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March 2016
Contraceptive Failure Rates in the Developing World:
An Analysis of Demographic and Health Survey Data in 43 Countries
Chelsea B. Polis, Sarah E.K. Bradley, Akinrinola Bankole, Tsuyoshi Onda, Trevor Croft and Susheela Singh
HIGHLIGHTS
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Using self-reported data from national surveys of women aged 15–49, we estimated typicaluse contraceptive failure rates for seven methods at 12, 24 and 36 months of use. We provide a median estimate for each method across 43 countries overall, in seven subregions and
in individual countries. We also give estimates for various demographic and socioeconomic
populations. Estimates are not corrected for potential errors in reporting contraceptive use or
potential underreporting of abortion, which may vary by country.
Across all countries analyzed, reported 12-month failure rates were lowest for users of
longer-acting methods such as implants (0.6 failures per 100 episodes of use), IUDs (1.4) and
injectables (1.7); intermediate for short-term resupply methods such as oral contraceptive pills
(5.5) and male condoms (5.4); and highest for users of traditional methods such as withdrawal
(13.4) or periodic abstinence (13.9), a group largely using calendar rhythm.
The 12-month failure rate varied across subregions: The range was 0.2–1.3 per 100 episodes
of use for implants, 0.9–2.2 for IUDs, 0.9–4.2 for injectables, 3.6–8.5 for oral contraceptive
pills, 2.2–8.7 for male condoms, 7.8–17.1 for withdrawal and 6.1–20.9 for periodic abstinence.
We assessed differences in contraceptive failure rates by age, marital status, parity, contraceptive intention, wealth, residence and education. Of these, age was associated with the
largest differences in rates. For all methods except implants (for which the failure rate did not
vary by age), 12-month contraceptive failure rates were higher among women younger than
25 years as compared with their older counterparts.
Although comparing our estimates for contraceptive failure rates with those for the United
States is complex, ours were somewhat higher than U.S. estimates derived from clinical data
for implants (0.6 vs. 0.05 per 100 episodes of use) and IUDs (1.4 vs. 0.8). On the other hand,
ours were markedly lower than U.S. estimates for injectables (1.7 vs. 6), oral contraceptive
pills (5.5 vs. 9), male condoms (5.4 vs. 18), withdrawal (13.4 vs. 22) and periodic abstinence
(13.9 vs. 24).
Our findings help to highlight those methods, subregions and population groups that may
be in need of particular attention for improvements in policies and programs to address high
levels of contraceptive failure.
March 2016
Contraceptive Failure Rates in the Developing
World: An Analysis of Demographic and Health
Survey Data in 43 Countries
Chelsea B. Polis, Sarah E.K. Bradley, Akinrinola Bankole,
Tsuyoshi Onda, Trevor Croft and Susheela Singh
ACKNOWLEDGMENTS
This report was written by Chelsea B. Polis (Guttmacher
Institute), Sarah E.K. Bradley (University of California,
Berkeley), Akinrinola Bankole (Guttmacher Institute),
Tsuyoshi Onda (Guttmacher Institute), Trevor Croft (ICF
International) and Susheela Singh (Guttmacher Institute).
The authors would like to thank the following Guttmacher
colleagues: Jacqueline E. Darroch and Kathryn Kost for
providing comments on an earlier version of the report;
Kathleen Randall for supervising production; and Alyssa
Browne for research assistance. We also thank Glen
Heller, independent consultant, for providing data tabulations, and Susan London, independent consultant, for
editing the report.
The authors are also grateful to the following external
reviewers who provided helpful comments on an earlier
version of the report: James Trussell, Princeton University;
Sian Curtis, University of North Carolina, Chapel Hill; John
Cleland, London School of Hygiene & Tropical Medicine;
Tom Pullum, ICF International; and Michelle Weinberger,
Avenir Health.
This report was funded by UK aid from the UK Government. The views expressed are those of the authors and
do not necessarily reflect the UK Government’s official
policies. The Guttmacher Institute also gratefully acknowledges the generous unrestricted support it receives from
individuals and foundations—including major grants from
The William and Flora Hewlett Foundation and the David
and Lucile Packard Foundation—which undergirds all of
the Institute’s work. The findings and conclusions of this
report are those of the authors and do not necessarily
reflect positions or policies of the donors.
© Guttmacher Institute, 2016
Suggested citation: Polis CB et al., Contraceptive Failure
Rates in the Developing World: An Analysis of Demographic and Health Survey Data in 43 Countries, New York:
Guttmacher Institute, 2016, http://www.guttmacher.org/
report/contraceptive-failure-rates-in-developing-world
www.guttmacher.org
CONTENTS
Introduction.......................................................................................5
Data Sources and Methods...........................................................7
Data Sources...............................................................................7
Countries and Surveys Included in Analysis.......................7
Calculation of Failure Rates....................................................8
Demographic and Socioeconomic Characteristics...........8
Methods.......................................................................................8
Statistical Approach................................................................8
Contraceptive Methods Analyzed.........................................8
Sampling Weights and Rules for Estimating
Failure Rates...........................................................................8
Limitations..................................................................................10
Background and Context..............................................................12
Demographic and Socioeconomic Indicators.....................12
Sexual and Reproductive Behaviors.....................................12
Marriage and Sexual Activity...............................................12
Fertility Level and Preferences............................................12
Access to Health Care...........................................................13
Contraceptive Prevalence and Method Mix........................13
Overall and Subregional Contraceptive
Failure Rates....................................................................................16
Overall Contraceptive Failure Rates (Medians)...................16
Subregional Contraceptive Failure Rates
(Pooled Estimates)....................................................................16
Implants...................................................................................17
Intrauterine Devices..............................................................17
Injectables...............................................................................17
Oral Contraceptive Pills.........................................................17
Male Condoms........................................................................17
Withdrawal..............................................................................17
Periodic Abstinence..............................................................17
Contraceptive Failure Rates by Demographic
and Socioeconomic Characteristics.........................................27
Twelve Month Contraceptive Failure Rates By Single
Characteristics (Pooled Estimates).......................................27
Age............................................................................................27
Marital Status.........................................................................27
Parity........................................................................................27
Contraceptive Intention.........................................................28
Wealth......................................................................................28
Residence................................................................................28
Education.................................................................................28
Twelve Month Contraceptive Failure Rates by
Combinations of Characteristics (Pooled Estimates).........28
Discussion and Conclusions.......................................................35
Contraceptive Failure Rates Across 43 Countries...............35
Contraceptive Failure Rates by Subregion...........................36
Contraceptive Failure Rates by Demographic and
Socioeconomic Groups.........................................................37
Implications and Conclusions.................................................37
Appendix A: Calculation of Failure Rates................................39
Appendix B: Median Failure Rates Versus Pooled
Failure Rates....................................................................................42
Tables................................................................................................43
References.......................................................................................64
Appendix Tables.............................................................................66
3
4
Introduction
Many women and couples around the world desire fewer
children than they already have; others want to prevent
or control the timing of future births but don’t always
succeed. Unintended pregnancy is common: Worldwide,
approximately 85 million pregnancies (40% of all pregnancies) were unintended in 2012.1 In the developing
world, 74 million unintended pregnancies occur annually,
of which a sizable share, 30%, are due to contraceptive
failure among women using some type of contraceptive
method (whether traditional or modern).2 This includes
both method-related failures (i.e., failure of a method to
work as expected) and user-related failures (i.e., failure
stemming from incorrect or inconsistent use of a method).
Detailed information on contraceptive failure rates is critical to inform improvements in provision of contraceptive
information, supplies and services, which can help women
and couples to use methods correctly and consistently.
Unintended pregnancies can have many undesirable
consequences, including unwanted childbearing, recourse
to (potentially unsafe) abortion, and morbidity and mortality among mothers, newborns or both.3–5 In 2012, 38%
of all unintended pregnancies worldwide ended in an
unplanned birth, 13% in miscarriage, and 50% in abortion.1 Unintended pregnancy, as well as its two main outcomes (unplanned birth and abortion), can have negative
consequences for women, and in the case of unplanned
birth, also for newborns. For example, although elective
abortion may resolve unwanted pregnancy, access to safe
procedures is not always available, especially in developing countries. In 2008, about 40 million abortions occurred worldwide, approximately 22 million of which were
unsafe.6 Furthermore, a review published the same year
suggested an association between unintended pregnancy
and delayed initiation of antenatal care, a decreased number of antenatal care visits, or both in developed and some
developing countries.4
A small number of studies have focused on estimating contraceptive failure rates in developed or developing countries.7–13 Much of what is known about these
rates in developing countries comes from Demographic
and Health Survey (DHS) data. For example, Ali et al.14
assessed causes and consequences of contraceptive
discontinuation using DHS data from married women in
19 countries. Using single-decrement life tables, they
found that median values for contraceptive failures by
12 months were 1.1% for the IUD, 1.5% for injectables,
5.6% for the pill, 7.6% for the male condom, 15.3% for
withdrawal and 17.4% for periodic abstinence (the rate
for sterilization was not assessed). Reported failure rates
were lowest for IUD and injectable users, intermediate for
pill and condom users, and highest for users of withdrawal
or periodic abstinence.
Other studies have estimated contraceptive failure
rates using DHS data, although many have restricted
analysis to particular subgroups or a limited number of
countries. For example, some studies11,14,15 assessed
rates only among women who were married at the time
of interview, and others analyzed data from 25 or fewer
countries.7,16 Moreover, studies using DHS data often
estimate 12-month failure rates; less is known about rates
beyond 12 months.
We undertook a study to update contraceptive failure
rates and provide a more comprehensive global picture.
Our study takes advantage of the increasing number of
DHS countries with reproductive calendar data—questions
asked about contraceptive use for each month of the last
five years before the interview—to increase knowledge
of contraceptive failure rates. We provide new estimates
of contraceptive failure in 43 countries across seven
subregions using recent data; more than half of the included surveys were conducted in 2010 or more recently.
Specifically, we report data for 10 countries in Eastern
Africa, five in Western Africa, six in Northern Africa and
Western Asia, five in Eastern Europe and Central Asia, five
in Southern Asia, four in Southeastern Asia, and eight in
Latin America and the Caribbean.
Because our primary interest is comparing contraceptive failure rates for each method across countries and
demographic and socioeconomic groups, we calculated
rates using a single-decrement approach. Other studies
using DHS data have used a multiple-decrement approach
to calculate failure rates for different purposes.15,16
We calculated failure rates for all sexually active
women rather than only married women (with the excep-
5
tion of seven included DHS surveys* that included only
ever-married women). We also calculated estimates for
durations of contraceptive use longer than 12 months
(specifically, for 24 and 36 months) and for subgroups
stratified by demographic and socioeconomic characteristics (such as age, education, marital status and wealth).
We pooled data for countries within the same geographic
subregion to estimate failure rates at the subregional
level, permitting more stable estimates. Potential limitations of our data and methods are described to properly
contextualize our results.
By using data from 43 countries to present the most
comprehensive and detailed estimates of contraceptive
failure rates to date, we hope this report can provide policymakers and program planners with useful information to
help mitigate the challenges that women and couples face
in using contraceptives effectively.
*Viet Nam 2002, Turkey 2003, Egypt 2008, Maldives 2009,
Bangladesh 2011, Jordan 2012 and Pakistan 2012–2013.
