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October 15, 2002-14
Copyright © 2002 Earth Policy Institute
STERILIZATION IS WORLD'S MOST POPULAR CONTRACEPTIVE METHOD
One of Four Births Still Unplanned
Janet Larsen
Female sterilization is the world's most
popular method of birth prevention. A global survey of reproductive
health among married couples by the United Nations found that one
fifth rely on female sterilization (tubal ligation) to control their
fertility. In Brazil, India, and China, a third or more of all married
women have been sterilized.
Even though male sterilization (vasectomy)
is safer, quicker, and less expensive, it is much less common, used
by just 4 percent of married couples. In only a few countries, including
New Zealand, the United Kingdom, the Netherlands, and Bhutan, do
more couples choose male over female sterilization.
Out of the world's 1 billion married couples,
some 650 million plan their families. It is the other 350 million
couples who either do not have access to family planning services
or do not want to plan their families who contribute a disproportionately
large share of the near 80 million people added to the world's population
each year. It is also couples in this group who seek out more abortions
and who are most at risk from higher maternal mortality.
Among the world's married couples who do
practice modern contraception, the next most popular methods after
female sterilization, which is used by 36 percent, are intrauterine
devices (IUDs), at 27 percent, and the pill, at 14 percent. An additional
6 percent choose other modern female methods.
Just 17 percent of modern contraception
is in the hands of men. In addition to the 7 percent of couples
relying on male sterilization, 9 percent use condoms. But male methods
are used by only 12 percent of couples in the developing world,
compared with 38 percent in the industrial world. Among traditional
methods, withdrawal—perhaps the oldest method of birth control—is
practiced by more than 32 million married couples worldwide. It
is the leading method for couples in several East European countries,
including Yugoslavia, Bulgaria, and Romania.
New Zealand boasts the world's highest vasectomy
rate; there, nearly one in five married men has been sterilized.
The method is just slightly less popular than the pill. Family planning
researchers from Bangladesh, the world's eighth most populous country,
are examining New Zealand's high vasectomy rates for clues on how
to promote this method in their own densely populated country.
More men assume responsibility for family
planning in Japan than in any other country, no doubt because the
pill became available only recently. In 2000, condoms accounted
for almost 78 percent of modern contraceptive use there. This is
down from at least 86 percent in 1994. Condom use has fallen in
recent years as some couples switched to the pill, which was finally
approved by the Japanese government in 1999.
The condom is becoming somewhat less popular
in Japan just when its use elsewhere is increasing as a means of
protection against sexually transmitted infections, importantly
HIV. Among all American contraceptive users, for instance, pill
use dropped from 31 percent in 1988 to 27 percent in 1995, while
condom use climbed from 15 to 20 percent. Similar shifts have been
observed in Canada, France, and Australia.
In the United States, 38 percent of married
modern contraceptive users depend on male methods, split between
condoms and vasectomy, but female sterilization remains the single
most popular method, chosen by 34 percent of couples. Twenty-two
percent rely on the pill. Less than 1 percent choose IUDs—one
of the world's lowest rates.
In China and India, home to the world's
two largest populations, female contraceptive measures predominate.
In China, 44 percent of married women using modern contraceptives
rely on the IUD and 40 percent on sterilization. In India, female
sterilization is the overwhelming choice, accounting for a full
four fifths of contraceptive use.
Government encouragement, a high female
literacy rate, and low infant mortality have helped raise China's
modern contraceptive use among married couples to 83 percent—the
world's highest. As a result, population growth has slowed to less
than 1 percent annually, roughly the same as in the United States.
Chinese women on average have fewer than two children.
By contrast, fewer than half of India's
married couples use any form of birth control. Low literacy levels,
high infant mortality, and a lack of access to affordable and reliable
contraceptives have kept the annual population growth rate at 1.7
percent. On average, women in India give birth to more than three
children.
Lowering fertility to replacement level
(roughly two children per couple) sets the stage for population
stabilization—the ultimate goal of most population policies.
This is typically achieved when at least 70 percent of reproductive-age
women practice some form of family planning. Unfortunately, more
than half of the world's women live in countries where regular birth
control use is much lower. Many of these women do not have any access
to affordable and reliable reproductive health services, or do not
have the support of their husbands, extended families, or communities
to try to plan their families.
