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Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions
Unwanted Pregnancies and Births
Figure 4-1 shows the proportions of recent births and current pregnancies reported as unwanted in the most recent DHS survey in 34 countries, grouped by region.3 The proportion varies widely among countries within regions, but it is clearly lowest in sub-Saharan Africa, where large desired family sizes are still reported, and generally highest in Latin America, the Middle East, and North Africa. Outside Africa, the proportion of births unwanted ranges in most countries from 12 to 34 percent.
Figure 4-2 shows the proportion of unwanted births in the same countries, grouped by the percentages of married women aged 15-49 currently using any form of contraception (the contraceptive prevalence rate). The countries with the lowest contraceptive prevalence (most of which are in sub-Saharan Africa) have low proportions of unwanted births. The median is 18 percent among the nine countries with contraceptive prevalence of more than 50 percent, considerably higher than the median of 5 percent among the ten countries with contraceptive prevalence of less than 20 percent. This difference does not necessarily mean that women in the highest contraceptive prevalence countries are more likely to have an unwanted birth in a particular year. Precisely because they use contraception more, they are less likely to have a baby than are women in countries where contraceptive use is uncommon. This can be seen in Figure 4-3, showing the range of values for the unwanted birth rate (unwanted births per 1,000 women per year) for countries in the same contraceptive prevalence categories as in Figure 4-2.4 Countries with contraceptive prevalence above 50 percent tend to have lower unwanted birth rates than countries with contraceptive prevalence between 20 and 30 percent, despite having higher proportions of unwanted births, because they have much lower overall birth rates. Women are most at risk of unwanted births in countries where contraceptive use is in the range 20-40 percent, presumably because contraceptive behavior and fertility are lagging behind the more rapid change in fertility preferences.
The proportion of unwanted births is the appropriate measure for discussing the consequences of unwantedness for children. It highlights
Countries chosen for DHS do not represent a random sample of all countries in a region, but they do cover a wide variety of conditions in developing countries outside China.
The unwanted birth rate was calculated as the product of the proportion of most recent births or current pregnancies reported as unwanted multiplied by the general fertility rate (births per 1,000 women aged 15-49 per year) as estimated by the United Nations.