6
Guttmacher Institute
Data Sources and Methods
We used data from 43 Demographic and Health Surveys
(DHS), which are large-scale, nationally representative
household surveys that include interviews with women
of reproductive age (15–49). Participants are asked about
pregnancies, births, terminations and episodes of contraceptive use that occurred over the past five or more years,
producing a retrospective month-by-month reproductive
calendar history for each woman. For each episode of contraceptive use that was discontinued, women are asked,
“Why did you stop using the (method)?” Responses are
categorized into one of 14 precoded responses, including
“became pregnant while using” (i.e., reported contraceptive failure). These histories allow use of life table methods to calculate failure rates by contraceptive method.17
Failure rates in this report are calculated based on
women’s self-reports (which are subject to recall and
other biases, as described in detail below) and should be
interpreted as typical use failure rates for women using a
specific contraceptive method in a specific setting, rather
than as clinical or perfect use failure rates. Typical-use contraceptive failure rates reflect actual use of the method (including inconsistent and incorrect use), whereas perfectuse failure rates reflect the effectiveness of a method if
instructions for use are perfectly followed at all times.
Data Sources
Countries and Surveys Included in Analysis
We used the most recent (as of June 2014) DHS survey
available in each country that included a reproductive calendar containing information on reasons for contraceptive
discontinuation. More than half of the surveys analyzed
were conducted in 2010 or later. For nearly all countries,
we used the most recent survey, but for a small number,*
that survey either did not collect the reproductive calendar or did not include the information on the reasons
for discontinuation in the calendar that is necessary for
calculating the contraceptive failure rate.† For example,
in Kenya, Ethiopia and Malawi, calendar data including
reasons for contraceptive discontinuation were collected
in 2003, 2005 and 2004 respectively, but not in the more
recent surveys conducted in 2008–2009, 2010 and 2011.
For these countries, we used the latest survey that col-
lected the necessary information, excluding from analysis
the more recent ones that did not. Additionally, some
countries (notably Bolivia, Brazil, Guatemala and Paraguay)
no longer collect data through DHS surveys. Rather than
exclude them, we used data from older surveys to ensure
more comprehensive representation, especially for the
Latin America and Caribbean (LAC) region. Some studies
indicate that differences in contraceptive failure rates over
time may be small (which supports our decision to include
older surveys), although they may be larger for certain
user-dependent methods.13,14 Thus, although we included
older surveys for comprehensiveness, we acknowledge
the limitations of doing so and note that estimates may
not always reflect the most current situation.
The 43 included countries are shown in Table 1 (page
43). They cover a wide range of socioeconomic contexts
and patterns of contraceptive use. One-third of the countries come from Sub-Saharan Africa; one-quarter from
North African, West Asian, Eastern European and Central
Asian countries combined; and the rest are relatively evenly split between Southern and Southeastern Asia and LAC.
The countries cover a substantial proportion of the
population in Eastern Africa (81% based on UN population estimates18), Western Africa (69%), Southern Asia
(92%) and Southeastern Asia (73%), but the data are less
representative in other subregions (Appendix Table 1,
page 66). For LAC, the countries included cover only 54%
of the population, largely because data were not available
from Mexico, the second most populous country in that
subregion. Countries from Northern Africa and Western
Asia cover 47% of the population for that subregion, and
those included for Eastern Europe and Central Asia cover
just 22%.
*Bolivia, Dominican Republic, Ethiopia, Kenya, Malawi, the
Philippines and Tanzania.
†Between approximately 2004 and 2009, the DHS core questionnaire did not include information on the reasons for discontinuing use in the contraceptive calendar. Many surveys conducted
during (or shortly after) this time therefore did not collect the
information needed to calculate contraceptive failure rates.
7
Calculation of Failure Rates
We assessed contraceptive failure rates across the 43 included countries in two ways: by ascertaining the median
failure rate by method across all countries and by calculating a pooled failure rate across all countries. Further detail
regarding the two approaches is available in Appendix B,
(page 42).
We also pooled data from multiple countries within the
same subregion. As countries included in our study are
not necessarily representative of their respective subregions, we created these pooled subregional estimates by
giving equal weight to each country, regardless of population size. For example, although India’s population is about
45 times larger than Nepal’s, data from the two countries
contribute equally to the Southern Asia pooled estimates.
These pooled estimates should therefore be interpreted
as average method-specific rates across the countries
(with data) in each subregion. Weighting by population
size would be a reasonable approach if data were available
for all or almost all countries, or for countries that constitute the large majority of the population of all subregions.
However, this was not the case for the data available to
estimate contraceptive failure rates. Thus, averaged unweighted rates that reflect variation across countries are
preferable: These averaged rates are useful for purposes
of modeling and estimation at regional and subregional
levels. Such averaged values may also be used for estimation at the country level, for countries in a given subregion
that lack data.
Demographic and Socioeconomic Characteristics
We linked retrospective calendar information on reported
contraceptive failures that occurred during the five years
preceding the survey with data from other sections of
each woman’s individual interview. This linkage allows
calculation of estimates of reported contraceptive failure
stratified by demographic and socioeconomic characteristics. Data on age, parity, marital status, whether a method
was being used to space births or to limit births (hereafter,
contraceptive intention) were measured for each episode
of method use. In contrast, data on education, wealth and
urban-rural residence were measured only once, when
women were interviewed, and may have changed during
the period on which failure rates are based (see Box, page
9 for more detail).
To capture interrelationships between demographic
and socioeconomic characteristics, we also present
contraceptive failure rates by combining pairs of these
characteristics. For example, we examine failure rates
by education (completed primary or less, secondary or
higher) within wealth categories (poorest three quintiles,
8
wealthiest two quintiles) to determine whether patterns of
reported contraceptive failure by education differ among
poorer versus wealthier women.
Methods
Statistical Approach
Single-decrement life tables estimate probabilities of
cause-specific contraceptive discontinuation including
contraceptive failure leading to a pregnancy, in the absence of competing reasons for discontinuation, such as
stopping use because of an intention to become pregnant.
Different populations may have widely varying levels of
discontinuation for reasons other than failure; for example,
women may stop use because of side effects or access
issues. Differences in levels of discontinuation for other
reasons can make multiple-decrement estimates, which
calculate failure rates in the presence of other competing
reasons for discontinuation, difficult to compare across
populations. Single-decrement rates are helpful for comparing failure rates across multiple surveys or between
subgroups; thus, we calculated single-decrement monthby-month life table rates in this exploration of contraceptive failure across multiple countries and demographic
and socioeconomic groups. A detailed explanation of our
methods for calculating failure rates and confidence intervals is given in Appendix A, page 39.
Contraceptive Methods Analyzed
For this report, we calculated contraceptive failure rates
for seven methods: five modern methods (oral contraceptive pills, IUDs, injectables, implants and male condoms)
and two traditional methods (periodic abstinence/rhythm
method and withdrawal). Where possible, women who
reported using fertility awareness methods (such as the
Standard Days method or the TwoDay method) were
classified as users of “other modern methods,” as their
numbers are too few to calculate failure rates. In some
cases, however, the category of periodic abstinence users
and their failure rates may include some women using
these methods who were not identified as such through
the survey.
Sampling Weights and Rules for Estimating Failure Rates
In all analyses, we used individual-level sampling weights
to produce results that are nationally representative within
each country to account for unequal selection probabilities
in each survey’s sample design. (The unweighted numbers of contraceptive episodes contributing to each failure
rate are shown in the Online Appendix Tables. http://
www.guttmacher.org/sites/default/files/report_downloads/
guttmacher-contraceptive-failure-rates-online-appendix-
Guttmacher Institute
Measurement of Demographic and Socioeconomic Characteristics
Characteristics Measured for Each Episode of Use
Age, parity, marital status and contraceptive intention were measured at the time of each contraceptive
discontinuation.* Marital status during each episode
of contraceptive use was measured by comparing
the date of the end of the episode (i.e., contraceptive
discontinuation) with the date of the woman’s (first)
marriage. Each episode was then classified according to
whether the woman was married (defined as formally
married or living in a union) or had never been married
at the time of discontinuation.† Measurement of these
characteristics at the time of discontinuation introduces
an additional complication for contraceptive episodes
that continued beyond the period of estimation (be it
month 12, 24 or 36), or that continued into the end of
the observation period at three months before the interview. For these episodes, we measured age and marital
status at the end of the relevant life table (month 12, 24
or 36) or at the time the observation was censored.‡
Following the method of Lightbourne,19 we classified women’s contraceptive intention for each episode
of contraceptive use by comparing the number of children ever born to her with her ideal number of children
from the question, “If you could go back to the time
you did not have any children and could choose exactly
the number of children to have in your whole life, how
many would that be?” If a woman’s ideal number of
children was less than or equal to her actual number of
children, she was assumed to have already achieved
her ideal family size, and the episode was classified as
use of contraception to limit births. All other episodes
of use were classified as use to space births.§ Note
that this measure does not use information from the
questions about future fertility intentions (“Would you
like to have (a/another) child, or would you prefer not to
have any (more) children?”) that are used in calculations
of unmet need for contraception, along with the question on retrospective fertility intentions for women who
are pregnant or have postpartum amenorrhea,20 or that
are used in other classifications of contraceptive users
by fertility intentions.2 We followed the approach of
Lightbourne instead because the comparison between
current and ideal number of children can be recalculated at the beginning of each episode, whereas the
questions about future fertility intentions refer only to
women’s preferences at the time of the survey. Characteristics Measured Only at the Time of Interview
For some other characteristics—household wealth
quintile,** women’s education level (no education or
incomplete primary, complete primary, and secondary school or higher), and urban-rural residence—we
applied information collected at the time of the survey
interview to all of the woman’s episodes of contraceptive use. Although this approach may result in some
misidentification (e.g., if women have become more
educated or experienced substantial changes in asset
ownership in the last five years), we assume that for
the vast majority of women, current wealth, education
and residence are reasonably representative of those
measures they have had during the prior five-year
period.
*Although the sample of interviewed women is limited to those currently of reproductive age (15–49), for the youngest women, some
episodes of use took place before age 15. We place these (few)
episodes into the youngest age-group in analysis.
†For women who were married only once and report they are currently married at the time of survey, “ever married” is synonymous
with currently married at the time of discontinuation. For formerly
married women, however, we do not know the date of marital dissolution, and for women who were married more than once, we do
not know the date of any marriage after the first. We therefore can
classify women only as “ever-married” or “never-married” at the time
of the episode of contraceptive use. We note that, although Ali et al.14
say they analyze only episodes of use that occurred within marriage,
it is not possible to measure marital status at the time of the episode
for all women (except in a few surveys that also included a month-bymonth history of marriage within the calendar).
‡It is impossible for parity or contraceptive intention to change
between the start and end of an episode of use, because births
cannot occur during one continuous use episode. Age and marital
status, however, could change during one episode of use. Although
this means that the characteristics are measured at different times
for different episodes of use, we thought it preferable to classify
failures by women’s age and marital status when the failure occurred,
rather than by age and marital status at the start of the episode up to
three years prior. In practice, very few episodes of use would change
categories if the classification were based on the beginning of the episode, because likely very few women transitioned from never-married
to ever-married or from younger than age 25 to age 25 or older during
one use episode.
§This includes nonnumeric responses to the question on ideal number of children, such as “up to God.” We reason that women who do
not give a numeric ideal family size, but still use contraception, are
using it in order to space, rather than limit, their births.
**DHS surveys do not collect direct information on income or wealth,
but do collect information on household ownership of durable goods
and amenities that have been shown to be correlated with household wealth status. (For more information, see: Rutstein SO and
Johnson K, The DHS Wealth Index. DHS Comparative Reports No.
6, Calverton, MD, USA: ORC Macro, 2004.) For each DHS survey, a
“wealth index” made up of these survey items is constructed using
principal components analysis, placing households on a continuous
scale of wealth, which is then divided into equally sized quintiles.
