Unintended pregnancy in sub-Saharan Africa: magnitude of the problem and potential role of contraceptive implants to alleviate it.
BACKGROUND
Unintended pregnancies continue to burden many countries in sub-Saharan Africa. Our aim was to estimate the number of unintended pregnancies in the region and model the impact of expanding use of contraceptive implants at the expense of short-term hormonal birth control methods.


METHODS
For the 42 countries in mainland sub-Saharan Africa, we estimated current levels of unintended pregnancy, prevalence of hormonal contraceptive use and number of unintended pregnancies stemming from early discontinuation and typical method failure rates. Using a decision-analytic model, we estimated the potential impact of more widespread use of the contraceptive implant.


RESULTS
Every year in sub-Saharan Africa, approximately 14 million unintended pregnancies occur and a sizeable proportion is due to poor use of short-term hormonal methods. If 20% of the 17.6 million women using oral contraceptives or injectables wanted long-term protection and switched to the contraceptive implant, over 1.8 million unintended pregnancies could be averted over a 5-year period.


CONCLUSIONS
Poor patterns of short-term hormonal contraceptive use (high discontinuation rates and incorrect use) contribute significantly to the problem of unintended pregnancy in sub-Saharan Africa. More availability and widespread use of highly effective methods, such as the contraceptive implant, will improve reproductive health in the region.
Family Health International, PO Box 13950, Research Triangle Park, NC 27709, USA. dhubacher@fhi.org
David
D
Hubacher
Ifigeneia
I
Mavranezouli
Erin
E
McGinn
D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara; D003267:Contraception / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D003268:Contraception Behavior; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D003276:Contraceptives, Oral / Q000008:administration & dosage; D003663:Decision Trees; D004343:Drug Implants; D005193:Family Planning Services; D005260:Female; D006801:Humans; D010349:Patient Compliance; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D012307:Risk Factors
D003271:Contraceptive Agents, Female; D003276:Contraceptives, Oral; D004343:Drug Implants