New Study Reveals Global Progress Towards Reducing Inequalities in Family Planning Access

A new study published January 1, 2025 in Lancet Global Health revealed that socioeconomic-related inequalities in modern contraception use have been reduced in all 48 countries included in the analysis. The research team, led by Bloomberg School of Public Health’s Carolina Cardona, PhD, MHS, assistant scientist in the Department of Population, Family and Reproductive Health, conducted an analysis across 48 low- and middle-income focus countries as part of the FP2030 (Family Planning 2030) global partnership. FP2030 evolved from the 2012 London Summit, that created a target of reaching 120 million additional users of modern contraceptive methods in the world’s poorest countries by 2020. Known as the “120 by 20,” the goal unites a wide range of partners across disciplines and sectors. 

While the “120 by 20” goal was not achieved, the researchers found notable improvements in the usage of contraception in these 48 countries, that represent 86% of the FP2030 population. Researchers examined two rounds of Demographic and Health Survey data per country, to assess the progress in reducing socioeconomic related inequalities in modern contraception prevalence rate and demand for family planning satisfied by modern methods among in-union and all women of reproductive age. Modern contraception methods include oral pills, intrauterine devices (IUDs), injections, male or female condoms, male or female sterilization, implants, and lactational amenorrhea. Women are considered to have a demand for family planning if they are sexually active but wish to delay, space, or limit childbearing.

Between 1990 and 2020, the modern contraceptive prevalence rate increased at an average annual growth rate of 2.1% across the 48 countries, with the poorest women seeing a growth rate of 3.1%, outpacing the 1.3% rate observed among the wealthiest. All countries in the analysis showed a reduction in income-related inequality, with Chad, Mali, and Uganda showing the greatest reduction in the equality gap. Similar results were found for demand for family planning satisfied by modern methods, the poorest recorded an average annual growth rate of 1.6%, outpacing the 0.5% rate among the richest women. The findings show that women in the bottom 20% of the wealth distribution initially had lower contraceptive use. However, they increased their use rapidly, catching up with wealthier women and meeting their needs faster than those in the top 20% of the wealth distribution.

The study demonstrates improved family planning access but also underscores the need for ongoing attention to equity as global contraceptive access continues to improve more slowly than anticipated. The study’s researchers suggest that more targeted interventions may be necessary to reach the most disadvantaged populations. Poor women still generally use contraception at lower rates than wealthier women. On average, in these 48 countries, the richest women still have modern contraceptive prevalence and demand for family planning satisfied by modern methods rates that are nine and seven percentage points higher, respectively, than those of the poorest women.

“This analysis opens the floor to a larger discussion on inequalities,” said lead researcher Cardona.  “As many countries approach the maximum achievable contraceptive prevalence rate, family planning and development communities need to ensure marginalized and vulnerable groups are not left behind,” she added. “These findings can and should inform decisions to include the nuances of income distribution in planning, developing, and implementing family planning programs.”