9
tables.xlsx) To ensure reliability of contraceptive failure
rates, we do not report any rates that were based on
fewer than 125 episodes of contraceptive use (specifically,
fewer than 125 unweighted episodes in month 1 of the
life table, excluding late entries). Failure rates based on
125–249 episodes of use (during month 1 of the life table)
are presented in parentheses in the tables and should be
interpreted with caution.* Numbers of episodes for each
country and method are shown in Appendix Table 2, page
68.
To estimate failure rates for each method within an
entire subregion, we pooled together all data for countries
within that subregion, including those from countries
with fewer than 125 episodes of use; again, results are
presented only when the total number of episodes of
contraceptive use from all countries in that subregion was
at least 125. We produced pooled estimates of failure
rates for all seven assessed methods in each subregion
except for implants in Eastern Europe and Central Asia
(where only six episodes of use were reported in the
entire subregion). As described above, each country
contributes equally to the pooled rate for a subregion and
for all countries combined. We also used pooled data to
calculate failure rates by demographic and socioeconomic
characteristics.
We conducted all analyses in CSPro version 4.1.002
and produced graphics using StataMP 14.
Limitations
As noted earlier, the timing of the measurement of certain
characteristics and the age of some of the surveys (particularly those in LAC) are analytic limitations. We used
the most recent data available and present results for the
largest number of countries possible, rather than exclude
data from subregions such as LAC. Wealth, educational attainment and urban-rural residence were measured at the
time of interview, rather than at the time of the episode
of contraceptive use, which may have occurred up to five
years earlier. If any of these variables had changed since
that episode, contraceptive failure rates by these characteristics may be inaccurate.
We were unable to include episodes of contraceptive use that began before the calendar period started,
because we did not know the duration of use for those
episodes. A detailed description of how this limitation
may affect our results is provided in Appendix A, page
39. In brief, it has a minimal impact on 12-month failure
rates and may cause a slight overestimation in 24- and
*This is a more conservative approach than that of Ali et al,14
which used a cutoff of 100 episodes.
10
36-month failure rates (more so for long-term methods),
but is likely to have a small impact overall.
In collecting reproductive calendar data, women were
asked to recall events that occurred up to seven years in
the past, which has raised some concern that calendar data
may be less reliable than current status data. Goldman,
Moreno and colleagues8,21,22 demonstrated that DHS
contraceptive calendar data were not subject to selection
bias or attrition. Curtis and Blanc7 theorized that women
can more accurately recall longer episodes of use, but may
omit or incorrectly recall shorter episodes of use. We therefore expect information on longer-term methods, especially
IUDs and implants, and to a lesser extent, pills and injectables, to be more accurately reported than that on shorterterm methods (condoms, periodic abstinence, withdrawal).
Conversely, longer-term methods are more likely to be excluded from analysis than shorter-term methods because
of missing information about the start and duration of use,
as described in Appendix A. Reported durations of contraceptive use have been found to cluster somewhat at one,
three, six and 12 months, but previous studies concluded
that clustering was probably not severe enough to substantively affect estimates of discontinuation.7,15
A useful approach to assess the quality of retrospective calendar data is to compare the current status contraceptive prevalence (and method mix) with estimates
based on retrospective calendar data, from two surveys
conducted fewer than five years apart in the same country. Early analyses found these estimates to be nearly
identical,7 or found calendar data to slightly underestimate
contraceptive prevalence relative to current-status data.15
However, a more recent and comprehensive analysis
using this approach found far greater underreporting of
contraceptive use in the calendar than in the earlier studies.23 This underreporting was particularly pronounced in
all Western African countries analyzed, but also present in
most other Sub-Saharan African surveys and those from
other subregions. Condom use appears particularly underreported in calendar data, and substantially so in more
than half of surveys analyzed. Traditional and short-term
modern methods also appear to be frequently underreported in calendar data in many surveys. If many episodes
of use—particularly those ending in contraceptive failure—are underreported, failure rate estimates may not be
reliable. On the basis of findings of Bradley et al.,23 failure
rates presented in this report, particularly those from
Asian and Sub-Saharan African countries, and especially
from Western African countries, may be underestimated
and should be interpreted with caution.
Even if contraceptive use and discontinuation are
reported accurately, contraceptive failure may still be
Guttmacher Institute
underreported. Women who experienced a failure leading
to an unintended pregnancy may, because of social desirability bias, instead report that they discontinued use in
order to become pregnant, or may give a different reason
for doing so. Such misclassification of the reason for discontinuation would bias failure rates downward. Omission
of episodes of use that ended in failure could have the
same effect. On the other hand, it has been argued that
women may overreport contraceptive use at the time they
became pregnant out of social desirability bias. If true, the
resulting overestimate may offset at least some of the underestimate associated with a lack of reporting of failures
that result in unintended pregnancies or abortions.12
A further source of underestimation results from
stigma around abortion, leading to underreporting of
contraceptive failures that result in abortion. Pregnancy
terminations, particularly induced abortions, are generally underreported in surveys, including DHS surveys and
surveys in countries with liberal abortion laws such as
United States.9,24,25 However, the degree of stigma and
underreporting may vary across countries. For example,
countries in the Eastern European and Central Asian
subregions, as well as two in the Northern African and
Western Asian subregion (Armenia and Azerbaijan) have
liberal abortion laws and relatively low abortion stigma.
Therefore, women in these areas may be less likely to
underreport abortion, leading to a relatively smaller impact
of underreporting on failure rates than in other countries.
We are unable to estimate the impact on failure rates of
omission, misreporting and underreporting of contraceptive use episodes, reasons for discontinuation, and abortions resulting from contraceptive failure. Bradley et al.15
investigated the potential impact of misreporting reasons
for discontinuation by reclassifying episodes of use that
ended in a pregnancy as failures even if women gave a
different reason for discontinuation. They found this type
of misclassification may occur, but the impact on failure
rates is likely relatively small.
Because of the limitations described, the failure
rates presented here should be viewed as direct reflections of women’s reports, which are potentially affected
by a number of biases and may not accurately reflect
women’s actual contraceptive histories and contraceptive
failures. Despite these limitations, our data contribute to
a better understanding of contraceptive failure rates over
time and across populations, which can provide important
insights and help to improve the effectiveness of contraceptive use.
11
Background and Context
Contraceptive use and failure occur within the larger
context of women’s lives. This chapter presents selected
national demographic and socioeconomic indicators for
the 43 countries included in this report, to provide context
for our estimates of contraceptive failure rates. It also
presents selected measures of sexual and reproductive
behaviors of women in these countries.
Demographic and Socioeconomic Indicators
Gross national income per capita varies greatly across the
included countries, but overall, is relatively low (Table 1).
In fact, the majority of these countries are among the 69
poorest globally, as classified by Family Planning 2020
(FP2020). Gross national income per capita is lowest for
those in Sub-Saharan Africa (generally less than US$1,000)
and highest for those in Latin America and the Caribbean
(LAC), Northern Africa and Western Asia on the basis of
data from 2013. There is marked variation across countries,
ranging from US$260 for Burundi to US$12,550 for Brazil.
At the subregion level, the proportion of women
age 15–49 living in urban areas is generally highest in
LAC, ranging from 45% in Honduras to 82% in Brazil.
Secondary or higher education is almost universal for
women in this age-group in the Eastern Europe and
Central Asia subregion and in Western Asia, whereas proportions are relatively low in Eastern and Western Africa.
*Because the DHS asks detailed questions about sexual activity
and contraception, decision makers in seven countries (Viet Nam
2002, Turkey 2003, Egypt 2008, Maldives 2009, Bangladesh
2011, Jordan 2012 and Pakistan 2012–2013) felt it was inappropriate to include never-married women. In these countries,
we cannot estimate sexual activity outside of marriage and
essentially assume that it occurs only within marriage. For these
countries, the columns with denominators of “sexually active
women” are therefore limited to those who are married or in
union (hereafter referred to as married). In Morocco, unmarried
women were interviewed but not asked about sexual activity. This survey sample is therefore treated like ever-married
samples, and “sexually active” refers to married women only.
In seven other countries (India 2005–2006, Azerbaijan 2006,
Armenia 2010, Cambodia 2010, Nepal 2011, Indonesia 2012 and
Tajikistan 2012), fewer than 1.5% of unmarried women reported
being sexually active. In all other countries, unmarried women are
considered to be sexually active if they report they had sex in the
three months preceding the interview.
12
Sexual and Reproductive Behaviors
Marriage and Sexual Activity
The proportion of women 15–49 who were ever married
(married or in union) in the 43 countries ranges from a low
of about 57% in Jordan and Morocco to a high of 92%
in Niger; most countries fall within the range of 67–80%
(Table 2, page 44). The proportion of unmarried women
who are sexually active, meaning they had intercourse
in the past three months, is also relevant in terms of
measuring the extent of exposure to risk of pregnancy and
potential need for effective contraceptive use. However,
some countries did not interview unmarried women,* and
others that did had data of questionable quality. Among
the 28 countries having data of acceptable quality and
regardless of marital status, the proportion of unmarried
women who are sexually active ranges from 2% in Ethiopia and the Philippines to 44% in Columbia.
Fertility Level and Preferences
Attainment of fertility goals can be assessed by comparing the number of children women want, the wanted total
fertility rate (TFR), with the number they already have,
the actual TFR. A smaller gap in this measure implies
that a country is closer to achieving its fertility goals. The
magnitude of the difference between the wanted and
actual TFRs varies considerably in the countries studied,
from a difference of 0.1 children in Armenia, Kazakhstan
and Ukraine, to a difference of 2.1 in Bolivia (Table 2).
By subregion, unweighted average differences between
actual and wanted TFR range from 0.2 in Eastern Europe
and Central Asia to 1.1 in Eastern Africa (data not shown).
Where the wanted TFR is very low (e.g., less than 2.5),
and where the gap between the two measures is moderate or large (e.g., 0.5 or greater), motivation to use contraception effectively is likely to be very high.
The proportion of married women in Eastern and
Western Africa who reported that they wanted to wait
at least two years before having a child or another child
(which we treat as wanting to space births) ranges from
34% to 56%, higher than in most other subregions. The
proportion of married women wanting no more children
ranges from 9% to 53% in Eastern and Western Africa,
Guttmacher Institute
and from 44% to 75% in other subregions (with the
exception of the Kyrgyz Republic at 26%), indicating that
smaller shares of women have completed childbearing
in Eastern and Western Africa as compared with other
subregions. Differences among countries and subregions
in the proportion wanting to space the next birth compared
with the proportion wanting to have no more children may
be related to contraceptive failure rates. Women who want
to stop childbearing and are using contraception are more
highly motivated to use their method effectively than peers
who want to delay childbearing or space the next birth.
Access to Health Care
In most countries, more than 75% of women who gave
birth recently reported receiving skilled antenatal care,
meaning care from a doctor, nurse or midwife (Table 2).
This indicator of access to basic health care is presented
as a proxy for access to facility- and provider-based contraceptive services. Countries with relatively low levels
of receipt of antenatal care—Ethiopia (where just 28% of
women received such care), Bolivia (53%), Bangladesh
(55%), Nepal (59%), Guatemala (60%), Nigeria (61%) and
Morocco (68%)—may have higher failure rates for modern
methods, as women and couples in those countries are
more likely on average to obtain their methods directly
from drug sellers and not receive proper counseling or
follow-up care regarding use.
Contraceptive Prevalence and Method Mix
The prevalence of contraceptive use and the methods
chosen vary considerably across the 43 countries assessed
(Table 3, page 45). It is important to note that survey dates
may have implications for the comparisons below; for
example, if a particular method was scaled-up after the survey date, levels of use may be higher than reported here.
