Contraception in Africa: Is the global 2030 milestone attainable?

Lorretta Ntoimo


The delivery and uptake of contraception remain major developmental challenges in Africa, especially among the most vulnerable women, youth, and adolescents. From the first population conference in Geneva in 19271 to the 1994 International Conference on Population and Development (ICPD) in Cairo2,3, the importance of controlling human reproduction through contraception has featured prominently in all international discourses around sexual and reproductive health and rights. Countries that held the perspective that development is the best contraceptive at the 1974 Bucharest conference4 have since adopted positions that support contraception to advance the health and human rights of individuals to decide if, when, how many, and with whom to have children.

The Programme of Action of the ICPD2,5 includes a commitment to ensure that women and men have access to the widest possible range of safe and effective family planning methods to enable them to exercise free and informed choice while recognizing that appropriate methods for couples and individuals vary according to their age, parity, family-size preference, and other factors. Global commitments such as the Millennium Development Goals and the current Sustainable Development Goals (SDGs) have explicit targets to advance reproductive health through family planning. The SDGs, target 3.7 calls on countries “by 2030, to ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes”; with 3.7.1 specified as the indicator for the proportion of women who have their need for family planning satisfied by modern methods6.

Although there are still 270 million women who have an unmet need for family planning, these global commitments have positively impacted contraceptive use. Global unmet need for contraception has declined from 15% in 1990 to 12.6% in 2020, while contraceptive prevalence (modern methods) increased from 19% to 57% during the same period7. The proportion of women whose need for family planning is satisfied with modern methods increased from 74% in 2000 to 77% in 20207–9. However, Africa remains the region with the least percentage of women whose need for family planning is met with modern methods: (57.8%) compared to 77-83% in other regions. In sub-Saharan Africa, 23 countries have less than 50% of the family planning need satisfied with modern methods9. The modern contraceptive prevalence among women in union is also least in Africa (32.8% in 2020), and if the current scenario remains, Africa would not attain the 1980 prevalence in Europe, Latin America and the Caribbean, and Asia even by 20307. With nine years to 2030, if countries in Africa would achieve universal access to modern contraception by all women who need it, governments in the region must begin to match commitments to family planning with adequate local funding10. Family planning programmes in many African countries are vulnerable and unsustainable due to the heavy dependence on donor funding which is subject to shifts in commitments and policy priorities.  Also, a more intensive tracking of existing family planning programmes with strong mechanisms to identify and address challenges and lacunas would be inevitable for accelerated progress towards achieving the global 2030 family planning milestone11.

Given the link between family planning and other sexual and reproductive health indicators, a strive towards achieving the family planning target is critical for significant progress in the other sexual and reproductive health targets of SDG 3 as well as the attainment of the three zeros recently espoused by the UNFPA- zero preventable maternal mortality, zero unmet need for family planning, and zero gender-based violence and harmful practices12. The daunting barriers to acceptance and uptake of modern contraceptives in the region can be tackled with strong political will and action towards addressing the fears of women and their partners about modern contraceptives and the socio-cultural drivers of desire for large family size.

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