all insurance providers that cover prescription drugs also cover all FDA-approved contraceptive drugs and devices. OR passed such a law too, and as of 2008, over 50% of states have such laws.
(To move to the next section in these notes (on decreasing demand for large families), click the box at the bottom of the page labeled ">>." To return to the previous section on trends in the developing world, click the box labeled "<<" and to return to the master directory for the BI301 web site, click the box labeled "CONTENTS.")
This page maintained by Patricia Muir at Oregon State University. Last updated Nov. 3, 2008.