Reducing Risks by Offering Contraceptive Services

In developing countries, women continue to die because they lack access to contraception. Each pregnancy multiplies a woman’s chance of dying from complications of pregnancy or childbirth. Maternal mortality rates are particularly high for young and poor women, those who have least access to contraceptive services.

Changing Attitudes: Family Planning in Ethiopia

Scaling-up Access to Long-term Family Planning Methods in Northern Ethiopia

When IUCDs were offered at the clinic five years ago, only about 16 were requested for the whole year. But as word has spread about this method, which is cheap, reversible, safe and effective for most women, demand has increased. Now an average of 75 women are getting IUCDs every month.

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Ethiopian Family in Crisis: Ayatu Nure and His 78 Children

At first glance, this unlikely family may appear carefree--but a closer look reveals that many of Ayatu’s children are suffering. “I have a big problem. I cannot afford their food, clothing, school materials, and rent. There is no more property and I’m getting tired.”

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It is estimated that one in three deaths related to pregnancy and childbirth could be avoided if all women had access to contraceptive services.  However, in many countries, funding for family planning has been curtailed, and many low-income countries find themselves without adequate supplies of contraceptives.

Reducing unwanted pregnancies

Expanding access to client-centred information and services, where a range of effective contraceptive methods is offered and responsive counselling provided, reduces the number of unplanned pregnancies. These unintended pregnancies often lead to sub-optimal pregnancy care, unsafe abortions and overwhelmed mothers. As many as 50 per cent of pregnancies are unplanned, and 25 per cent are unwanted. The unwanted pregnancies are disproportionately among young, unmarried girls who often lack access to contraception.

Unmet need leads to unsafe abortions

More than one quarter of pregnancies worldwide, about 52 million annually, end in abortion. Many of these procedures are clandestine, performed under unsafe conditions. About 13 per cent of maternal deaths are attributed to unsafe abortions, coupled with lack of skilled follow-up. Some 23,000 women each year die as a result. The high level of unmet need for quality contraceptive services and the corresponding number of unintended pregnancies — is a key reason why so many seek out abortions. Young women are especially vulnerable.

Contraceptive use stalled in some low-income countries

Some 222 million women who want to delay or cease childbearing—roughly one in six women of reproductive age—are in need of effective contraceptive methods. Substantial proportions of women in every country—more than 50 per cent in some—say their last birth was unwanted or mistimed.

The use of modern contraceptive methods, including voluntary sterilization, has generally increased rapidly over the past 30 years, especially in countries with strong family planning programmes. However, progress has stalled in many low-income countries. The use of modern contraceptive methods has changed little in the past decade throughout much of sub-Saharan Africa, and is still low (less than 10 per cent in many countries).

Limited contraceptive options

Differing patterns of contraceptive use may not reflect women’s personal preferences as much as political and economic decisions made by governments to emphasize certain methods, the attitudes of medical professionals, cost, the limited range of methods offered in some countries or an uneven availability of contraceptive supplies.

In fact, high quality family planning services are often not available: One evaluation of family planning programmes in 88 developing countries concludes that family planning services are routinely made available to women at reasonable cost in only 14 countries.

In many developing countries, at least a third of women need contraceptive services. However,

  • Some women do not know about modern methods, are unable to obtain or afford them, or distrust or dislike the methods that are available
  • Single women and teenagers may be barred from obtaining contraceptive services
  • Other women are ambivalent about whether they want a child or are unsure about their ability to become pregnant
  • Still others live with a partner who does not approve of contraception or who wants them to become pregnant

UNFPA is committed to closing the gap between the number of individuals who use contraceptives and those who would like to delay, space or limit their families. UNFPA supports family planning services in countries around the world, usually within a broader context of reproductive health services.

A smart investment

Each dollar spent on contraception would reduce total medical spending by $1.40 by cutting down on sums spent on unplanned births and abortions, according to a UNFPA/Guttmacher Institute study. Investing another $12 billion a year (for a total of $24 billion) would fulfill the unmet need for family planning and provide every woman with the recommended standard of maternal and newborn care. This would:

  • Reduce unintended pregnancies by more than 66 per cent
  • Prevent 70 per cent of maternal deaths
  • Avert 44 per cent of newborn deaths
  • Reduce unsafe abortion by 73 per cent

Investing in family planning enables faster economic growth in nations by changing the age structure and dependency ratio of a given population. Depending on what services are offered, each dollar spent on family planning can save government $4 in spending on health, housing, water, sewage and other public services. (Source: Achieving the Millennium Development Goals, May 2006).

But there is a donor gap when it comes to voluntary family planning at the same time that desire for it is growing. UNFPA estimates that contraception use may increase 30 percent over the next 15 years in order to fulfill current unmet needs.

Unprecedented action is required if we want to provide history's largest population of young people with the choices they need to shape a bright future – for themselves and their countries.