Use of Modern Contraception by the Poor Is Falling Behind

Background: The widespread increase in the use of contraception, due to multiple factors including improved access to modern contraception, is one of the most dramatic social transformations of the past fifty years. This study explores whether the global progress in the use of modern contraceptives has also benefited the poorest. Methods and Findings: Demographic and Health Surveys from 55 developing countries were analyzed using wealth indices that allow the identification of the absolute poor within each country. This article explores the macro level determinants of the differences in the use of modern contraceptives between the poor and the national averages of several countries. Despite increases in national averages, use of modern contraception by the absolute poor remains low. South and Southeast Asia have relatively high rates of modern contraception in the absolute poor, on average 17% higher than in Latin America. Over time the gaps in use persist and are increasing. Latin America exhibits significantly larger gaps in use between the poor and the averages, while gaps in sub-Saharan Africa are on average smaller by 15.8% and in Southeast Asia by 11.6%. Conclusions: The secular trend of increasing rates of modern contraceptive use has not resulted in a decrease of the gap in use for those living in absolute poverty. Countries with large economic inequalities also exhibit large inequalities in modern contraceptive use. In addition to macro level factors that influence contraceptive use, such as economic development and provision of reproductive health services, there are strong regional variations, with sub-Saharan Africa exhibiting the lowest national rates of use, South and Southeast Asia the highest use among the poor, and Latin America the largest inequalities in use. Analysis of demographic and health surveys from 55 developing countries confirms the increasing use of modern contraceptives, but their use by people living in absolute poverty lags considerably behind. Background.: Access to safe and effective methods of contraception is seen by many to be a basic human right. Contraception plays an important role in improving women's health (by reducing the risks that would otherwise accompany unwanted births), as well as the social and financial situation of women and their families. However, despite a steady increase in contraceptive use worldwide over the past few decades, the World Health Organization says there is still a significant unmet need for birth control. Very many women worldwide, probably around 123 million, would like to limit the number of children that they might have but, despite this, they are not using contraception. There are probably many factors responsible for this unmet need, including the availability of health services, a woman's level of education, her social and financial situation, and cultural factors. Why Was This Study Done?: Although it is clear that use of contraception has been increasing worldwide over the past few decades, particularly in developing countries, it is not clear whether the poorest people in each country have also benefited from this trend. Given that contraception has important effects on health and on the financial and social circumstances of a family, it is important to find out whether there are any differences in contraceptive use between the poorest and richer members of society. What Did the Researchers Do and Find?: This research project was based on data collected by a survey oganization about various aspects of the health, social, and economic status of households worldwide. Over 100 surveys conducted between 1985 and 2003 were used from the publicly available survey database. The researchers then classified each household for which there was survey information as being in the poorest 20% of households or not, worldwide. Importantly, this categorization reflects whether the household was in the “absolute poor” worldwide, not just the poorest for their respective country. Since information about household income was not directly available from the surveys, the researchers had to use an approach based on ownership of consumer goods and services (referred to as “asset-based wealth measures”). The researchers then looked at trends in contraceptive use amongst the poorest households, and examined whether contraceptive use was linked to other factors, such as level of education and average income. What Do These Findings Mean?: This study shows that although contraception use is increasing over time, its use by poor people is low. The gap in use of contraception between poor people and “average” people also seems to be increasing over time and is wider in richer countries. The reasons behind these findings are not clear, but the data suggest that nations and international health organizations need to focus their attention on providing contraceptive services in a way that will reach people who have very low incomes. Additional Information.: Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0040031.