Lessons on Family Planning Equity Among Youth

Unmet need for family planning among women ages 15 to 24 is higher than among older women, and meeting their need would significantly reduce unintended pregnancies and maternal deaths.

Advocates, service providers, and governments are increasingly focused on improving access to and use of contraception among young people. To tailor program efforts, it is critical to understand how young women’s access to and use of family planning varies by socioeconomic status and other measures.

PRB’s new Population Bulletin looks at whether demand satisfied for family planning, as a key indicator of universal access to sexual and reproductive health, is equitable among young women ages 15 to 24 in low- and middle-income countries, and to what extent that inequity has changed over time. We consider these questions at the global, regional, and national levels using survey data from 33 countries. Our analysis demonstrates that:

  1. Inequity in demand satisfied for family planning among young women remains substantial, but is improving over time. We find a strong correlation globally between wealth quintile and the likelihood of a young woman having her demand for modern family planning satisfied. For each increase in wealth quintile (from least to most wealthy), a young woman’s odds of having her demand for modern family planning satisfied increases by 30 percent. The influence of wealth quintile on demand satisfied for family planning among young women is strongest in Eastern Africa, Southern Africa, Western Africa, and Middle East and North Africa. On a positive note, the gap in demand satisfied between the richest and poorest young women has shrunk in most regions.
  2. Globally and in most regions, education, age, and other factors are at least as strong predictors of demand satisfied for family planning among young women as wealth. At the global level, education, age, and marital status each have at least as strong an impact on the likelihood of demand satisfied for modern family planning as wealth quintile. Controlling for other factors, young women with no education have a 40 percent likelihood of having their family planning demand satisfied, compared to higher likelihoods of above 50 percent among those with secondary education and those with more than secondary education.
  3. Increases in contraceptive use have been the primary factor driving recent improvements in demand satisfied for family planning among young women, rather than decreases in unmet need. Slightly more than half of countries (17 of the 33 in our sample) demonstrated improvements in both demand satisfied and equity over time. Among this group, most experienced larger proportional increases in the modern contraceptive prevalence rate compared to decreases in unmet need. This finding suggests that an increase in the percentage of young women who use family planning has had a larger effect on demand satisfied than a drop in the proportion of young women who wish to prevent pregnancy but are either unable or unwilling to adopt contraception.
  4. To overcome inequity among youth, emphasize service provision at the community level. Localized, community- and outreach-based interventions can be most effective in reducing inequities in health by addressing the challenges faced by disadvantaged subgroups in reaching facilities. By focusing on community-level interventions, program designers can ensure that all young women have access to family planning services and pave the way to both more equitable and higher levels of demand satisfied for family planning among youth.