Overall contraceptive prevalence among all women 15–
49 at risk for pregnancy (all those who are married as well
as those who are unmarried and sexually active) ranged
from 13% in Senegal to 79% in Viet Nam. By subregion,
contraceptive prevalence varied widely, and was extremely
low in Western African countries (range, 13–19%) and low
in Eastern African countries (14–58%). It was somewhat
higher in countries in Eastern Europe and Central Asia
(28–69%) and Southern Asia (35–61%), and generally the
highest in LAC (38–77%), Southeastern Asia (49–79%),
and Northern Africa and Western Asia (51–72%).
Patterns of use of modern versus traditional contraceptive methods can also be informative. We defined the
following to be modern methods: male and female sterilization; implants; IUDs; injectables; oral contraceptive pills;
male and female condoms; diaphragms; foam, jelly and
Guttmacher Institute
spermicides; Standard Days Method; emergency contraception; fertility wheel calculator; and the Mucus/Billings/
Basal body/Symptothermal method. Not all of these
methods were asked about in all surveys. We defined the
following to be traditional methods: periodic abstinence
(calendar rhythm); withdrawal; Lactational Amenorrhea
Method (LAM); and other traditional, local or folk methods.
Of note, as LAM is self-reported by women, it may be
confused with simple breastfeeding. A recent study of 78
Demographic Health Surveys found that on average, only
26% of women who reported using LAM met all three
criteria for this method (postpartum amenorrhea, fully or
exclusively breastfeeding, and having an infant younger
than six months old).26
As failure rates vary by type of contraceptive method,
their overall importance and implications for a particular
country will depend on its contraceptive method mix.
Specifically, where the proportion of women using less
effective methods is greater, those of reproductive age will
overall be more vulnerable to method failure and unintended pregnancy. For example, although Northern Africa
and Western Asia have a relatively high overall contraceptive prevalence, a substantial proportion of users rely on
traditional methods (particularly withdrawal); in contrast, in
Western Africa, overall contraceptive prevalence is low, but
most users rely on modern methods (Table 4, page 46 and
Figure 1, page 14).
Method mix varies considerably among subregions
(Table 4 and Figure 2, page 15). Implant use is low in most
countries, but accounts for a relatively larger proportion of
total use in Eastern and Western Africa (and was particularly high in Rwanda and Burkina Faso). Female sterilization
is common in Southern Asia and LAC; in five countries
(India, Nepal, Brazil, Dominican Republic and Guatemala), it
is used more commonly than any modern reversible methods. IUDs constitute a major share of contraceptive use in
Eastern Europe and Central Asia and in Northern Africa and
Western Asia. Injectable contraception accounts for more
than 30% of all contraceptive method use in the majority
of countries in Sub-Saharan Africa, and a substantial share
in Southeastern Asia as well (particularly Indonesia). Use of
the oral contraceptive pill was more proportionally consistent across subregions, but was particularly prevalent in
two countries, Zimbabwe and Morocco. The proportion
of contraceptive users relying on male condoms ranged
from less than 1% in Niger to 42% in Ukraine. Use of
withdrawal was most notable in Western Asia (particularly
Azerbaijan, Turkey and Armenia), while the prevalence of
periodic abstinence use was variable; constituting less than
10% of contraceptive use in most (33) countries, with a
notable exception in Bolivia, where it constituted nearly
50% of contraceptive use.
13
FIGURE 1. Current use of modern or traditional contraception, by subregion and country
E Africa
Burundi 2010
Comoros 2012
Ethiopia 2005
Kenya 2003
Malawi 2004
Mozambique 2011
Rwanda 2010
Tanzania 2004-05
Uganda 2011
Zimbabwe 2010-11
W Africa
Benin 2011-12
Burkina Faso 2010
Niger 2012
Nigeria 2013
Senegal 2010-11
N Afr/W Asia
Armenia 2010
Azerbaijan 2006
Egypt 2008
Jordan 2012
Morocco 2003-04
Turkey 2003
E Eur/C Asia
Kazakhstan 1999
Kyrgyz Republic 2012
Moldova 2005
Tajikistan 2012
Ukraine 2007
S Asia
Bangladesh 2011
India 2005-06
Maldives 2009
Nepal 2011
Pakistan 2012-13
SE Asia
Cambodia 2010
Indonesia 2012
Philippines 2003
Vietnam 2002
LAC
Bolivia 1994
Brazil 1996
Colombia 2010
Dominican Republic 2002
Guatemala 1998-99
Honduras 2011-12
Paraguay 1990
Peru 2012
0
20
40
60
80
% married and sexually active unmarried
women using a method
Any modern method
Any traditional method
Note: E Africa=Eastern Africa. W Africa=Western Africa. N Afr/W Asia = Northern Africa and Western Asia. E Eur/C Asia = Eastern Europe and Central
Asia. S Asia = Southern Asia. SE Asia = Southeastern Asia. LAC=Latin America and the Caribbean.
14
Guttmacher Institute
% of contraceptive users using a given method
20
40
60
80
100
FIGURE 2. Method mix among current contraceptive users 15–49 by subregion
Other traditional
Periodic abstinence
Withdrawal
Other modern
Male condom
Pill
Injectable
IUD
Female sterilization
0
Implant
E Africa
W Africa
N Afr/W Asia E Eur/C Asia
S Asia
SE Asia
LAC
Note: Subregional estimates are not weighted by country population sizes, rather, each country within a subregion contributes equally to the subregional
estimate. E Africa=Eastern Africa. W Africa=Western Africa. N Afr/W Asia = Northern Africa and Western Asia. E Eur/C Asia = Eastern Europe and Central
Asia. S Asia = Southern Asia. SE Asia = Southeastern Asia. LAC=Latin America and the Caribbean.
15
Overall and Subregional Contraceptive
Failure Rates
In this chapter, we present the 12-, 24-, and 36-month
failure rates by contraceptive method and highlight key
findings. Findings are discussed for the 43 countries
overall and for each subregion; information for individual
countries is given in the accompanying tables.
Overall Method-Specific Contraceptive Failure
Rates (Medians)
As expected, modern contraceptive methods with the
least room for user error had the lowest median failure
rates and the lowest variability in these rates (Table 5, page
47 and Figure 3, page 19). The overall 12-month median
failure rate for every 100 episodes of method use was 0.6
for implants (with a median of 95% confidence intervals for
all included countries, hereafter, median 95% confidence
interval, of 0.0–2.4), 1.4 for IUDs (0.0–2.4) and 1.7 for
injectables (0.6–2.9). The rate for implants in Benin was an
outlier at 3.7, but was based on fewer than 250 unweighted episodes of contraceptive use, and should be interpreted with caution. Injectable failure rates in Paraguay, Bolivia,
Dominican Republic and Brazil were also unexpectedly
high, at 13.6, 8.3, 8.2 and 8.0, respectively. However, these
estimates are based on somewhat older data, it is possible
that one-month injectables were available in at least some
LAC countries, and the 12 month injectable failure rate
estimates in both Benin and Bolivia were based on fewer
than 250 unweighted episodes (Appendix Table 2).
Oral contraceptive pills and condoms had higher failure
rates than implants, IUDs and injectables. The median
12-month failure rate for every 100 episodes of method
use was 5.5 (median 95% CI, 3.5–7.3) for oral contraceptive pills and 5.4 (2.3–8.7) for male condoms. The rate
for oral contraceptive pills in Kazakhstan was an outlier
at 15.3; that country also had some of the highest failure
rates for other methods, including IUDs, male condoms,
periodic abstinence and withdrawal.
Contraceptives typically considered to be traditional
methods, including withdrawal and periodic abstinence,
had the highest failure rates and the greatest variability.
*Please note that in Figures 7 through 13, the x-axes are not
consistent across methods.
16
The median 12-month failure rate for every 100 episodes
of use was 13.4 (median 95% CI, 9.1–17.1) for withdrawal
and 13.9 (9.2–19.3) for periodic abstinence.
Figures 4 (page 19), and 5 (page 20) depict failure
rates for each method across the 43 countries at 24 and
36 months, respectively. Data for individual countries are
shown in Table 6, page 48, and results are described in
greater detail below.
Contraceptive methods with lower failure rates had
less variation around the median rate at any given duration
of use (Figure 6, page 21). Failure rates are cumulative
(i.e., they can only increase from the first to second year,
or from the second to third year of use), but the magnitude of increase over time is smaller for longer-acting,
user-independent methods and larger for user-dependent
methods (Table 7, pages 17 and 49). For example, the
magnitude of increase in failure rates between 12 and 36
months was 0.5 for implants but 22.3 for withdrawal. It
was generally larger earlier in use (i.e., between 12 and
24 months) than later in use (i.e., between 24 and 36
months). This pattern is probably due to selection: Women
most likely to experience pregnancy from a contraceptive
failure (i.e., the most fecund and those with highest levels
of incorrect or inconsistent use) are removed from the
population at risk over time.
Subregional Method-Specific Contraceptive
Failure Rates (Pooled Estimates)
For each method, we calculated subregional failure rates
at various durations of use (12, 24 and 36 months) by
pooling country data. As previously noted, these findings
should be interpreted as averages across populations in
the countries analyzed and cannot be considered representative of the subregion (given uneven distribution
of populations as well as incomplete representation of
countries in a given subregion). Also, there are concerns
about the quality of calendar data in certain subregions,
particularly Western Africa, so these estimates should
be interpreted with caution. We did not conduct formal
significance testing, but the confidence intervals shown
provide an informal sense of whether differences in estimates between methods or other subgroups are likely to
be statistically significant.*
Guttmacher Institute
TABLE 7. Contraceptive failure rates by method, median across 43 countries, for each country’s most
recent DHS survey with calendar data, 43 countries, 1990–2013
Method
Median failure rate* during:
First year of use
(12 months)
Second year
of use
(24 months)
Differences in rates:
Third year
of use
(36 months)
24 vs.
12 mos.
36 vs.
24 mos.
36 vs.
12 mos.
Implants
0.6
1.0
1.1
0.4
0.1
0.5
IUD
1.4
1.9
2.1
0.5
0.2
0.7
Injectables
1.7
3.6
5.5
1.9
1.9
3.8
Pill
5.5
10.8
15.1
5.3
4.3
9.6
Male condom
5.4
13.3
16.0
7.9
2.7
10.6
Withdrawal
13.4
27.4
35.7
14.0
8.3
22.3
Periodic abstinence
13.9
25.8
32.4
11.9
6.6
18.5
*Number of failures per 100 episodes of use.
Implants
Across subregions, the 12-month failure rates for implants
ranged from 0.2 to 1.3 per 100 episodes of use (Figure 7,
page 22 and Table 8, page 50). The lowest were seen in
LAC, whereas the highest were seen in Northern Africa
and West Asia. Failure rates across subregions ranged
from 0.2 to 2.1 at both 24 months and 36 months.
Intrauterine Devices
Across subregions, the 12-month failure rates for the IUD
ranged from 0.9 to 2.2 per 100 episodes of use (Figure 8,
page 22 and Table 8). The lowest were seen in Western
Africa (but should be interpreted with particular caution)
and Southern Asia, whereas the highest were seen in
LAC. Failure rates across subregions ranged from 0.9 to
4.4 at 24 months and from 2.7 to 7.9 at 36 months, with
particularly high values seen in Eastern Africa at these
time points.
Injectables
Across subregions, the 12-month failure rates for injectables ranged from 0.9 to 4.2 per 100 episodes of use
(Figure 9, page 23 and Table 8). The lowest were seen in
Southeast Asia, whereas the highest were seen in LAC.
Unexpectedly, failure rates for injectables and IUDs were
not dissimilar. Failure rates across subregions ranged from
2.0 to 6.6 at 24 months and from 2.8 to 9.5 at 36 months.
