More than 1 billion women of reproductive age (15–49) live in low- and lower-middle-income countries. An estimated 371 million of those women are now using a modern method of family planning. That is 87 million more than just a decade ago. Their use of contraception averted more than 141 million unintended pregnancies, 29 million unsafe abortions, and almost 150,000 maternal deaths in the past year alone.
The language throughout this report refers to women or women and girls, which should be understood to include women and girls of reproductive age (15–49). But not all individuals who become pregnant are women and girls; transgender men and nonbinary people can and do become pregnant. However, the data used in this report overwhelmingly come from surveys and studies that identify participants as women or girls, and to extend the conclusions from those data to include gender-diverse people could result in inaccuracies or even the erasure of concerns specific to sexual minorities (UNFPA, State of World Population 2022). Therefore, we calculate contraceptive use and measure contraceptive prevalence based on women and girls using these methods, while acknowledging that some users may identify as transgender men or nonbinary people.
With this year’s FP2030 Measurement Report, we can now assess trends in contraceptive use over a full decade of data (Figure 1). One fact emerges clearly: Women are demanding and using modern contraception in ever greater numbers, in every region, despite every obstacle. Even in the face of COVID-19, which caused enormous disruptions to health systems, the demand for modern contraception has continued to grow.
In fact, disruptions are nothing new. While the scale of the pandemic is unprecedented, in the past 10 years health systems have been buffeted by natural disasters, violent conflicts, epidemics of Ebola and Zika viruses, political shifts, and changing economic conditions. But despite these challenges, the number of women seeking modern methods of contraception has continued to climb. In 14 countries, the number of contraceptive users has more than doubled in the last decade.
Modern Contraceptive Prevalence
Percentage Point Increase 2012-2022
East Asia & Pacific
Europe & Central Asia
Latin America & Caribbean
Middle East & North Africa
In low- and lower-middle-income countries, contraceptive prevalence among all women has increased from 31% to over 35% in the past decade (Table 1). This means that 1 in 3 women of reproductive age is now choosing to use modern contraception. All regions have experienced an increase, with the sharpest growth in sub-Saharan Africa (Figure 2).
As more and more young people enter their reproductive years, and as more and more women seek greater access to a wide range of methods, the demand for family planning will continue to grow. If this rising demand is not met by high-quality services, consistent contraceptive supplies, and supportive policies and financing, it will be a missed opportunity for millions of women—and for our collective futures.
Meeting this opportunity requires family planning programs to recognize and adapt to the changing needs and preferences of women and their partners. There have been rapid changes in method mix over just the past decade, and in many countries where long-acting reversible contraceptives, or LARCs, have become accessible, there has been a distinct shift toward implants. Today implants are the most commonly used method in 10 countries and the second most common method in 14 countries. This represents a stark contrast with method mix a decade ago, when implants were not as widely available.
Our understanding of method mix, however, needs to acknowledge that there are still many women who want to avoid pregnancy but are not using a modern method of contraception. Fifty million women across low- and lower-middle-income countries report using a traditional method of contraception to avoid pregnancy. Sixteen countries account for 80% of these users, most of whom are in the Asia-Pacific region. This raises many questions about whether traditional methods are a genuine preference or if family planning programs are failing to provide sufficient information or an adequate array of contraceptive method options.
Improved understanding of how to expand and adapt family planning services depends on increased visibility into the methods people are using, where they are getting information, and where they are going for services. In response to country feedback on the FP2030 Measurement Framework, new indicators and updated ways of reporting on indicators will now provide important new information. For the first time, this year’s report includes data on the source of method (public versus private) by method. Data from Rwanda’s most recent Demographic and Health Survey (DHS) in 2019–2020, for example, indicate that 99% of women who use implants—now the most common method in the country—receive them from the public sector. In contrast, only 50% of women who use injections, until recently the most popular method, receive them from the public sector. Data points such as these shed important light on the role of the public and private sectors in method provision. In some countries, such as Indonesia, the private sector is an important source for a wide range of contraceptive methods; in others, private sector provision is significant only for certain methods. The updated reporting of this new FP2030 indicator will allow for additional analysis and insights in the coming years.
Similarly, this year’s report includes an update to the Family Planning Information Indicator. Based on feedback from countries, including Track20 Country Monitoring and Evaluation Officers, the indicator now contains additional detail. The reporting provides information on the percentage of women (aged 15–49) who received information on family planning from the health care system and also now looks more deeply at what percentage of women went to a health facility or were visited by a fieldworker. This will help illuminate where there are missed opportunities for reaching women with more family planning information.
