Despite significant advancements in contraceptive technologies over the last six decades, a substantial unmet need for family planning persists globally. Researchers are now calling for a renewed focus on addressing the gaps and overcoming the obstacles that contribute to high rates of unplanned pregnancies and abortions worldwide. A recent study highlights the disconnect between the availability of modern contraceptives and their consistent and effective use, pointing to a complex interplay of social, biological, and systemic factors.
A new paper published in The Lancet, authored by a team of researchers led by Deborah Anderson, PhD, a professor of medicine at Boston University’s Chobanian & Avedisian School of Medicine, examines global trends in contraception and identifies key areas for improvement. The research underscores the urgency of developing new contraceptive methods and ensuring equitable access for all individuals. The authors argue that providing improved contraception choices is not only a matter of public health but also a crucial step toward social justice, enhancing the well-being and economic stability of women and their families.
Global Disparities in Contraceptive Use
A 2024 United Nations survey revealed that 57% of women of reproductive age worldwide wish to avoid pregnancy. Among these women, an estimated 77% use a modern method of contraception, while approximately 15% use no contraception at all. These figures, however, mask significant regional disparities. In Africa, for instance, the use of modern contraceptives varies widely, from as low as 40% in some regions to as high as 83% in others. In contrast, high-income countries in Europe report contraceptive use rates between 77% and 89%. These differences highlight the influence of socioeconomic factors, healthcare infrastructure, and cultural norms on contraceptive access and uptake. The patchwork pattern of use demonstrates that a one-size-fits-all approach to family planning is insufficient and that interventions must be tailored to the specific needs of different populations.
Barriers to Access and Uptake
A variety of factors contribute to the gap between the desire to avoid pregnancy and the consistent use of contraception. For some, the side effects and health risks associated with hormonal contraceptives—such as pills, rings, implants, and injections—are a significant barrier. These methods, while highly effective, can cause a range of issues that lead women to discontinue their use. Other obstacles include infrequent sexual activity, religious beliefs, and individual or social opposition to contraception. In some communities, there is a stigma attached to being sexually active and using contraception, which can deter individuals, particularly young people, from seeking out these services.
Myths and Misconceptions
Fear of side effects, often fueled by myths and misinformation, is a major deterrent to contraceptive use. A qualitative study conducted in Kenya found that the fear of infertility was the most significant concern among young women, preventing many from using any form of contraception. These fears are often spread through social networks, where both real side effects and myths are discussed and amplified. The study also found that many young women did not consider condoms to be a form of contraception and associated their use with promiscuity. These findings underscore the importance of accurate information and education in overcoming barriers to contraceptive use.
Underserved Populations
Certain populations face unique and significant challenges in accessing and using contraception. Adolescent girls and young women, in particular, are disproportionately affected by restrictive laws and policies, a lack of education, financial hardship, and social stigma. Adolescent pregnancies are a global issue, but they are more prevalent in marginalized communities where access to reproductive health services is limited. Men, too, are an underserved population in the context of contraception. Cultural pressures to prove their fertility can discourage them from taking an active role in family planning.
The Need for Male Contraception
For over a century, there have been no new contraceptive methods introduced for men. Currently, only about 2% of men worldwide opt for a vasectomy, and roughly 20% of couples rely on male condoms as their primary method of contraception. This lack of options places the burden of contraception primarily on women and limits the ability of men to participate fully in family planning decisions. The development of new male contraceptives is a critical area of research. Promising candidates are in clinical trials, including a hormonal gel that suppresses sperm production and an oral pill that targets testicular enzymes involved in spermatogenesis. These new methods have the potential to revolutionize contraception and promote greater gender equity in reproductive health.
A Call for Renewed Investment and Research
To address the persistent gaps in contraception, researchers are calling for a multi-pronged approach that includes intensified research, increased financial support, and a focus on the needs of underserved populations. There is a need for more basic and clinical research, as well as social and behavioral science, to better understand the factors that influence contraceptive use. Governments, philanthropic organizations, and the private sector must all increase their investment in the development of new and improved contraceptive methods. The goal is to produce novel contraceptives that address some of the current gaps within the next decade. By prioritizing the needs of all individuals and working to overcome the existing barriers, it is possible to create a world where everyone has the power to decide if and when to have children.