Much of the family planning shortfall occurs
in the developing world, although this varies widely among countries.
Though contraceptive use among women in developing countries has
increased dramatically—from 24 percent in 1970 to 60 percent
in the late 1990s (but 49 percent if China is excluded)—it
still lags behind the industrial world's rate of 68 percent. (See
figure).
African countries have the lowest levels
of contraceptive use, suffering from a lack of reproductive health
funding. In some 30 African countries, less than 20 percent of married
couples use contraception. The Democratic Republic of the Congo,
Eritrea, Rwanda, Angola, and Somalia are among the dozen or so countries
where less than 5 percent of couples plan their families. Making
condoms available there would both prevent births and the surging
spread of HIV.
Partly as a result of the continuing family
planning gap, at least one fourth of the 133 million babies born
worldwide each year are unplanned. When family planning needs are
not met, women's health is compromised. Some women turn to abortion
as a last option, simply because they may not have enough food for
another child.
The 1994 International Conference on Population
and Development held in Cairo set goals for funding a 20-year population
and reproductive health program, but donor countries—mostly
industrial nations—have fallen short on their funding commitments
by some two thirds. Few funding shortfalls have such a high social
toll. The United Nations Population Fund (UNFPA) estimates that
each $1 million shortfall in contraceptive spending translates into
360,000 additional unwanted pregnancies, 150,000 additional induced
abortions, 800 maternal deaths, 11,000 infant deaths, and 14,000
additional deaths of children under the age of 5—all preventable.
Now that the United States has ignored the
recommendations of its own State Department and withdrawn a promised
$34 million in funding for UNFPA, other donor countries and individuals
are scrambling to try to make up the difference so that women will
not lose access to vital services. With the world's largest generation
of young people entering their reproductive years, this is not the
time to cut family planning funds.
See
Additional Data
Copyright
© 2002 Earth Policy Institute
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FOR ADDITIONAL INFORMATION
From Earth Policy Institute
Lester R. Brown, Chapter 10: "Stabilizing Population
by Reducing Fertility," in Eco-Economy:
Building an Economy for the Earth (W.W. Norton & Company,
2001)
Janet Larsen, "Population Growing by 80 Million
Annually," in Lester R. Brown, Janet Larsen, and Bernie Fischlowitz-Roberts,
The Earth Policy Reader
(New York: W.W. Norton & Company, 2002).
Janet Larsen, "Iran's Birth Rate Plummeting at Record
Pace," Eco-Economy Update, 28
December 2001.
From Other Sources
John Bongaarts and Elof Johansson, Future Trends
in Contraception in the Developing World: Prevalence and Method
Mix, Policy Research Division Working Paper No. 141 (New York:
The Population Council, 2000).
Nada Chaya and Kali-Ahset Amen, with Michael Fox,
Condoms
Count: Meeting the Need in the Era of HIV/AIDS (Washington,
DC, Population Action International: 2002).
Global Health Council, Promises
to Keep: The Toll of Unintended Pregnancies on Women's Lives in
the Developing World (Washington, DC: 2002).
Population Reference Bureau, Family
Planning Worldwide: 2002 Data Sheet (Washington, DC, June
2002).
United Nations Population Division, World
Contraceptive Use 2001 (New York: May 2002).
United Nations Population Fund, Reproductive
Health Essentials: Securing the Supply (New York: 2002).
World Health Organization, Selected
Practice Recommendations for Contraceptive Use, 2002
(Geneva: 2002).
LINKS
The Alan Guttmacher Institute
http:/www.agi-usa.org
PlanetWire.org
http:/www.planetwire.org
Population Action International
http:/www.populationaction.org
Population Connection
http:/www.population
connection.org
Population Council
http:/www.popcouncil.org
Population Reference Bureau
http:/www.prb.org
United Nations Population Division
http:/www.un.org/esa/
population/unpop.htm
United Nations Population Fund
http:/www.unfpa.org
United Nations Population Information Network
http:/www.un.org/popin
U.S. Census Bureau International Population Database
http:/www.census.gov/ipc/
www/idbnew.html
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