Progress in Reducing Socioeconomic Inequalities in the Use of Modern Contraceptives in 48 Focus Countries As Part of the FP2030 Initiative Between 1990 and 2020: a Population-based Analysis

Overview

Journal Lancet Glob Health

Specialty Public Health

Date 2024 Dec 20

PMID 39706659

Authors

Carolina Cardona

Jean Christophe Rusatira

Carolina Salmeron

Michelle Martinez-Baack

Jose G Rimon

Philip Anglewicz

Saifuddin Ahmed

Affiliations

Soon will be listed here.

Abstract

Background: Despite increases in modern contraception use, socioeconomic inequalities in family planning persist. In this study, we aimed to measure progress in reducing socioeconomic inequalities in modern contraceptive prevalence rate (mCPR) and demand for family planning satisfied by modern methods (mDFPS) in 48 countries as part of the Family Planning 2030 (FP2030) initiative between 1990 and 2020 for which Demographic and Health Survey data were available.

Methods: We analysed two rounds of Demographic and Health Survey data per country. Changes in concentration indices between two survey rounds were compared to measure reductions in overall socioeconomic-related inequalities in modern contraceptive use. Poisson regression models were used to measure the adjusted average annual rate of change across wealth quintiles.

Findings: In this population-based analysis study, all countries reduced socioeconomic-related inequalities in modern contraceptive use among in-union women of reproductive age (15-49 years) during the observed 30-year period. On average, mCPR increased at an annual rate of 2·1% (95% CI 2·1-2·2), and the rate of increase for the poorest women was 3·1% (3·0-3·2), which outpaced the rate of increase for the richest women of 1·3% (1·3-1·4%). The pattern of progress was similar for mDFPS, but at a slower pace. Overall, levels of mCPR and mDFPS increased, and socioeconomic-related inequalities were reduced during this period.

Interpretation: Substantial progress has been made in reducing socioeconomic-related inequalities in family planning across the 48 studied countries, which account for 86% of the population of the 82 FP2030 initiative countries. During the past three decades, poorer women have seen greater improvements in modern contraceptive use and demand satisfaction compared with richer women. As contraceptive prevalence rates are near their maximum, it is crucial to ensure marginalised and vulnerable groups are not left behind.

Funding: Bill & Melinda Gates Foundation.

Translations: For the French and Spanish translations of the abstract see Supplementary Materials section.

References

Gakidou E, Vayena E . Use of modern contraception by the poor is falling behind. PLoS Med. 2007; 4(2):e31. PMC: 1796626. DOI: 10.1371/journal.pmed.0040031. View

Gummerson E, Cardona C, Anglewicz P, Zachary B, Guiella G, Radloff S . The wealth gradient and the effect of COVID-19 restrictions on income loss, food insecurity and health care access in four sub-Saharan African geographies. PLoS One. 2021; 16(12):e0260823. PMC: 8673610. DOI: 10.1371/journal.pone.0260823. View

Blumenberg C, Hellwig F, Ewerling F, Barros A . Socio-demographic and economic inequalities in modern contraception in 11 low- and middle-income countries: an analysis of the PMA2020 surveys. Reprod Health. 2020; 17(1):82. PMC: 7268403. DOI: 10.1186/s12978-020-00931-w. View

Hellwig F, Coll C, Ewerling F, Barros A . Time trends in demand for family planning satisfied: analysis of 73 countries using national health surveys over a 24-year period. J Glob Health. 2019; 9(2):020423. PMC: 6820067. DOI: 10.7189/jogh.09.020423. View

Deaton A . COVID-19 and Global Income Inequality. LSE Public Policy Rev. 2021; 1(4). PMC: 8301493. DOI: 10.31389/lseppr.26. View

Sreeramareddy C, Acharya K, Tiwari I . Inequalities in demand satisfied with modern methods of family planning among women aged 15-49 years: a secondary data analysis of Demographic and Health Surveys of six South Asian countries. BMJ Open. 2022; 12(6):e049630. PMC: 9189818. DOI: 10.1136/bmjopen-2021-049630. View

Brown W, Druce N, Bunting J, Radloff S, Koroma D, Gupta S . Developing the "120 by 20" goal for the Global FP2020 Initiative. Stud Fam Plann. 2014; 45(1):73-84. DOI: 10.1111/j.1728-4465.2014.00377.x. View

. Quantitative goals in the ICPD draft Programme of Action. ICPD 94. 1994; (15):4. View

ODonnell O, ONeill S, Van Ourti T, Walsh B . conindex: Estimation of concentration indices. Stata J. 2016; 16(1):112-138. PMC: 4819995. View

10.

. UNFPA gears up to implement ICPD Programme of Action. Asian Forum Newsl. 1995; :7. View

11.

Chen W, Qian L, Shi J, Franklin M . Comparing performance between log-binomial and robust Poisson regression models for estimating risk ratios under model misspecification. BMC Med Res Methodol. 2018; 18(1):63. PMC: 6013902. DOI: 10.1186/s12874-018-0519-5. View

12.

. The International Conference on Population and Development, Cairo Egypt, September 5-13, 1994. Pathways. 1994; 8(2):1-2. View

13.

Ogundele O, Pavlova M, Groot W . Inequalities in reproductive health care use in five West-African countries: A decomposition analysis of the wealth-based gaps. Int J Equity Health. 2020; 19(1):44. PMC: 7099835. DOI: 10.1186/s12939-020-01167-7. View

14.

Filmer D, Pritchett L . Estimating wealth effects without expenditure data--or tears: an application to educational enrollments in states of India. Demography. 2001; 38(1):115-32. DOI: 10.1353/dem.2001.0003. View

15.

Creanga A, Gillespie D, Karklins S, Tsui A . Low use of contraception among poor women in Africa: an equity issue. Bull World Health Organ. 2011; 89(4):258-66. PMC: 3066524. DOI: 10.2471/BLT.10.083329. View

16.

Hellwig F, Coll C, Blumenberg C, Ewerling F, Kabiru C, Barros A . Assessing Wealth-Related Inequalities in Demand for Family Planning Satisfied in 43 African Countries. Front Glob Womens Health. 2021; 2:674227. PMC: 8594043. DOI: 10.3389/fgwh.2021.674227. View

17.

Wagstaff A, Paci P, Doorslaer E . On the measurement of inequalities in health. Soc Sci Med. 1991; 33(5):545-57. DOI: 10.1016/0277-9536(91)90212-u. View

18.

Mutua M, Wado Y, Malata M, Kabiru C, Akwara E, Melesse D . Wealth-related inequalities in demand for family planning satisfied among married and unmarried adolescent girls and young women in sub-Saharan Africa. Reprod Health. 2021; 18(Suppl 1):116. PMC: 8210345. DOI: 10.1186/s12978-021-01076-0. View

19.

Ross J . Improved Reproductive Health Equity Between the Poor and the Rich: An Analysis of Trends in 46 Low- and Middle-Income Countries. Glob Health Sci Pract. 2015; 3(3):419-45. PMC: 4570016. DOI: 10.9745/GHSP-D-15-00124. View