ESPEYB20 11. Global Health for the Paediatric Endocrinologist Endocrinology (6 abstracts)
11.13. Measuring contraceptive method mix, prevalence, and demand satisfied by age and marital status in 204 countries and territories, 1970-2019: a systematic analysis for the Global Burden of Disease Study 2019
Haakenstad A , Angelino O , Irvine CMS , Bhutta ZA , Bienhoff K , Bintz C , Causey K , Dirac MA , Fullman N , Gakidou E , Glucksman T , Hay SI , Henry NJ , Martopullo I , Mokdad AH , Mumford JE , Lim SS , Murray CJL & Lozano R
Institute for Health Metrics and Evaluation and Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA; Centre for Global Child Health, University of Toronto, Toronto, ON, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan; Swedish Family Medicine, First Hill, Seattle, WA, USA. rlozano@uw.edu Lancet 2022; 400: 295–327. DOI: 10.1016/S0140-6736(22)00936-9.
Brief summary: An analysis of contraception data in 204 countries and territories between 1970 and 2019 shows that 162.9 million women had unmet needs for contraception (65.5% in sub-Saharan Africa and in south Asia). Demand was not satisfied for 64.8% of women aged 15–19 years, the highest proportion of any age group.
This study included women aged 15–49 years and analysed contraceptive prevalence rate (CPR) and ‘demand satisfied’. We highlight this article because of the importance of the results for the youngest age group (15–19 years), commonly cared for by pediatric endocrinologists or by adult endocrinologists with a focus on adolescence. As a reminder, the WHO list of essential medicines for children (EMLc) includes ages 0–12 years, and oral contraceptives are therefore included in the adult list.
The encouraging finding of this study is that CPR and ‘demand satisfied’ have increased steadily between 1979 and 2019 in all countries and for all age groups. However, the 15–19 years age group still ranks lowest across all sociodemographic markers (married or unmarried, geographical location) for both CPR and ‘demand satisfied’, in particular in Africa, Middle East and South Asia. This article, in a non-judgmental way, highlights the negative consequences of the lack of access to contraception on gender equity (delaying childbearing to later in life allows women to pursue education, to gain work experience and to have better access to paid employment) while acknowledging that being married and having children can lead to financial and social security. They also highlight some barriers such as culture (i.e. traditions, religion) and cost (birth control pill in particular, preferred by younger women who want reversible methods) that negatively affect access to contraception.
This article should help pediatric endocrinologists reflect on the role of contraception while balancing culture, gender equity and successful future for their adolescent female (and male) patients. We all have a role to play in supporting United Nations Sustainable Development Goal (SDG) 3.7 which aims to ensure by 2030 ‘universal access to sexual and reproductive health-care services, including for family planning, information and education, and integration of reproductive health into national strategies’ (www.un.org/development/desa/pd/data/sdg-indicator-371-contraceptive-use).
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ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
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