Oral Contraceptive Pills
Across subregions, the 12-month failure rates for oral
contraceptive pills ranged from 3.6 to 8.5 per 100 episodes
of use (Figure 10, page 23 and Table 8). The lowest were
seen in Western Africa (but should be interpreted with par-
ticular caution), whereas the highest were seen in Eastern
Europe and Central Asia, and in Northern Africa and Western Asia. Failure rates across subregions ranged from 6.6
to 13.9 at 24 months and from 9.7 to 18.4 at 36 months.
Male Condoms
Across subregions, the 12-month failure rates for condoms ranged from 2.2 to 8.7 per 100 episodes of use
(Figure 11, page 24 and Table 8). The lowest were seen
in Western Africa (but should be interpreted with particular caution), whereas the highest were seen in Northern
Africa and Western Asia. Failure rates across subregions
ranged from 4.8 to 16.4 at 24 months and from 6.2 to 24.1
at 36 months.
Withdrawal
Across subregions, the 12-month failure rates for withdrawal ranged from 7.8 to 17.1 per 100 episodes of use
(Figure 12, page 24 and Table 8). The lowest were seen
in Southern Asia and Western Africa (but these estimates
should be interpreted with particular caution), whereas the
highest were seen in Northern Africa and Western Asia,
and in LAC. Failure rates across subregions ranged from
16.6 to 32.6 at 24 months and from 23.4 to 41.0 at 36
months.
Periodic Abstinence
Across subregions, the 12-month failure rate for periodic
abstinence ranged from 6.1 to 20.9 per 100 episodes of
use (Figure 13, page 25 and Table 8). The lowest rates
were seen in Southern Asia, whereas the highest were
seen in Northern Africa and Western Asia, as well as in
17
LAC. Failure rates across subregions ranged from 13.7 to
35.8 at 24 months and from 17.5 to 43.3 at 36 months.
Pooled 12-month failure rates for all methods, by subregion
When 12-month failure rates for each method are compared across subregions, Western Africa had among the
lowest rates for four of the seven methods assessed: oral
contraceptive pills, IUDs, male condoms and withdrawal
(Figure 14, page 26 and Table 8), but estimates from this
sub-region should be interpreted with particular caution.
On the other hand, LAC had among the highest failure
rates for four of the seven methods: IUDs, injectables,
periodic abstinence and withdrawal.
18
Guttmacher Institute
Be
n
in
FIGURE 3. Twelve-month failure rate (median) by method
ua
ag
Ka
za
kh
st
an
Injectable
Median: 1.7
Pa
r
B
BoDo razi
livmin l
ia ic
an
IUD
Median: 1.4
y
R
ep
ub
lic
Implant
Median: 0.6
Pill
Median: 5.5
Male Condom
Median: 5.4
Withdrawal
Median: 13.4
Periodic Abstinence
Median: 13.9
0
5
10
15
20
Cumulative probability of pregnancy per 100 episodes of method use
25
* Among all countries contributing data for a given method
Notes: Median failure rates across all countries contributing data for a given method were calculated by including estimates from countries with
125 or more unweighted episodes of contraceptive use at life table month 1. Width of box is the interquartile range (IQR); whiskers are drawn to the
lowest and highest values inside the area defined by Q1 – 1.5(IQR) and Q3 + 1.5(IQR); outliers beyond these ranges are depicted as individual dots.
E
Be gyp
ni t
n
FIGURE 4. Twenty-four–month failure rate (median) by method
Bu
r
un
di
Implant
Median: 1.0
Bo
l
Pa ivia
ra
gu
ay
IUD
Median: 1.9
Bu
ru
n
di
Injectable
Median: 3.6
Pill
Median: 10.8
Male condom
Median: 13.3
Withdrawal
Median: 27.4
Periodic abstinence
Median: 25.8
0
5
10
15
20
25
30
35
40
Cumulative probability of pregnancy per 100 episodes of method use
45
Notes: Median failure rates across all countries contributing data for a given method were calculated by including estimates from countries with 125
or more unweighted episodes of contraceptive use at life table month 1. Width of box is the interquartile range (IQR); whiskers are drawn to the lowest
and highest values inside the area defined by Q1 – 1.5(IQR) and Q3 + 1.5(IQR); outliers beyond these ranges are depicted as individual dots.
19
FIGURE 5. Thirty-six–month failure rate (median) by method
Implant
Median: 1.1
Bu
ru
nd
i
Injectable
Median: 5.5
Tu
rk
ey
Br
a
Pa zil
ra
gu
ay
IUD
Median: 2.1
Jo
Karda
za n
kh
st
an
Pill
Median: 15.1
Male condom
Median: 16.0
Withdrawal
Median: 35.7
Periodic abstinence
Median: 32.4
0
10
20
30
40
50
Cumulative probability of pregnancy per 100 episodes of method use
Notes: Median failure rates across all countries contributing data for a given method were calculated by including estimates from countries with 125 or
more unweighted episodes of contraceptive use at life table month 1. Width of box is the interquartile range (IQR); whiskers are drawn to the lowest and
highest values inside the area defined by Q1 – 1.5(IQR) and Q3 + 1.5(IQR); outliers beyond these ranges are depicted as individual dots.
20
Guttmacher Institute
FIGURE 6. Twelve-, 24- and 36-month failure rate (median) by method
Implant
IUD
Injectable
Pill
Male condom
Withdrawal
Periodic abstinence
0
10
20
30
40
50
Cumulative probability of pregnancy per 100 episodes of method use
Notes: Median failure rates across all countries contributing data for a given method were calculated including estimates from countries with 125 or more
unweighted episodes of contraceptive use at life table month 1. Width of box is the interquartile range (IQR); whiskers are drawn to the lowest and highest
values inside the area defined by Q1 – 1.5(IQR) and Q3 + 1.5(IQR); outliers beyond these ranges are depicted as individual dots.
21
FIGURE 7. Failure rates for implants by subregion (pooled estimates)
0.6
0.6
Eastern Africa
1.2
0.9
0.9
1.2
Western Africa
1.3
Northern Africa
and Western Asia
Eastern Europe
and Central Asia
2.1
2.1
n/a
0.5
0.5
0.5
Southern Asia
0.7
1.3
1.5
Southeastern Asia
0.2
0.2
0.2
Latin America
and the Caribbean
0
2
4
6
8
10
Cumulative probability of pregnancy
per 100 episodes of method use
12 month
24 month
36 month
95% CI
Notes: The implant estimate for Northern Africa and Western Asia is based on fewer than 250 unweighted episodes of implant use at month 1 (all
occurring in Egypt or Jordan), so it should be interpreted with caution. The implant estimate in Eastern Europe and Central Asia is not reported because
of insufficient episodes of implant use (n=6 at month 1) for estimation.
FIGURE 8. Failure rates for the IUD by subregion (pooled estimates)
1.2
4.3
Eastern Africa
0.9
0.9
Western Africa
2.7
1.2
Northern Africa
and Western Asia
2.4
1.6
Eastern Europe
and Central Asia
3.2
3.1
1.2
1.6
Southern Asia
3.9
3.2
1.8
Southeastern Asia
3.4
2.2
Latin America
and the Caribbean
7.9
4.4
4.4
0
5.3
5
10
15
Cumulative probability of pregnancy
per 100 episodes of method use
12 month
22
24 month
36 month
95% CI
Guttmacher Institute
FIGURE 9. Failure rates for injectables by subregion (pooled estimates)
1.9
4.0
Eastern Africa
1.0
2.2
Western Africa
1.8
Northern Africa
and Western Asia
6.2
2.8
2.9
4.0
3.0
3.3
Eastern Europe
and Central Asia
1.4
3.1
Southern Asia
0.9
Southeastern Asia
9.5
2.0
4.3
3.4
4.2
Latin America
and the Caribbean
0
6.6
8.9
5
10
15
20
Cumulative probability of pregnancy
per 100 episodes of method use
12 month
24 month
36 month
95% CI
FIGURE 10. Failure rates for oral contraceptive pills by subregion (pooled estimates)
4.7
10.3
Eastern Africa
3.6
6.6
Western Africa
14.8
9.7
7.0
Northern Africa
and Western Asia
13.9
8.5
Eastern Europe
and Central Asia
13.8
5.5
10.1
Southern Asia
4.5
7.9
Southeastern Asia
0
5
16.2
15.2
10.9
6.2
Latin America
and the Caribbean
18.4
11.4
10
15.2
15
20
Cumulative probability of pregnancy
per 100 episodes of method use
12 month
24 month
36 month
95% CI
23
FIGURE 11. Failure rates for male condoms by subregion (pooled estimates)
3.5
8.5
Eastern Africa
2.2
Western Africa
4.8
11.9
6.2
8.7
Northern Africa
and Western Asia
16.4
7.2
Eastern Europe
and Central Asia
12.7
7.4
17.7
13.9
Southern Asia
8.3
18.7
15.4
Southeastern Asia
6.7
Latin America
and the Caribbean
11.5
0
24.1
19.1
16.1
10
20
30
Cumulative probability of pregnancy
per 100 episodes of method use
12 month
24 month
36 month
95% CI
FIGURE 12. Failure rates for withdrawal by subregion (pooled estimates)
14.6
32.6
Eastern Africa
7.8
19.4
Western Africa
24.1
16.4
Northern Africa
and Western Asia
29.7
13.6
Eastern Europe
and Central Asia
9.4
25.8
16.6
Southern Asia
14.2
34.4
27.2
17.1
10
38.0
23.4
Southeastern Asia
Latin America
and the Caribbean
41.0
35.8
29.4
20
30
37.4
40
50
Cumulative probability of pregnancy
per 100 episodes of method use
12 month
24
24 month
36 month
95% CI
Guttmacher Institute
FIGURE 13. Failure rates for periodic abstinence by subregion (pooled estimates)
13.0
26.5
Eastern Africa
8.1
13.7
Western Africa
34.6
17.5
20.3
Northern Africa
and Western Asia
16.0
Eastern Europe
and Central Asia
6.1
14.2
Southern Asia
33.4
26.0
32.3
19.2
13.3
24.8
Southeastern Asia
34.4
20.9
Latin America
and the Caribbean
0
10
40.9
20
35.8
30
43.3
40
50
Cumulative probability of pregnancy
per 100 episodes of method use
12 month
24 month
36 month
95% CI
25
FIGURE 14. Twelve-month failure rates and overall median (pooled estimates) by method and subregion
E Africa
W Africa
N Afr/W Asia
E Eur/C Asia
S Asia
SE Asia
LAC
E Africa
W Africa
N Afr/W Asia
E Eur/C Asia
S Asia
SE Asia
LAC
E Africa
W Africa
N Afr/W Asia
E Eur/C Asia
S Asia
SE Asia
LAC
E Africa
W Africa
N Afr/W Asia
E Eur/C Asia
S Asia
SE Asia
LAC
0
0
5
5
10
Implant
15
10
Injectable
15
20
20
0
5
10
15
Male condom
20
0
5
10
15
Periodic abstinence
20
E Africa
W Africa
N Afr/W Asia
E Eur/C Asia
S Asia
SE Asia
LAC
E Africa
W Africa
N Afr/W Asia
E Eur/C Asia
S Asia
SE Asia
LAC
E Africa
W Africa
N Afr/W Asia
E Eur/C Asia
S Asia
SE Asia
LAC
0
5
0
0
10
IUD
15
20
5
10
15
Oral contraceptive pill
20
5
10
Withdrawal
20
15
Cumulative probability of pregnancy per 100 episodes of method use
Notes: The implant estimate for Northern Africa and Western Asia is based on fewer than 250 unweighted episodes of implant use at month 1 (all
occurring in Egypt or Jordan), so it should be interpreted with caution. The implant estimate in Eastern Europe and Central Asia is not reported because
of insufficient episodes of implant use (n=6 at month 1) for estimation. Vertical red line indicates 12-month median estimates displayed in Figure 3. E
Africa=Eastern Africa. W Africa=Western Africa. N Afr/W Asia = Northern Africa and Western Asia. E Eur/C Asia = Eastern Europe and Central Asia. S
Asia = Southern Asia. SE Asia = Southeastern Asia. LAC=Latin America and the Caribbean.
