Modern contraceptives in sub-Saharan African countries
Authors: Luis Bahamondes, Alessandra Peloggia
Journal: The Lancet Global Health (2019)

In The Lancet Global Health, Saifuddin Ahmed and colleagues1Ahmed S Choi Y Rimon JG et al.Trends in contraceptive prevalence rates in sub-Saharan Africa since the 2012 London Summit on Family Planning: results from repeated cross-sectional surveys.Lancet Glob Health. 2019; (published online May 17.)http://dx.doi.org/10.1016/S2214-109X(19)30200-1Summary Full Text Full Text PDF Scopus (49) Google Scholar present the findings from their study in which they assessed the progress in modern contraceptive prevalence rates since the 2012 London Summit on Family Planning in some sub-Saharan African countries. This programme was launched by the Bill & Melinda Gates Foundation, the UK government, and other partners and laid the foundations for the Family Planning 2020 initiative, which aims to enable 120 million additional women to use modern contraceptive methods by 2020 ("120 by 20") in the world's 69 poorest countries. This goal will require increasing the pre-2012 annual growth rate of modern contraceptive prevalence rates from an estimated 0·7 to 1·4 percentage points. Ahmed and colleagues1Ahmed S Choi Y Rimon JG et al.Trends in contraceptive prevalence rates in sub-Saharan Africa since the 2012 London Summit on Family Planning: results from repeated cross-sectional surveys.Lancet Glob Health. 2019; (published online May 17.)http://dx.doi.org/10.1016/S2214-109X(19)30200-1Summary Full Text Full Text PDF Scopus (49) Google Scholar used data from 45 rounds of Performance Monitoring and Accountability 2020 surveys, all undertaken after 2012, to ascertain trends in modern contraceptive prevalence rates among women aged 15–49 years in nine settings in eight sub-Saharan African countries: Burkina Faso; Kinshasa, Democratic Republic of Congo; Ethiopia; Ghana; Kenya; Niamey, Niger; Kaduna, Nigeria; Lagos, Nigeria; and Uganda. The overall weighted average annual rate of change in rates was 1·92 percentage points (95% CI 1·14–2·70). A high rate of change was achieved in Burkina Faso, Ghana, Kaduna (Nigeria), Kinshasa (DR Congo) and Uganda; however, not in Ethiopia, Kenya, Lagos (Nigeria), or Niamey (Niger), which had non-significant changes of less than 1 percentage point. Consequently, there are doubts whether all sub-Saharan African countries will achieve the Summit's 120 by 20 goal, mainly based on the data from Nigeria, a sub-Saharan African country with a large population, which has showed, at present, little change in modern contraceptive prevalence rates. The information from this study correlates with data from WHO2WHOFamily planning/contraception. 2018 (published Oct 30, 2018).http://www.who.int/news-room/fact-sheets/detail/family-planning-contraceptionDate accessed: April 4, 2019Google Scholar, 3Brown W Druce N Bunting J et al.Developing the 120 by 20 goal for the Global FP2020 Initiative.Stud Fam Plann. 2014; 45: 73-84Crossref PubMed Scopus (79) Google Scholar showing that many sub-Saharan African countries still present a high total fertility rate: almost 5·4 births per woman and a low modern contraceptive prevalence rate. One of the consequences of the high total fertility rate is the migration crisis, which affects mainly sub-Saharan African countries and can also be observed in some countries from Central America that are part of the 69 countries in the FP 2020 goal.4Obwoya JG Wulifan JK Kalolo A Factors influencing contraceptives use among women in the Juba city of South Sudan.Internat J Popul Research. 2018; 2018: 1-7Crossref Google Scholar The importance of Ahmed and colleagues' study1Ahmed S Choi Y Rimon JG et al.Trends in contraceptive prevalence rates in sub-Saharan Africa since the 2012 London Summit on Family Planning: results from repeated cross-sectional surveys.Lancet Glob Health. 2019; (published online May 17.)http://dx.doi.org/10.1016/S2214-109X(19)30200-1Summary Full Text Full Text PDF Scopus (49) Google Scholar was to highlight and update the situation regarding changes in modern contraceptive prevalence rates in some sub-Saharan African countries. Provision of modern contraceptive methods is one of the main components of sustainable global development, poverty alleviation, environmental safe sustainability, increased life expectancy, women empowerment, gender equality, and health promotion including the reduction of maternal morbidity, mortality, and unsafe abortion, and the improvement of child survival through birth spacing.5Cleland J Bernstein S Ezeh A Faundes A Glasier A Innis J Family planning: the unfinished agenda.Lancet. 2006; 368: 1810-1827Summary Full Text Full Text PDF PubMed Scopus (590) Google Scholar, 6Osotimehin B Family planning as a critical component of sustainable global development.Glob Health Action. 