Reproductive health interventions: latest situation and change over time
Modern contraceptive use
84 low- and middle-income study countries, DHS and MICS 2005–2013
In half of study countries, at least one in three women reported using modern methods of contraception; nearly one quarter of study countries reported levels of modern contraceptive use of 50% or higher. Use was much lower (10% or less) in one tenth of study countries. Modern contraceptive use across study countries ranged from 1.2% in Somalia to 75.1% in Thailand.
Latest situation: by education
71 low- and middle-income study countries, DHS and MICS 2005–2013
The use of modern methods of contraception tended to be lowest in women with no education, and generally increased across education levels. This pattern was evident in many of the study countries. A comparison of the median values of contraceptive prevalence for each of the three education subgroups illustrates greater prevalence of modern contraceptive use in subgroups with higher levels of education. Ethiopia, for instance, demonstrated a gradient pattern of contraceptive use across education subgroups.
The gap in modern contraceptive use between the most- and least-educated women was substantial in many study countries. For example, in half of study countries, the prevalence of modern contraceptive use in the secondary school or higher subgroup exceeded the prevalence in the no education subgroup by over 14 percentage points. In the Central African Republic, Guinea-Bissau and Nigeria, contraceptive use among women in the highest education category was at least 10 times greater than that among women with no education.
Large education-related inequalities in modern contraceptive use were not reported by all countries. Some countries reported relatively low levels of education-related inequality: Cambodia and the Dominican Republic, for example, had a difference of less than 1 percentage point between contraceptive use in the secondary school or higher subgroup and the no education subgroup. Bhutan, Maldives, Nepal and Viet Nam demonstrated higher usage among women with no education, with contraceptive use at least 7.5 percentage points higher in the no education subgroup than in the secondary school or higher subgroup. The magnitude of inequality in modern contraceptive use did not appear to be associated with the national level of usage. For example, the overall prevalence of modern contraceptive use averaged around 35% in both the Plurinational State of Bolivia and Cambodia; whereas disaggregated data for Cambodia showed little education-related inequality, the Plurinational State of Bolivia reported a marked education-related difference in contraceptive use (usage was 21.0 percentage points greater among women with secondary schooling or higher than women with no education).
Change over time: by education
38 low- and middle-income study countries, DHS and MICS 1995–2004 and 2005–2013
The majority of low- and middle-income study countries included in change-over-time analyses reported national increases in modern contraceptive use between the two survey periods. Rwanda reported an especially elevated increase in the national prevalence of modern contraceptive use of 4.1 percentage points per year.
In most countries, the pace of increase in contraceptive use tended to be faster – or otherwise favourable – among women with no education than in women with secondary schooling or higher. In Zambia, for instance, the annual absolute increase was faster in the no education subgroup (1.9 percentage points per year) than the secondary school or higher subgroup (1.3 percentage points per year), resulting in a positive annual absolute excess change of 0.6 percentage points.
The median absolute increase in contraceptive use across all study countries was 0.7 percentage points per year in the no education subgroup, and 0.2 percentage points per year in the secondary school or higher subgroup; the median absolute excess change was positive, reflecting a tendency for faster increases in contraceptive use among women in the no education subgroup.
Other key findings: inequality in reproductive health interventions
- In over half of study countries, the demand for family planning satisfied was at least 17 percentage points higher among women with secondary school or higher education than in women with no education.
- Nearly one third of study countries reported considerable economic-related inequality in the use of modern and traditional contraception, with prevalence values at least twice as high in the richest compared with the poorest quintile of households.
- Over a 10-year period, most study countries demonstrated increasing national levels of demand for family planning satisfied. In nearly half of study countries, increased national prevalence was realized alongside faster improvements in the poorest subgroups compared with the richest subgroups.
For more information about this feature story, including considerations for interpreting the results, please refer to the report State of inequality: reproductive, maternal, newborn and child health.