26
Guttmacher Institute
Contraceptive Failure Rates by Demographic
And Socioeconomic Characteristics
Assessing failure rates among demographic and socioeconomic groups is important to inform efforts to improve
contraceptive information, services and use, and to minimize contraceptive failures. For example, understanding
which subgroups have the highest failure rates can allow
contraceptive programs and service providers to better
identify those clients who may require more assistance to
effectively use their chosen method. In turn, this information can serve as a starting point to illuminate how to
better assist specific groups, for example, by focusing
on enhancing consistency of supply availability if contraceptive failures are high among clients who are likely to
face cost or access issues, or by improving counseling of
contraceptive clients with high failure rates that may be
related to motivational factors such as their contraceptive
intention (i.e., whether they are using a method to space
births versus limit births).
In this chapter, we describe findings for 12-month
failure rates, pooled across all 43 included countries (with
each country equally weighted),* by contraceptive method
and population subgroup.† Pooling data across countries
provides sufficient sample sizes to assess failure rates (for
all included countries, as well as for subregion) for each
contraceptive method by various demographic and socioeconomic characteristics, as well as by combinations of
those characteristics. Detailed information for subregions
is given in Tables 9 (page 52) and 10 (page 56). We did not
conduct formal significance testing, but the confidence
intervals shown in the figures and tables provide an informal sense of whether differences in estimates between
methods or other subgroups are likely to be statistically
significant.
Twelve-Month Contraceptive Failure Rates
By Single Characteristics (Pooled Estimates)
Age
Across all methods, 12-month contraceptive failure rates
were significantly higher among younger women (those
younger than 25) than among older peers, except for
implant users, who had no difference by age (Table 9 and
Figure 15, page 30). This pattern generally held across
most subregions except Western Africa, where older
women had higher or slightly higher failure rates for implants, pills, male condoms and periodic abstinence. The
absolute differential in the failure rate by age exceeded
10 percentage points among users of traditional methods
such as withdrawal or periodic abstinence, although the
relative difference was largest for IUD users, with younger
users 2.8 times more likely to experience a contraceptive
failure than older counterparts.
Marital Status
Ever-married women had similar or lower 12-month failure
rates than never-married counterparts for most contraceptive methods, except for condoms, for which this pattern was reversed (Table 9 and Figure 16, page 30).‡ The
absolute differential in rate by marital status was largest
(5.2 percentage points) among users of withdrawal. The
relative difference was largest among IUD users (with
never-married users 4.1 times more likely to report a contraceptive failure than ever-married peers). However, estimates for never-married women for IUDs were based on
384 episodes of use, and therefore had wide confidence
intervals that overlapped those of ever-married women.
Parity
Across all methods, 12-month contraceptive failure
rates among lower-parity women (having 0–2 children)
exceeded those among higher-parity counterparts (Table
9 and Figure 17, page 31), although the gap was small
for implant users, and confidence intervals overlapped
substantially for condom users. Periodic abstinence users
reported the largest absolute differential in failure rates
by parity (6.0 percentage points). IUD users reported the
*Unless a country did not contribute any episodes of use for a
given method; unweighted numbers of contraceptive episodes
are provided in the Online Appendix Tables.
†Age, marital status and parity at the end of a contraceptive use
episode; contraceptive intention at the start of each episode of
use; and wealth quintile, residence and education at the time of
the interview.
‡As previously noted, never-married women were not included in
surveys in seven countries, which may affect results and lead to
less stable estimates among this group.
27
largest relative differential by parity; lower-parity women
had double the risk of IUD failure as higher-parity peers.
Contraceptive Intention
Across all methods, the 12-month contraceptive failure
rates were higher (albeit by fewer than 4.0 percentage
points for any individual method) among women using
contraception to space, rather than limit, future childbearing (Table 9 and Figure 18, page 31), although confidence
intervals overlapped substantially for implant, IUD and
oral contraceptive pill users. Periodic abstinence users
reported the largest absolute differential in failure rates
by contraceptive intention (3.9 percentage points). Implant users reported the largest relative differential, with
women using the method to space births 2.3 times more
likely to experience contraceptive failure than peers using
the method to limit births (although confidence intervals
overlapped substantially for these two groups).
Wealth
Across most methods, 12-month contraceptive failure
rates were higher for women in the lower three wealth
quintiles compared with better-off peers, except among
women relying on methods that depend less on the user
(i.e., implants, IUDs and injectables), among whom the
rates were very similar (Table 9 and Figure 19, page 32).
Periodic abstinence users reported the largest absolute differential in failure rates by wealth (3.7 percentage points),
while condom users reported the largest relative differential, with poorer women 1.4 times more likely to report
failure as compared with wealthier counterparts. These
overall patterns generally held true across subregions for
most methods, except in LAC, where wealthier injectable
users reported higher failure rates than poorer peers.
Residence
The 12-month contraceptive failure rates were fairly similar among urban and rural users, except for injectables; for
this method, urban users had a higher failure rate (Table 9
and Figure 20, page 32). Injectable users reported the largest absolute differential in point estimates for failure rates
by residence (1.2 percentage points). Relative differentials
among IUD and injectable users by residence—with urban
women using these methods 1.5 and 1.7 times, respectively, more likely to report a contraceptive failure than
rural peers—were larger than the absolute differentials.
Education
When comparing results by educational level across countries, it is important to understand that a given category
such as “secondary or more” may require a different
28
number of years of schooling in different locations. In
most countries, secondary or higher schooling indicates
seven or more years of education, but in some, it can
indicate anywhere from six to eight or even more years of
schooling. We used this variable as opposed to assessing
the specific number of years of education, given that the
latter more often has missing data.
The 12-month contraceptive failure rates were generally similar by educational attainment for most methods,
with the exception of injectables and withdrawal, for
which women who had at least some secondary education had slightly higher failure rates (Table 9 and Figure
21, page 33). However, in Eastern Africa, more highly
educated women had lower condom failure rates. The
absolute differential in failure rates by educational status
was somewhat larger among users of traditional methods
such as withdrawal (2.0 percentage points) and periodic
abstinence (1.9 percentage points), whereas it was quite
similar across the remaining methods.
Twelve Month Contraceptive Failure Rates
By Combinations of Characteristics
(Pooled Estimates)
We estimated 12 month contraceptive failure rates by
various combinations of demographic and socioeconomic
characteristics for a variety of reasons. For example, this
approach helps to clarify whether the generally observed
pattern of higher failure rates among socioeconomically
disadvantaged women changes within particular demographic groups. Such analyses can determine whether
the pattern of higher failure rates among younger versus older women persists across all categories of other
characteristics. These analyses help to further refine the
identification of specific subgroups with high failure rates
who may need more attention by providers, in terms of
both counseling and the quality of contraceptive services.
At the same time, it is important to note that analyses
assessing failure rates in two-characteristic combinations
cannot control for potentially confounding effects of third
characteristics.
We assessed numerous combinations of wealth, age,
contraceptive intention, education, residence and parity.
All combinations assessed are shown in Table 10, pooled
across the 43 countries and also by subregion. Although
these data may be helpful for informing policies and programs focused on improvement of contraceptive services,
we comment briefly on only a handful of results, and
instead provide tables to allow readers to inspect results in
subregions and with combinations of interest.
Figure 22 (page 34) displays median 12-month failure
rates by age and wealth across 43 countries. Regardless
Guttmacher Institute
of age, women in the lower three wealth quintiles generally had higher contraceptive failure rates than those in
the upper two quintiles, except for less user-dependent
methods, such as implants, IUDs and injectables, where
differences are very small and occasionally in the opposite
direction. Similarly, regardless of wealth, younger women
generally had higher failure rates, again with the exception
of the implant, where differences were small and in the
opposite direction. Although both younger age and being
poorer are related to the effectiveness of contraceptive
use (particularly for more user-dependent methods), age
may have a stronger influence than wealth: Women in the
upper two quintiles of wealth who were also younger than
25 generally had slightly higher failure rates than peers in
the lower three quintiles of wealth who were 25 or older.
Table 11 below and page 63, shows 12-month failure
rates by residence and age for the 43 countries combined. Regardless of whether women lived in urban or
rural settings, younger users generally reported higher
contraceptive failure rates than older counterparts (with
the exception of implant users). However, differences
between urban and rural residents were relatively small,
and there was no systematic pattern, with urban women
having higher failure rates for some combinations of age
and method, and lower rates for other combinations. In
sum, age appears to have a stronger and more systematic
influence on failure rates than place of residence.
In another example (data not shown), we assessed
12-month failure rates by age and contraceptive intention.
As expected, across most methods (except implants) and
within each fertility intention subgroup, older women re-
ported lower failure rates than younger peers. Within the
older age-group, those using the method to space births
and those using it to limit births reported generally similar
failure rates (with a difference of less than 0.5 percentage
points) for all methods except withdrawal and periodic
abstinence. This suggests that the minor influence of contraceptive intention observed in Table 9 may be explained
to a large extent by the higher likelihood of older women
using methods to limit births.
In a fourth example (data not shown), we assessed
12-month failure rates by contraceptive intention and parity. Regardless of parity, contraceptive failure rates across
most user-dependent methods were slightly higher for
women who desired to space births instead of limit them.
However, higher-parity IUD users were an exception:
within this group, women using the method to limit births
reported a slightly higher failure rate than those using it to
space births (1.0 vs. 0.7). A similar pattern was evident for
high-parity pill users, with a slightly higher rate for women
using the method to limit births (5.4 vs. 4.3). Overall, however, differences in failure rates by fertility intention were
modest. In general, rates among higher-parity women fell
below those of lower-parity peers, particularly for users of
withdrawal or periodic abstinence.
TABLE 11. Twelve-month failure rates according to method, by residence and age, 43 countries,
1990–2013
Residence
and age
12-month failure rate*
Implants
IUD
Injectables
Pill
Male
condom
Withdrawal
Periodic
abstinence
Urban
<25 y
0.2
3.8
4.4
8.5
8.2
23.8
24.1
≥25 y
0.4
1.4
2.2
4.5
5.4
11.6
14.2
<25 y
1.0
2.7
2.9
8.1
10.3
20.5
25.2
≥25 y
0.8
0.8
1.3
4.2
5.4
10.9
12.2
Rural
*Number of failures per 100 episodes of use.
29
FIGURE 15. Twelve-month failure rates by age (pooled estimates)
0.6
0.6
Implant
1.1
IUD
3.2
1.6
Injectable
3.5
4.4
Pill
8.3
5.4
Male condom
8.9
11.7
Withdrawal
22.7
13.3
Periodic
abstinence
0
5
10
24.6
15
20
25
Probabilities per 100 episodes
Age ≥25
Age <25
95% CI
Note: Age was measured at the end of the episode of use.
FIGURE 16. Twelve-month failure rates by marital status (pooled estimates)
0.6
0.6
Implant
1.5
IUD
2.2
Injectable
6.1
3.6
5.7
6.3
Pill
4.7
Male condom
7.3
14.6
Withdrawal
19.8
16.3
17.2
Periodic
abstinence
0
5
10
15
20
25
Probabilities per 100 episodes
Never married
Ever married
95% CI
Note: Marital status was measured at the end of the episode of use.
