12 million women in African cities want to use family planning but can’t get access to it

IUSSP Press release in relation to the International Conference on Family Planning (ICFP2022), Pattaya, Thailand 14-17 November 2022

(revised 12 November 2022)

African cities have millions of women who wish to avoid getting pregnant but face obstacles to the use of family planning. This is what delegates at the International Conference on Family Planning heard this week in Thailand. The conference, the world’s largest gathering of family planning researchers and practitioners, was presented with the latest research, sponsored by the International Union for the Scientific Study of Population, about this so-called ‘unmet need’.  

People living in African cities want to be able to plan their births and prevent unwanted pregnancies. An estimated 12 million urban women in those cities want to space or limit their births but are not using contraception.  This is called 'unmet need' and ranges from 1 in ten women in Zimbabwe to 4 in ten in Angola.

Empowering women and couples to meet their need for contraception also has positive impacts on urban development.  Current urban population growth is mainly due to natural increase (that is, a greater number of births than deaths within cities) and not to rural-to-urban migration as many people think. City populations tend to be younger than in rural areas. Africa's urban population is currently doubling in size every 20 years. Such mounting urbanization presents challenges for the planning and provision of physical infrastructure and social services. Over half of the urban population live in slum-like conditions. Conference participants learned that while fertility rates in all major African cities have gone down over past decades, these declines have now stalled in about half of those cities, at levels that imply rapid continued growth of population.

Most of the world’s future population growth will take place in urban areas and this is especially true for sub-Saharan Africa. This urban population growth is mainly due to natural increase (that is, a greater number of births than deaths within cities) and not rural-to-urban migration as many people think. Africa’s urban population is currently doubling in size every 20 years. Such mounting urbanization presents challenges for the planning and provision of physical infrastructure and social services. Over half of the urban population live in slum-like conditions. Conference participants learned that while fertility rates in all major African cities have gone down over past decades, these declines have now stalled in about half of those cities, at levels that imply rapid continued growth of population. People living in African cities want to be able to plan their families. City populations tend to be younger than in rural areas and an estimated 12 million urban women want to space or limit their births but face difficulties in achieving these wishes. This is called ‘unmet need’ and ranges from 1 in ten women in Zimbabwe to 4 in ten in Angola.

Prof Thomas LeGrand from the University of Montreal, Canada noted that "the importance of providing couples with the ability to plan their families cannot be overestimated for enabling women to invest in their own schooling and careers, and families to invest in their children's schooling and health – essential elements for alleviating poverty. Indeed, efforts to improve human welfare and promote environmental sustainability – and more generally to attain the sustainable development goals (SDGs) - must place a much greater emphasis on the rapidly growing cities of sub-Saharan Africa and include a focus on reproductive health and family planning services targeting the urban poor."

Dr Sunday Adedini of the Federal University Oye-Ekiti, Nigeria told the conference that Africa's intermediate-sized cities will be home to more than half its urban population by 2030 but that these types of cities lack critical infrastructure and are thus less resilient and face disproportionate disasters and risks of climate stressors and other environmental challenges. He noted that increased investment to ensure that women have access to contraception when they want it can also play a role in changes in the current rates of rapid urban growth in this neglected category of cities.

Dr Pierre Akilimali of Kinshasa University, Democratic Republic of Congo reported his surprising finding that women living in Kinshasa slums use more contraceptives than women living in wealthier neighborhoods of the city. This is partly due to active community health workers in the slum neighborhoods and demonstrates how need can be met even in very low-income urban settings.

And for those wondering if we can afford all this: the experts explained that family planning is a low-cost way to help women improve their lives, while at the same time promoting urban economic development and city resilience. They also emphasized that research has long shown that meeting family planning needs is associated with improved maternal, infant and child health, along with increased women empowerment and reduced household poverty. The average direct cost of supplying a modern, effective contraceptive to a couple in Africa is about US$8 a year