With the DHS program returning to normal as the pandemic wanes, the large number of surveys that were delayed in 2020 and 2021 are now scheduled to be completed. A large influx of data for assessing family planning progress will be available over the next few years in a variety of new ways. With our new regional offices in place and closer collaborative engagement with countries, the partnership will be able use those data more effectively than ever to accelerate progress.
The Performance Monitoring & Evidence (PME) Working Group developed the FP2030 Measurement Framework to track country progress from 2021 to 2030 and report on progress toward the overall FP2030 vision. The FP2030 Measurement Framework builds upon the FP2020 Core Indicators and results framework. Countries have described the FP2020 Core Indicators as essential building blocks to monitor aspects of the enabling environment for family planning, the process of delivering services, the output of those services, expected outcomes, and the impact of contraceptive use. Given the success of these indicators, the PME Working Group aimed to maintain a degree of consistency when revising the indicators for the new FP2030 framework.
The FP2030 framework features important additions and modifications to the FP2020 indicators, including the move from tracking additional users to reporting total users in a country. The modern contraceptive prevalence indicator is now disaggregated for all women into married (or in union) and unmarried. To supplement the adolescent birth rate indicator, the framework includes a set of indicators on family planning use in relation to life events, such as sexual activity, marriage, and first birth, as well as contraceptive behaviors. Additionally, there are new reporting mechanisms, such as communicating uncertainty ranges for estimates to improve data transparency and reporting on traditional contraceptive prevalence (TCP) in countries where TCP is 5% or higher among married women. Finally, other changes include new indicators to better track method source, counseling on method switching, and unintended pregnancies.
Countries began using the FP2030 Measurement Framework in 2021. The annual reporting process has remained similar to the country-led FP2020 process (Figure 3). Countries analyze their family planning data, hold stakeholder consultations on monitoring progress, and report on indicators. The country consensus meetings are critical for ensuring that the process remains country-driven and that stakeholders dedicate time to review and understand the data, take stock of progress, and adjust their strategies as necessary. Beyond these annual reviews, governments collaborate with Track20 throughout the year to identify weaknesses in their data systems and make changes or adopt tools that can help them better use their available data to actively assess progress. This process has led to increased capacity for data analysis, more regular conversations on progress, greater transparency on family planning measures, and more opportunities for the use of data in decision making.
Although the reporting process is similar, more countries are now involved. The FP2020 Core Indicators were reported for the 69 poorest countries in the world, based on gross national income (GNI) per capita in 2010. With the shift to the FP2030 partnership, which is open to any country that wishes to make a commitment, the geographic scope of the Measurement Report needed to be revised. As a starting point, FP2030 is reporting progress for all 82 low- and lower-middle-income countries, based on the World Bank’s GNI per capita classifications as of 2020. The geographic scope of reporting will be continually reassessed to make adaptations as additional countries make commitments and as country classifications shift
Over the course of a year, Track20, FP2030, and other partners produce and publish data oon the progress of the movement. The FP2030 indicator estimates are produced by the Track20 team and in-country Monitoring & Evaluation (M&E) Officers.
Future of family planning measurement
The FP2030 Measurement Framework reflects the advances made during the FP2020 partnership and may be considered the current state of the art in family planning measurement. The PME Working Group recognizes, however, that improved measurement is still needed in many aspects of family planning. Additional measurement challenges to address include improving the understanding of fertility intentions and the desire to use contraception; incorporating indicators to measure social and behavioral change efforts; improving the measurement of empowerment and decision making, exploring measures of equity related to contraceptive use; improving the monitoring and measuring of quality of care; and identifying measures at the supportive environment level for policy, financing, and accountability. The FP2030 Measurement Framework highlights these needs in the section titled “Areas of Future Work,” and the FP2030 data hub features full briefs for each of these topic areas.
Earlier this year, the PME Working Group collaborated to publish a commentary on refining the language and measurement of the unmet need and demand satisfied indicators: Language and Measurement of Contraceptive Need and Making These Indicators More Meaningful for Measuring Fertility Intentions of Women and Girls (Global Health Science and Practice). The measures for unmet need and demand satisfied are commonly misused and not always representative of the desired contraceptive methods and services. This commentary calls on the family planning community to establish more accurate labels for these indicators and eventually to work toward developing more refined measures that do a better job of capturing people’s fertility intentions and contraceptive preferences. As mentioned above, the FP2030 Measurement Framework includes traditional contraceptive prevalence as an additional indicator. The inclusion of TCP helps to contextualize unmet need and demand satisfied indicators, since it shows that at least some women who are not using modern methods are in fact using traditional methods to prevent pregnancy. Over the coming years, FP2030 will support more discussion and action on advancing measures for unmet need and other measurement challenges.