Chapter 5. Planning pregnancy and protecting reproductive health.(Statistical Data Included)

The use of contraceptive methods, including sterilization, has increased rapidly in much of the developing world over the past 30 years, especially in countries with strong family planning programs. However, most of the increase reflects adoption of methods by women, since men have not played a large direct role in this contraceptive revolution. The methods women use differ widely by country and may not reflect women's personal choices so much as political decisions made by governments, or economic and other supply factors. Despite worldwide increases in the practice of family planning, many women--both those who practice contraception and those who do not--turn to abortion to avoid unwanted childbearing. Very large proportions of women of reproductive age are in need of contraception have limited contraceptive choices or have access only to poor services.

What are couples doing to avoid unplanned pregnancies? In most countries, a more accurate question would be what are women doing to avoid unplanned pregnancies, since men's role in contraceptive use typically is small. The proportion of couples who rely on male methods--the condom, withdrawal or vasectomy--is 1-12% in most countries; however, it is 54% in Japan, where the condom is the leading method, and 22% in the United States, where the condom and vasectomy are both important (see Table K). (1) Because men in most countries rake only a small role in family planning, the focus here is mainly on women.

Most Women Prefer Modern Contraceptives

Until the introduction of modern contraceptive methods, coitus interruptus (withdrawal) and periodic abstinence (rhythm) were the techniques most commonly used to avoid pregnancy. These methods require a high degree of self-control, and they fall quite often. Modern reversible contraceptives--the pill, the IUD, the injectable, the implant, female barrier methods, spermicides and the condom--are more reliable than rhythm and withdrawal if used correctly and consistently. They are safe for most women and, in the case of those methods that users do not have to think about at the time of intercourse, less intrusive to use. For these reasons, given the choice, most people select modern methods over traditional ones. In addition to the reversible methods, contraceptive sterilization--which is normally nonreversible--is an option.

The use of either a modern reversible method or sterilization is low in Cameroon, Guatemala, Nigeria and Pakistan (4-19% of sexually active women of reproductive age use these methods); moderate in Jordan, Kenya and the Philippines (25-27%); and high in Colombia, Egypt, Indonesia and Mexico (45-53%). It reaches very high levels in Thailand, China and the three developed countries in this report (64-76%) (see Chart 15). In developing countries with moderate or high levels of contraceptive practice, the proportion of couples using a method increased very rapidly--from around 10% in the early 1970s to the current levels of 50-60% by the late 1980s. (2)

Large differences exist among countries and regions in the types of contraceptive methods used. In China, almost all use of a modern reversible method involves the IUD; in Japan, the condom. (3) In France, few women use any modern method except the pill. (4) Reliance on contraceptive sterilization when desired childbearing has ended is common in China, Thailand and the United States (29-35% of couples depend on this method); moderate in Colombia, Guatemala, Mexico and the Philippines (11-20%); and rare in the remaining selected countries. (5) Traditional methods--chiefly periodic abstinence--predominate in Cameroon, and are used by 12-15% of women in Colombia, Jordan and the Philippines, but account for only a small part of contraceptive use in the remaining selected countries.

These differing patterns of contraceptive use are often unrelated to what methods women want to use. Women's choices can be influenced by governments or international donor agencies that emphasize particular methods, by the attitudes of medical professionals, by cost and by the limited range of methods offered or the uneven availability of contraceptive supplies.