Many couples in the developing world lack the means to exercise a basic right that most Americans take for granted: the right to choose the number and timing of their children.

Although family planning services are more widely available than ever, more than 120 million women in the developing world still want to space or limit childbearing but do not have access to contraception, and the number of reproductive-age couples is expected to increase by at least 20 million each year.

In the developing world, limited access to family planning results in high rates of unintended pregnancy, millions of unsafe abortions, and thousands of maternal deaths. Some 585,000 women die of pregnancy-related causes every year -- more than one woman every minute of the day.

Limited access to family planning is also a leading cause of infant deaths in developing countries. Children born into large families are far more likely to die before their fifth birthday than children in smaller families. This is especially true when births are closely spaced. By spacing births at least two years apart, family planning can prevent an average of one in four infant deaths.

Addressing unmet need among adolescents is particularly important. Family planning and other reproductive health programs are often ineffective at reaching young adults, yet the risk of dying due to pregnancy-related causes is twice as high for women ages 15-19 than for women ages 20-24.

Facts and Figures

In developing countries as a whole, excluding China, about 20 per cent of married women of reproductive age have unmet need for family planning. There is wide variation in the percentage among regions and countries. The level of unmet need is highest in sub-Saharan Africa, where in some countries one married woman in every three has unmet need. Because of the large population of Asia, however, by far the greatest number of women with unmet need live in this region.

India has the most unmet need for family planning, at about 31 million women. Other countries where large numbers of women have unmet need are Pakistan (5.7 million), Bangladesh (4.4 million), Nigeria (3.9 million), and Mexico (3.1 million).

Based on the most recent data, demand for family planning (married women who want to space or limit their children) is: 62 per cent in Ghana, yet only 9 per cent of couples use modern methods of contraception; 75 per cent in Bolivia, yet only 12 per cent use modern methods; 57 per cent in Guatemala, yet only 18 per cent use modern methods; and 69 per cent in the Philippines, yet only 15 per cent use modern methods.

Just to maintain current levels of modern contraceptive use, the number of users would have to increase by 50 per cent in Bangladesh (an increase of 5 million over today's 11 million users), and by about 25 per cent in Indonesia (an increase of 7 million over today's 30 million users), over the next 15 years.

USAID: Providing Technical Leadership, Saving Lives

For over 30 years, the United States has played a critical role in the global effort to meet the enormous unmet need for family planning information and services. Not only has it been a leading donor of population assistance, but USAID remains the technical leader in designing and delivering high quality, cost-effective, voluntary family planning services to the developing world.

• USAID's experienced technical staff works with U.S. and host-country partners to design family planning and reproductive health programs centered on client needs -- emphasizing choice among a wide range of contraceptives, and quality of care and counseling. Increasingly, these programs are integrated with other community-based efforts to improve maternal and child health, prevent HIV/AIDS, and enhance women's status -- including literacy training and microenterprise loans.

• USAID has been at the forefront of training physicians and other medical professionals in family planning and reproductive health as well as community-based health workers -- an important part of providing access to hard-to-reach rural communities. These programs have trained over half a million providers around the world over the past two decades, helping to increase both access to, and quality of, services and information.

• USAID-funded innovative mass media and public information campaigns have helped strengthen efforts to prevent unintended pregnancies, promote healthy births, and slow the transmission of HIV/AIDS and other sexually transmitted infections.

• USAID manages a global system for the delivery of contraceptive supplies. Numerous countries and donors rely on USAID's contraceptive- supply forecasting system, designed to ensure availability and choice of contraceptives year-round.

• USAID supports ground-breaking research that results in improved strategies to deliver family planning together with other health services, ensuring that programs reflect local needs and are cost-effective.

• USAID is the largest donor in the development of safe and effective contraceptives, helping to increase contraceptive options for citizens of the developing world, as well as for Americans.

Hundreds of thousands of women and children are alive today because of USAID's family planning assistance. These programs are integral to USAID's broader efforts to promote population stabilization, economic development, human health and well-being, environmental quality, food security, and global peace and stability.

Global Issues USIA Electronic Journal, Vol. 3, No. 2, September 1998