International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.
Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
Reprod Health. 2018 Mar 6;15(1):42. doi: 10.1186/s12978-018-0483-x.
Family planning is key for reducing unintended pregnancies and their health consequences and is also associated with improvements in economic outcomes. Our objective was to identify groups of sexually active women with extremely low demand for family planning satisfied with modern methods (mDFPS) in low- and middle-income countries, at national and subnational levels to inform the improvement and expansion of programmatic efforts to narrow the gaps in mDFPS coverage.
Analyses were based on Demographic and Health Survey and Multiple Indicator Cluster Survey data. The most recent surveys carried out since 2000 in 77 countries were included in the analysis. We estimated mDFPS among women aged 15-49 years. Subgroups with low coverage (mDFPS below 20%) were identified according to marital status, wealth, age, education, literacy, area of residence (urban or rural), geographic region and religion.
Overall, only 52.9% of the women with a demand for family planning were using a modern contraceptive method, but coverage varied greatly. West & Central Africa showed the lowest coverage (32.9% mean mDFPS), whereas South Asia and Latin America & the Caribbean had the highest coverage (approximately 70% mean mDFPS). Some countries showed high reliance on traditional contraceptive methods, markedly those from Central and Eastern Europe, and the Commonwealth of Independent States (CEE & CIS). Albania, Azerbaijan, Benin, Chad and Congo Democratic Republic presented low mDFPS coverage (< 20%). The other countries had mDFPS above 20% at country-level, yet in many of these countries mDFPS coverage was low among women in the poorest wealth quintiles, in the youngest age groups, with little education and living in rural areas. Coverage according to marital status varied greatly: in Asia & Pacific and Latin America & the Caribbean mDFPS was higher among married women; the opposite was found in West & Central Africa and CEE & CIS countries.
Almost half of the women in need were not using an effective family planning method. Subgroups requiring special attention include women who are poor, uneducated/illiterate, young, and living in rural areas. Efforts to increase mDFPS must address not only the supply side but also tackle the need to change social norms that might inhibit uptake of contraception.
计划生育是减少意外怀孕及其健康后果的关键，也与经济成果的改善有关。我们的目标是在国家和国家以下各级确定对计划生育需求极低但对现代方法满意的活跃性女性群体（mDFPS），以改善和扩大方案努力，缩小 mDFPS 覆盖范围方面的差距。
分析基于人口与健康调查和多指标类集调查数据。自 2000 年以来，在 77 个国家进行的最新调查均包含在分析中。我们估计了 15-49 岁女性的 mDFPS。根据婚姻状况、财富、年龄、教育、读写能力、居住地（城市或农村）、地理区域和宗教信仰，确定了覆盖范围较低（mDFPS 低于 20%）的亚组。
总体而言，仅有 52.9%有计划生育需求的妇女使用现代避孕方法，但覆盖范围差异很大。西非和中非地区的覆盖率最低（平均 mDFPS 为 32.9%），而南亚和拉丁美洲及加勒比地区的覆盖率最高（平均 mDFPS 约为 70%）。一些国家高度依赖传统避孕方法，特别是来自中东欧和独立国家联合体（CEE & CIS）的国家。阿尔巴尼亚、阿塞拜疆、贝宁、乍得和刚果民主共和国的 mDFPS 覆盖率较低（<20%）。其他国家的国家层面 mDFPS 超过 20%，但在这些国家中，最贫困的五分之一财富阶层、最年轻的年龄组、受教育程度较低和生活在农村地区的妇女的 mDFPS 覆盖率较低。按婚姻状况划分的覆盖范围差异很大：在亚洲和太平洋以及拉丁美洲和加勒比地区，已婚妇女的 mDFPS 较高；而在西非和中非地区以及 CEE & CIS 国家，情况则相反。
几乎有一半有需求的妇女未使用有效的计划生育方法。需要特别关注的亚组包括贫困、受教育程度低/文盲、年轻和生活在农村地区的妇女。增加 mDFPS 的努力不仅必须解决供应方面的问题，还必须解决改变可能抑制避孕采用的社会规范的需求。