30
Guttmacher Institute
FIGURE 17. Twelve-month failure rates by parity (pooled estimates)
0.6
0.7
Implant
0.9
IUD
1.9
1.7
Injectable
2.8
5.0
Pill
6.2
6.0
Male condom
7.0
12.2
Withdrawal
16.3
12.7
Periodic
abstinence
0
5
10
18.7
15
20
25
Probabilities per 100 episodes
0-2 children
3+ children
95% CI
Note: Parity was measured at the end of the episode of use.
FIGURE 18. Twelve-month failure rates by contraceptive intention (pooled estimates)
0.4
0.9
Implant
1.3
1.8
IUD
1.8
2.6
Injectable
5.4
6.0
Pill
5.9
Male condom
7.3
13.1
Withdrawal
14.2
Periodic
abstinence
0
5
10
15
16.7
18.1
20
25
Probabilities per 100 episodes
Spacing
Limiting
95% CI
Note: Contraceptive intention was measured at the end of the episode of use.
31
FIGURE 19. Twelve-month failure rates by wealth (pooled estimates)
0.6
0.6
Implant
1.6
1.4
IUD
2.3
2.2
Injectable
4.9
Pill
6.5
5.9
Male condom
8.2
13.3
Withdrawal
16.0
14.6
Periodic
abstinence
0
5
10
18.3
15
20
25
Probabilities per 100 episodes
Lower 3 quintiles
Upper 2 quintiles
95% CI
Note: Wealth was measured at the time of the interview.
FIGURE 20. Twelve-month failure rates by residence (pooled estimates)
0.8
0.4
Implant
1.2
1.8
IUD
1.8
Injectable
3.0
5.5
5.9
Pill
7.3
6.5
Male condom
14.6
15.1
Withdrawal
15.9
16.8
Periodic
abstinence
0
5
10
15
20
25
Probabilities per 100 episodes
Urban
Rural
95% CI
Note: Residence was measured at the time of the interview.
32
Guttmacher Institute
FIGURE 21. Twelve-month failure rates by education (pooled estimates)
0.5
0.7
Implant
1.5
1.5
IUD
2.0
2.7
Injectable
5.6
5.9
Pill
6.5
6.9
Male condom
13.5
Withdrawal
15.5
15.2
Periodic
abstinence
0
5
10
15
17.1
20
25
Probabilities per 100 episodes
Completed primary or less
Secondary +
95% CI
Note: Education was measured at the time of the interview.
33
FIGURE 22. Twelve-month failure rates by age and wealth, across 43 countries
Implant
12 month failure rate
0.2
IUD
0.9
0.7
0.5
3.4
0.9
Injectable
3.0
1.3
3.4
1.6
3.7
1.6
<25 ≥25
<25 ≥25
<25 ≥25
<25 ≥25
<25 ≥25
<25 ≥25
lower 3 quintiles
upper 2 quintiles
lower 3 quintiles
upper 2 quintiles
lower 3 quintiles
upper 2 quintiles
Pill
Male condom
Withdrawal
23.6
9.6
4.7
6.6
4.1
11.2
6.2
7.5
4.9
21.2
12.8
10.1
<25 ≥25
<25 ≥25
<25 ≥25
<25 ≥25
<25 ≥25
<25 ≥25
lower 3 quintiles
upper 2 quintiles
lower 3 quintiles
upper 2 quintiles
lower 3 quintiles
upper 2 quintiles
Periodic Abstinence
27.3
14.5
34
21.5
12.3
<25 ≥25
<25 ≥25
lower 3 quintiles
upper 2 quintiles
Guttmacher Institute
Discussion and Conclusions
Contraceptive Failure Rates Across 43 Countries
Contraceptive failure rates calculated with data from
Demographic and Health Surveys (DHS) conducted in
43 countries generally reflected expected patterns. We
observed low rates among users of longer-acting methods
such as implants, IUDs and injectables (although with
less difference between IUDs and implants as compared
with injectables than previous studies have suggested27).
Failure rates were higher among users of shorter-acting
methods or those that are coitally dependent, such as oral
contraceptive pills and male condoms. The highest failure
rates were evident among users of traditional methods,
such as withdrawal or periodic abstinence. Pooling data
across countries allowed us to calculate contraceptive
failure rates for methods that are less commonly used
in most countries, such as implants. Implant users were
about half as likely to report contraceptive failure as IUD
users, and 23 times less likely to report contraceptive
failure as users of periodic abstinence.
Our estimates for IUDs, injectables and oral contraceptive pills were similar to those of Ali et al.14 (the most
recent large-scale comparative study of contraceptive
failure rates): for each contraceptive method, the two sets
of estimates differed by less than 0.3 percentage points
(Table 12, pages 36 and 63). For condoms, withdrawal
and periodic abstinence, our estimates are somewhat
lower than those of Ali et al., but within a difference of
2.2, 1.9 and 3.5 percentage points, respectively, despite
the greater variability in rates we found for these methods
(Figure 3).
Nonetheless, there are several notable differences
between these two analyses. Ali et al. analyzed data
from DHS surveys in 19 countries conducted between
2002 and 2009; we analyzed data from DHS surveys in
43 countries conducted largely after 2010 (but including
five surveys done during the 1990s to maximize coverage of the Latin America and Caribbean [LAC] region).
Representation across subregions also differed; for
example, Ali et al. included just four Sub-Saharan African
countries, whereas we included 15. Different representation of subregions may have implications for overall median failure rates. As one example, a greater emphasis on
Guttmacher Institute
the correct and consistent use of condoms in subregions
of higher HIV prevalence (such as Eastern Africa) may
result in comparatively lower failure rates for condoms
in that subregion, which could contribute to an overall
lower median failure rate for this method in our analysis.
Finally, unlike Ali et al., we included unmarried women in
countries where possible. As failure rates differ by marital
status, this difference may also have implications for overall median estimates.
Comparing our estimates with those for the United
States is more complicated. Ours were somewhat
higher than U.S. estimates derived from clinical data27 for
implants (0.6 vs. 0.05 per 100 episodes of use) and IUDs
(1.4 vs. 0.8). On the other hand, ours were markedly lower
than U.S. estimates for injectables (1.7 vs. 6), oral contraceptive pills (5.5 vs. 9.0), male condoms (5.4 vs. 18.0),
withdrawal (13.4 vs. 22.0) and periodic abstinence (13.9
vs. 24), which are derived from 1995 and 2002 National
Surveys of Family Growth, and, importantly, corrected for
abortion underreporting.
Fewer than one-half of induced abortions performed in
the United States between 1997 and 2001 were reported
in face-to-face interviews in the National Survey of Family
Growth.24 Data obtained from a national survey of abortion
clients provided information was used to correct for abortion underreporting when estimating contraceptive failure
rates.13 The effect of this correction varied by method
type: It had less of an impact on rates for oral contraceptive pills, injectables or withdrawal (producing less than
a one–percentage point change in the failure rate, with
inconsistent directionality), and a stronger impact on increasing failure rates for condoms (from 13.9 to 17.4) and
fertility awareness-based methods (from 23.0 to 25.3).
As noted earlier, contraceptive failure rates calculated
from DHS data (including ours) are likely underestimates
because of expected high levels of underreporting of abortions, which we were unable to correct for.
Contraceptive failure rates calculated using calendar
data may also vary depending on the methods used. For
example, although the definition of “using” is generally
clear for an IUD or implant, it may be less clear for shorteracting or coitally dependent methods, such as condoms or
withdrawal. Typical-use failure rates would include periods
35
TABLE 12. Twelve-month failure rates according to study or other data source
Method
Median 12-month failure rate* (95% CI)
Current study†
Study of Ali et al.
na
14
12-month typical-use failure rate*
estimated from U.S. data (95% CI)27
Implant
0.6 (0.0–2.4)
0.05 (Implanon) ‡
IUD
1.4 (0.0–2.4)
1.1
0.8 (0.4–1.2) (ParaGard)§
Injectable
1.7 (0.6–2.9)
1.5
6 (Depo-Provera)**
Pill
5.5 (3.5–7.3)
5.6
9 (COC, POP)**
5.4 (2.3–8.7)
7.6
18**
Withdrawal
13.4 (9.1–17.1)
15.3
22**
Periodic abstinence
(largely calendar rhythm)
13.9 (9.2–19.3)
17.4
24** (largely calendar rhythm) ***
Male condom
*Number of failures per 100 episodes of use. †Median CIs are calculated as a median of all CIs. ‡No clinical study has
reported an Implanon failure, but pregnancies during its use have been reported; thus typical-use (and perfect-use)
failure rates for this implant were arbitrarily set at 0.05; 95% CIs were not provided.27 §Estimate derived from 1979
study of 3,536 women using the TCu 380A IUD.28 95% CI calculated from one-year gross cumulative pregnancy rate per
100 women accepting the TCu 380A IUD (0.8) and the associated standard error (0.2) provided in Table 8 of the study
by Sivin and Stern.28 **Weighted averages of estimates derived from the 1995 and 2002 National Surveys of Family
Growth, corrected for abortion underreporting; 95% CIs were not provided.27 ***The overwhelming majority of women
using fertility awareness-based methods (FABMs) in the NSFG are believed to be using calendar rhythm, although this
could also include women using newer FABM methods such as Standard Days, TwoDay, Ovulation, or Symptothermal.
Notes: CI=confidence interval (when available). na=not available (method was not assessed). COC=combined oral
contraceptive pill. POP=progestin-only pill.
of inconsistent contraceptive use (which may result in an
unintended pregnancy), but a woman who missed an oral
contraceptive pill and subsequently became pregnant, for
example, may or may not have considered herself to have
been using the method during the period in question.
If she fails to define herself as a user during the collection of calendar data, the unintended pregnancy will not
be captured in the calculation of failure rates for the oral
contraceptive pill. Thus, less variability may be inherent in
failure rates for longer-acting methods.
Another potential difference between various studies calculating failure rates is that the characteristics and
formulation of certain methods may vary. For example,
U.S. rates for implants are specific to Implanon (a one-rod
implant containing etonogestrel), whereas those from DHS
data may relate to other kinds of implants, such as Norplant
(a six-rod implant containing levonorgestrel available until
2008), Jadelle (a two-rod implant containing levonorgestrel)
or others. Similarly, domestic and international rates for
injectables are likely to be primarily for the three-month
injectable depot medroxyprogesterone acetate (DMPA),
but in some countries, may also include uses of one-month
combined (estrogen and progestin) injectables.
36
Contraceptive Failure Rates by Subregion
In general (and aside from estimates for Western
Africa), we generally observed the lowest method-specific
contraceptive failure rates in Eastern Africa and Southern
Asia; this finding needs to be considered in conjunction
with overall contraceptive prevalence in those subregions
(low in the former and moderate in the latter) as well as
with contraceptive method mix (predominantly injectables
and pills in the former, and a substantial amount of female
sterilization along with a mix of other methods in the
latter). Where use is low, such as in Eastern Africa, users
may be more highly motivated. One subregion, Northern
Africa and Western Asia combined, emerges as an area in
need of particular attention for prevention of unintended
pregnancy: It had high contraceptive failure rates and a
moderate contraceptive prevalence consisting substantially of traditional methods.
As noted in Chapter 2 the quality of calendar data may
vary substantially by country and subregion. In particular,
a recent comprehensive analysis suggested that failure
rates based on calendar data from particular subregions
(particularly Western Africa, and to a lesser extent,
Eastern Africa) should be interpreted with caution because
of concerns about data quality.23 Indeed, our comparisons
of pooled failure rates by subregion revealed unexpectedly
Guttmacher Institute
low values for Western Africa across most contraceptive
methods. Concerns about data quality in the subregion
suggest that underreporting of contraceptive method use
(and method failure) is likely to result in greater underestimation of failure rates in this subregion as compared with
others.
