美国华盛顿大学Rafael Lozano团队研究了204个国家和地区按年龄和婚姻状况分列的避孕方法组合、流行率和需求。该研究于2022年7月23日发表在《柳叶刀》杂志上。
满足育龄妇女的避孕需求有利于妇女儿童的健康，亦有利于增强妇女的经济和社会能力。较高的避孕覆盖率与更多样化的避孕方法的可用性有关。研究组对1970至2019年204个国家和地区每隔5岁年龄组的有伴侣和无伴侣妇女的避孕普及率（CPR）、现代避孕普及率（mCPR）、需求满足率和避孕方法进行了估计。
研究组使用了1162项以人口为基础的调查，记录了1970至2019年间女性的避孕措施使用情况，其中育龄（15-49岁）女性自我报告了她们或其伴侣目前为计划生育目的使用避孕措施的情况。时空高斯过程回归用于生成按年龄和婚姻状况的CPR、mCPR、需求满足和避孕方法组合的估计。使用全球疾病、伤害和风险因素负担研究中的元回归贝叶斯正则化修剪方法，评估了特定年龄的mCPR和需求满足如何随社会人口指数（SDI，衡量社会和经济发展的一种指标）变化。
2019年，1.629亿名妇女的避孕需求未得到满足，其中29.3%居住在撒哈拉以南非洲，27.2%居住在南亚。15-19岁的女性（64.8%）和20-24岁的女性（71.9%）需求满足率最低，2019年，15-24岁的女性有4320万（95%）的需求未得到满足。在SDI值低于60（以0-100分为标准）时，15-19岁女性的mCPR和需求满足率显著低于20-49岁女性，但随着SDI增加到60以上，两者开始趋于平衡。
1970-2019年间，全球mCPR增长了20.1个百分点。在此期间，传统避孕方法在所有避孕方法中所占比例下降，而植入物、注射、女性绝育和避孕套的使用增加。方法组合因年龄和地理位置而异，女性绝育比例随年龄增长而增加，占南亚使用方法的50%以上。2019年28个国家中超过50%的用户使用了一种方法。
单种避孕方法在某些地方占主导地位，这就提出了一个问题，即计划生育政策是否应该旨在扩大方法组合，还是应该投资于使现有方法更容易获取。15-24岁女性的需求满足率较低也令人担忧，因为25岁之前的意外怀孕可能会阻止或消除导致社会和经济赋权的教育和就业机会。决策者应努力使计划生育方案适应最需要的群体偏好，同时保持现有用户使用的方案。
附：英文原文
Title: Measuring contraceptive method mix, prevalence, and demand satisfied by age and marital status in 204 countries and territories, 1970–2019: a systematic analysis for the Global Burden of Disease Study 2019
Author: Annie Haakenstad, Olivia Angelino, Caleb M S Irvine, Zulfiqar A Bhutta, Kelly Bienhoff, Corinne Bintz, Kate Causey, M Ashworth Dirac, Nancy Fullman, Emmanuela Gakidou, Thomas Glucksman, Simon I Hay, Nathaniel J Henry, Ira Martopullo, Ali H Mokdad, John Everett Mumford, Stephen S Lim, Christopher J L Murray, Rafael Lozano
Issue&Volume: 2022/07/23
Abstract:
Background
Meeting the contraceptive needs of women of reproductive age is beneficial for the health of women and children, and the economic and social empowerment of women. Higher rates of contraceptive coverage have been linked to the availability of a more diverse range of contraceptive methods. We present estimates of the contraceptive prevalence rate (CPR), modern contraceptive prevalence rate (mCPR), demand satisfied, and the method of contraception used for both partnered and unpartnered women for 5-year age groups in 204 countries and territories between 1970 and 2019.
Methods
We used 1162 population-based surveys capturing contraceptive use among women between 1970 and 2019, in which women of reproductive age (15–49 years) self-reported their, or their partners, current use of contraception for family planning purposes. Spatiotemporal Gaussian process regression was used to generate estimates of the CPR, mCPR, demand satisfied, and method mix by age and marital status. We assessed how age-specific mCPR and demand satisfied changed with the Socio-demographic Index (SDI), a measure of social and economic development, using the meta-regression Bayesian, regularised, trimmed method from the Global Burden of Diseases, Injuries, and Risk Factors Study.
Findings
In 2019, 162·9 million (95% uncertainty interval [UI] 155·6–170·2) women had unmet need for contraception, of whom 29·3% (27·9–30·6) resided in sub-Saharan Africa and 27·2% (24·4–30·3) resided in south Asia. Women aged 15–19 years (64·8% [62·9–66·7]) and 20–24 years (71·9% [68·9–74·2]) had the lowest rates of demand satisfied, with 43·2 million (95% UI 39·3–48·0) women aged 15–24 years with unmet need in 2019. The mCPR and demand satisfied among women aged 15–19 years were substantially lower than among women aged 20–49 years at SDI values below 60 (on a 0–100 scale), but began to equalise as SDI increased above 60. Between 1970 and 2019, the global mCPR increased by 20·1 percentage points (95% UI 18·7–21·6). During this time, traditional methods declined as a proportion of all contraceptive methods, whereas the use of implants, injections, female sterilisation, and condoms increased. Method mix differs substantially depending on age and geography, with the share of female sterilisation increasing with age and comprising more than 50% of methods in use in south Asia. In 28 countries, one method was used by more than 50% of users in 2019.
Interpretation
The dominance of one contraceptive method in some locations raises the question of whether family planning policies should aim to expand method mix or invest in making existing methods more accessible. Lower rates of demand satisfied among women aged 15–24 years are also concerning because unintended pregnancies before age 25 years can forestall or eliminate education and employment opportunities that lead to social and economic empowerment. Policy makers should strive to tailor family planning programmes to the preferences of the groups with the most need, while maintaining the programmes used by existing users.
DOI: 10.1016/S0140-6736(22)00936-9
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00936-9/fulltext