2015; 8: 29978Crossref PubMed Scopus (18) Google Scholar The investigators have provided a picture of modern contraceptive prevalence rates; however, it is also important to assess the reasons associated with the low achievements in contraceptive provision and the means to solve this enormous problem. A low modern contraceptive prevalence rates is a consequence of societal and personal barriers. Societal barriers include civil war and conflict zones in many settings, political disturbances, absence of health services, attacks on health-care professionals, and sexual violence against women, among others. Habitually, contraceptive provision and services are neglected during civil conflicts.7Ackerson K Zielinski R Factors influencing use of family planning in women living in crisis affected areas of Sub-Saharan Africa: a review of the literature.Midwifery. 2017; 54: 35-60Summary Full Text Full Text PDF PubMed Scopus (27) Google Scholar The removal of the societal barriers is a difficult, lengthy, and complex process. Another important issue to consider is that because of their few years of schooling, women in many sub-Saharan African countries have many misconceptions and myths regarding the use of contraceptive methods, including a fear of side-effects. In many settings men are the head of the family and consequently women need the permission of their partner to use contraceptives. Additionally, many religions and cultural values are against contraception. High fertility rates increase poverty and the relative increase in human activity has major effects on greenhouse-gas emissions.8Mbizvo MT Phillips SJ Family planning: Choices and challenges for developing countries.Best Pract Res Clin Obstet Gynaecol. 2014; 28: 931-943Crossref PubMed Scopus (23) Google Scholar Contraceptive use empowers women and facilitates access to education, work outside the home, and engagement in family income. According to Ahmed and colleagues,1Ahmed S Choi Y Rimon JG et al.Trends in contraceptive prevalence rates in sub-Saharan Africa since the 2012 London Summit on Family Planning: results from repeated cross-sectional surveys.Lancet Glob Health. 2019; (published online May 17.)http://dx.doi.org/10.1016/S2214-109X(19)30200-1Summary Full Text Full Text PDF Scopus (49) Google Scholar one reason for an increase in modern contraceptive prevalence rates was the increase of contraceptive implants use in the assessed settings; however, this contraceptive method cannot be hidden from a partner, and consequently its use is restricted to more open societies.9Tsui AO Brown W Li Q Contraceptive practice in sub-Saharan Africa.Popul Dev Rev. 2017; 43: 166-191Crossref PubMed Scopus (105) Google Scholar The achievements of modern contraceptive prevalence rates could be also due to other initiatives such as the donations of the levonorgestrel-intrauterine system by the International Contraceptive Access Foundation to eight sub-Saharan African settings and countries including Kaduna, Nigeria.10International Contraceptive Access Foundationhttp://www.ica-foundation.org/About_the_Programs/About_the_Projects/index.htmlDate accessed: April 16, 2019Google Scholar An absence of health services and trained health-care professionals poses a barrier to accessing modern contraceptives—mainly implants and intrauterine contraceptives (IUCs)—which require adequate facilities with infection prevention services, instruments for placement and removals, and commitment and expertise to follow-up women with side-effects. Additionally, provision of implants and IUC should be expanded or introduced in the immediate post-partum period. Working out logistics, decentralisation of services, mobilisation of the community, and provision of mobile services in rural areas are strategies among others to explore. There is no doubt that a great effort is needed, but family planning programmes are essential to support countries' social and economic development and the wellbeing of women.2WHOFamily planning/contraception. 2018 (published Oct 30, 2018).http://www.who.int/news-room/fact-sheets/detail/family-planning-contraceptionDate accessed: April 4, 2019Google Scholar In conclusion, Ahmed and colleagues recognised that the main limitation of the reported data was that they assessed only eight of 69 countries included in the Summit and that progress in the non-surveyed countries could be lower than expected. The study could help policy makers and stakeholders to improve and scale-up the provision of modern contraceptives in sub-Saharan African countries not only to reduce the high total fertility rate, but also to improve economy, food security, and health issues, and to contribute to sustainable development. We declare no competing interests. Trends in contraceptive prevalence rates in sub-Saharan Africa since the 2012 London Summit on Family Planning: results from repeated cross-sectional surveysThe Family Planning 2020 (FP2020) initiative, launched at the 2012 London Summit on Family Planning, aims to enable 120 million additional women to use modern contraceptive methods by 2020 in the world's 69 poorest countries. It will require almost doubling the pre-2012 annual growth rate of modern contraceptive prevalence rates from an estimated 0·7 to 1·4 percentage points to achieve the goal. We examined the post-Summit trends in modern contraceptive prevalence rates in nine settings in eight sub-Saharan African countries (Burkina Faso; Kinshasa, DR Congo; Ethiopia; Ghana; Kenya; Niamey, Niger; Kaduna, Nigeria; Lagos, Nigeria; and Uganda). Full-Text PDF Open Access