Key Findings and Gaps in Evidence on Unwanted Pregnancy, Contraception and links to Abortion in Africa

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Arlene Cook
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1 Key Findings and Gaps in Evidence on Unwanted Pregnancy, Contraception and links to Abortion in Africa Alex C. Ezeh APHRC, Nairobi, Kenya With support from: J. John-Langba, R. Towett, A. Bankole, and S. Singh

2 Understanding the Concepts Abortion Contraception Unwanted pregnancy: Unwanted births Induced abortions (what %?) Miscarriages (what %?) About 40% of all pregnancies!

3 Measuring Unwanted Pregnancy Difference between TFR and Wanted TFR Planning status of recent births or current pregnancy Mistimed Unwanted Abortion and miscarriage Unmet need for contraception

4 Magnitude of unwanted pregnancy in SSA: Excess TFR Niger Chad Nigeria Eritria Mali Mozambique Madagascar Cote d'ivoire Burkina Tanzania Ethiopia Zambia Zimbabwe Ghana Malawi Benin Rwanda Namibia Togo Senegal Kenya Uganda

5 Magnitude of unwanted pregnancy: Current pregnancy mistimed/unwanted Niger Nigeria Madagascar Chad Mali Mozambique Benin Tanzania Burkina Faso Eritria Cote d'ivoire Senegal Rwanda Ethiopia Zimbabwe Uganda Ghana Malawi Zambia Kenya Namibia

6 Potential unwanted pregnancy: Unmet Need for Family Planning Senegal Zimbabwe Namibia Nigeria Mozambique Tanzania Chad Kenya Malawi Niger Zambia Cote d'ivoire Ethiopia Mali Ghana Benin Burkina Faso Madagascar Uganda Togo Rwanda Unmet N (Guttmacher) Unmet Need (DHS)

7 What proportion of pregnancies are unwanted? Pregnancy Wantedness, Uganda 2003 (1.84 million prenancies) 15% 16% Pregnancy Wantedness, Nigeria 2006 (6.6 million prenancies) 16% 11% 10% 26% 43% Induced Abortion Planned Births Unplanned Births Miscarriage 63% Induced Abortion Planned Births Unplanned Births Miscarriage Source: Singh et al (2005); Bankole et al (2006)

8 Who are these women with unwanted pregnancies? Distribution of women who had unwanted Pregnancy by age, Nigeria 2006 Distribution of women who had unwanted pregnancy by marital status, Nigeria % 28% 27% 35% 67% Never married Married Divorced/separated/widowed 38% < Dirstribution of women who had unwanted pregnancy by wealth status, Nigeria % 53% Source: Bankole et al (2006) 24% Poorest Middle Wealthiest

9 Why do women have unwanted pregnancies? Low contraceptive use 20% for SSA Non-use accounts for ½ High unmet need for family planning 25% compare to about 10% in other DC Overall level of unmet need in SSA has not changed much over the past 15 yrs Other reasons include: Contraceptive failure, non-consensual sex, changed personal circumstances, etc.

10 Why women do not use contraception 100% 75% 50% 25% 0% Burkina Faso Chad Ghana Mali Nigeria Rwanda Uganda Lack access Opposition Fear side effects Postpartum/Breadfeeding No/Infrequent sex Primary reason for non-use of FP among married, non-pregnant women with unmet need for FP

11 The tragedy of current demographic trends: Poor-Rich Differences in Trends in TFR Survey 1 (First in the 1990s) Survey 2 (Latest) Poor Rich Poor Rich Poor Rich Poor Rich Poor Rich Poor Rich Poor Rich Benin Burkina Faso Kenya Mozambique Nigeria Tanzania Source: DHS

12 Widening gap in TFR between the poor and the rich across SSA Uganda Niger Zambia Malawi Malawi Niger Zambia Mali Mali Rwanda Uganda Er itrea Zambia Madagas car Burkina Faso Kenya Nigeria Benin Nigeria Madagascar Namibia Senegal Tanzania Tanzania Madagas car Tanzania Senegal Namibia Benin Burk MozCa am ina mbique Faso er oo n Rwanda Cote d'ivoire Ghana Kenya Ghana Cote d'iv oire Ghana Kenya Nigeria Eritrea Zimbabwe Zimbabwe Moz am bique nyear Uganda Zam bia Rw a n da Nig e r Zam bia Ni g e ria Malawi Madagasc ar Na Rw Tanzania m a n ib da ia Mali Madagascar Mali Nigeria Nig e Kenya r Nigeria Uganda Zambia Senegal Ca m er oo n Benin MozGhana Kenya am bique Tanzania Cote Erd'Ivoire itrea Madagascar Zim babwe Zimbabwe Na m ib ia Tanzania Ghana Kenya Senegal Eritrea Burkina Malawi Faso Moz ambique Ghana Benin Bur kina Faso Cote d'ivoire nyear fertility rate poor Fitted values f ert ility rate rich F itt ed va lue s

13 What s driving the high fertility of the poor? TFR/Percent Poorest Second Middle Fourth Richest TFR CPR Unmet Need TFR, CPR & Unmet Need: Differences Across Socioeconomic Groups; Source: KDHS 2003

14 Where are the gaps in research? More accurate measure of unwanted pregnancy (not just births) Community-based studies? How are pregnancy intentions related to contraceptive use? What are the planning status of pregnancies ending in abortion? Why do many women fail to implement their fertility desires?

15 Thank you

FAMILY PLANNING TRENDS IN SUB SAHARAN AFRICA:

FAMILY PLANNING TRENDS IN SUB SAHARAN AFRICA: PROGRESS, PROSPECTS AND LESSONS LEARNED Mona Sharan, Saifuddin Ahmed, John May & Agnes Soucat Background : Sub Saharan Africa Highest TFR (5.1) compared to