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.
Hubacher
David
D
Family Health International, PO Box 13950, Research Triangle Park, NC 27709, USA. dhubacher@fhi.org
Mavranezouli
Ifigeneia
I
McGinn
Erin
E
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