Planning Ahead: Evaluating trends in modern contraceptive prevalence and contraception's effect on fertility rates between 1990 and 2010

Abstract

As contraceptive prevalence is a key indicator of a country's population health and socioeconomic development, we seek to describe national and global trends in method-specific prevalence, and to quantify the effect of changes in contraceptive use on trends in fertility. We applied ensemble modeling to estimate contraceptive prevalence in 187 countries between 1990 and 2010. We used attributable risk calculations to quantify the impact of changes in contraceptive use on changes in fertility. We found that a slow yet steady increase in global modern contraceptive prevalence masked substantial differences between countries and ages groups. Moreover, modern contraceptive prevalence in adolescent girls remained low, despite the health and economic risks posed by pregnancy. Finally, we found that a 0.52 decline in the total fertility rate between 1990 and 2010 was attributable to increases in contraceptive prevalence. While modern contraception has substantially impacted birth rates in certain countries and age groups, there remains considerable room for progress among women in Sub-Saharan Africa and adolescent girls worldwide. Policymakers in settings with low prevalence should evaluate how programs from other countries can be applied in their own communities. Finally, funders, researchers, and policymakers should carefully assess why uptake of contraception has been low among certain groups in order to devise effective strategies for encouraging all women of reproductive age to use contraception.