Population coverage also has implications for interpretation of results across various subregions. For
example, estimates from Eastern Africa, Southern Asia
and Southeastern Asia are based on surveys for countries
representing more than 70% of the population in those
subregions; failure rates for these subregions may be
more representative than those for LAC, Northern Africa
and Western Asia, and Eastern Europe and Central Asia
(where population coverage of represented countries was
54%, 47% and 22%, respectively).
Contraceptive Failure Rates by Demographic and
Socioeconomic Groups
Subgroup analyses suggested that contraceptive failure
rates were generally higher among women younger than
25. More frequent intercourse and higher natural fertility rates in this age-group may contribute to increased
contraceptive failure rates, and younger women may be
particularly vulnerable to challenges in correct and consistent use of contraceptive methods, especially those that
are more user-dependent. Among the demographic and
socioeconomic characteristics assessed, age was associated with some of the most extreme differences in failure
rates, and its influence persisted among both poorer and
wealthier users.
Never-married women reported higher contraceptive
failure rates than their ever-married counterparts for some
methods (such as withdrawal and injectables) and lower
rates for others (condoms). Having ever been married is
somewhat correlated with older age, so one might expect
higher contraceptive failure rates among never-married
(i.e., younger) women. Condom use is more prevalent in
casual partnerships and decreases in longer-term partnerships.29 When use of condoms is perceived as intended
for infection prevention, married women may be less able
to negotiate condom use without raising concerns about
infidelity, which may result in less or less consistent use
of this method.
Women with fewer children reported somewhat
higher contraceptive failure rates for several methods
(IUDs, injectables, pills, withdrawal and periodic abstinence); these women may have less motivation to avoid a
pregnancy (because of greater desire for more children or
ambivalence about having a child or another one) and are
also likely to be younger. Similarly (as found in previous
studies from the United States13) women who were using
injectables, condoms, withdrawal and periodic abstinence
to space (versus limit) pregnancies reported somewhat
higher failure rates; this is not surprising, as they may
have less motivation to avoid pregnancy (and again, are
likely younger).
Although wealth had little impact on failure rates for
longer-acting methods such as implants, IUDs or injectables, poorer women reported higher failure rates for
more user-dependent methods such as pills, condoms,
withdrawal or periodic abstinence. Women of lower
socioeconomic status may be more challenged in terms
of affordability, time or ability when it comes to obtaining a
resupply of methods, and may potentially be less empowered to consistently use condoms or traditional methods.
Differentials in failure rates by factors such as urbanrural residence and by educational attainment (whether
women had completed primary school or less versus secondary or more) were less striking. The similarity in failure
rates by extent of schooling is consistent with findings
from other studies based on DHS data.7
Implications and Conclusions
Although most unintended pregnancies occur because
couples do not use contraception, contraceptive failure is
also a major underlying cause, particularly where contraceptive prevalence is high and where the contraceptive
method mix skews toward methods with higher failure
rates. Use of a contraceptive method indicates existing
motivation to prevent pregnancy, and also provides information about the availability, accessibility and acceptability
of various methods for that individual. Reducing unintended pregnancy among contraceptive users is important, in addition to helping nonusers who wish to prevent
unintended pregnancy to adopt a contraceptive method
with which they will be satisfied.30
Availability of a wide variety of contraceptive methods
is an essential first step to enable women and couples to
select the most effective method that they prefer to use.
This greatly increases the likelihood that they will obtain a
method that they are comfortable using and that they can
use correctly and consistently. Provision of clear information about the risks and benefits of all available methods
is also crucial in facilitating informed contraceptive choice.
Our analysis focused on the effectiveness of contraceptive methods and provides new evidence documenting
that in a broad cross-section of countries, failure rates
range widely by contraceptive method in expected
directions. Longer-acting methods such as implants and
IUDs have the lowest failure rates. Improving access to
a full spectrum of contraceptive options, including such
37
methods, may help to reduce contraceptive failure and
unintended pregnancy, particularly in subregions where
access to these methods is currently limited, or among
groups with high failure rates for user-dependent methods
(e.g., young women). Especially in areas with high HIV
prevalence, counseling and services should consider the
need for HIV prevention strategies in conjunction with
contraceptive services. Provision of adequate information, counseling services and follow-up care may help to
improve correct and consistent use, facilitate switching
to preferred methods, and reduce discontinuation due to
contraceptive failure for all methods. It may be particularly
helpful to ensure that individuals initiating a contraceptive
method are well supported to establish effective patterns
of use at early stages of use, when the risk of failure is
highest.
We did not assess contraceptive discontinuation for
reasons other than contraceptive failure. It is important
to note that discontinuation of contraceptive methods
(e.g., because of health concerns or side effects) may be
high, particularly for methods that can be stopped without
provider assistance (unlike implants or IUDs). This type
of contraceptive discontinuation may also leave women
vulnerable to unintended pregnancy, so although not
examined in this report, other reasons for contraceptive
discontinuation are important to consider as well.
Our results help to highlight those methods, subregions and population groups that have above-average
failure rates—and that are therefore in greater need of
attention. For example, it may be useful to increase attention to Northern Africa and Western Asia, where failure
rates are generally higher than those in other subregions,
contraceptive prevalence is moderate to high, and method
mix includes a substantial amount of traditional method
use. Similarly, certain population groups, such as young
women, appear to need particular assistance to achieve
greater contraceptive effectiveness of the method they
select. Increased availability and promotion of youthfriendly contraceptive counseling and services would
assist young people in successfully using their chosen
contraceptive method.
This analysis contributes to the existing literature in
several ways. We provide a more comprehensive assessment of contraceptive failure rates across a large
range of countries, according to duration of method use
(12, 24 and 36 months), using largely recently collected
data and including unmarried women where possible. In
addition, pooling data allowed us to estimate failure rates
for subregions and for population groups having different
demographic and socioeconomic characteristics, including
by duration of method use. This analysis also has limita-
38
tions; for example, undercounting of contraceptive failures
due to underreporting of abortions likely resulted in an
underestimation of contraceptive failure rates. However,
although the level of underreporting may vary somewhat
across groups and subregions, large differences in failure
rates are likely to indicate meaningful differences in
failure rates between subregions and population groups.
Furthermore, the advantages and disadvantages of including older surveys, as discussed in Chapter 2, also highlights the need for more recent data in particular regions,
such as LAC. The limitations inherent to this study also
point toward potential directions for improving data collection and analytic approaches that could enhance accurate
estimation of contraceptive failure rates using DHS data.
For example, it may be worth considering novel approaches to improve the quality of reproductive calendar data,
developing techniques to achieve more reliable reporting
of abortions (so failure rates are less affected by this factor), or assessing characteristics related to contraceptive
failure using multivariate analysis.
Despite the limitations inherent when estimating
contraceptive failure rates using the available data, this
analysis contributes to our understanding of worldwide
contraceptive failure rates and some of the factors associated with lower contraceptive effectiveness. In turn, this
information can be leveraged to better assist women and
couples to avoid unintended pregnancies and their negative consequences, and to have the number of children
they desire when they feel ready and able to do so.
Guttmacher Institute
Appendix A: Calculation of Failure Rates
In the calculation of failure rates, the unit of analysis is
the episode of contraceptive use. A single woman could
contribute multiple episodes, if she stopped and started
using contraception several times over the last five years,
or no episodes if she did not use any method during that
period. A woman could also contribute no episodes to the
analysis if, for example, her only contraceptive use began
more than five years and three months before the date of
survey, or began in the three months preceding the survey. Examples of hypothetical episodes of contraceptive
are shown in shown in Figure A1, page 40 and discussed
below.
In Figure A1, the month of interview (MI) is on the far
right. The gray range represents the contraceptive calendar. It generally begins in January of the calendar year five
years before the interview.* To standardize the calendar
length for all women, we begin the observation period
62 months before the month of interview (MI minus 62).
The exact length of the calendar varies for each woman,
depending on the month in which she was interviewed.†
Each lettered line in the figure represents an episode of
contraceptive use, with the beginning of the episode, if
observed, marked with a diamond, and the end, if observed, marked with a circle.
The period of observation for calculating contraceptive
failure rates is months 3–62 preceding the survey. We
do not use information from the month of interview or
the two preceding months because women in their first
trimester may not yet recognize that they are pregnant,
possibly as the result of contraceptive failure. Doing so
could lead to an underestimation of failure rates because
their months of contraceptive use would be included, but
their contraceptive failure would not. To avoid this potential for underestimation, we exclude the calendar data for
the most recent three months, and include data from only
a five-year period that began 62 months before the survey,
for a total of 60 months, or five years.
To calculate the duration of contraceptive use for each
episode, we need to know when it began and when it
ended. For episodes that began before the beginning of
the calendar period—such as episodes A and G in Figure
A1—we do not have information on when use began or
how long the woman had been using the method at the
start of our observation periods, and so must exclude the
episode. While excluding these episodes from analysis
may introduce bias into our failure rate estimates, we
examined this possibility with sensitivity tests, assuming
various durations of use for these episodes, as explained
in our discussion of study limitations, and found that any
biases introduced by the exclusion of these cases are
likely to be small.
If an episode of use began before our observation
period but within the calendar period (such as episode B),
we include the episode as a late entry into the life table,
using only the months of contraceptive use that occurred
within the 3–62-month period of observation. For example, if episode B began two months before the period of
observation (64 months before the date of interview) and
ended 10 months later, the first two months of use would
be excluded because they occurred outside the period of
observation. The episode would enter into the life table at
month 3 and contribute eight months before the woman
either experienced a failure or discontinued use for another reason.
In Figure A1, episode C is completely observed within
the period of observation, and thus is fully included in the
life table. Episode D begins within the period of observation but continues into the three months before the interview, which is outside the period of observation. Episode
E is similar, but the end of the episode is not observed,
meaning that the woman was still using contraception
at the time of interview. Both episodes D and E will be
*Most contraceptive calendars begin in the January five years (or
six years, depending on the survey) before the date of interview
in countries with Gregorian calendars. Countries such as Ethiopia
and Nepal use local calendars, which begin in the first month
of their year. A small number of other countries have calendars
that start in different months; for example, the Columbia 2010
survey used November 2004 as a start point, and earlier surveys
in Bangladesh (although not the 2011 survey) used April or June
as the start point.
†For example, in the Indonesia 2012 survey, the calendar began
in January of 2006, and interviews were conducted in May
through August of 2012. For women interviewed in May, the
calendar contains 65 months of data, and for women interviewed
in August, it contains 68 months of data.
39
FIGURE A1. Hypothetical episodes of contraceptive use as captured with calendar data.
Figure A1
Period of observation: months 3–62 prior to
month of interview (MI)
A
B
C
D
E
F
G
Calendar
start
month
MI minus 62
Time
censored three months before the interview. Episode F
begins within the three months before interview and so is
excluded entirely from analysis.
Calculation of confidence intervals
In constructing the 95% confidence intervals for each
cell of Tables 5, 8 and 9, we used the jackknife method.
This method is a resampling technique that involves the
removal of a single sampling unit, and the recalculation of
the indicator from the one-less–sized sample, and doing
this systematically—removing, recalculating then replacing—for each unit in the sample. This process allows for
an estimate of the variance, and thus the calculation of the
confidence intervals. Demographic and Health Surveys
use a two-stage
(or sometimes
three-stage) sampling
MI minus 3
MI
design; the first stage is the selection of primary sampling
units (PSUs), which are typically enumeration areas based
on a census or master sample sampling frame. The last
stage in the sample selection is the selection of households, either from the PSUs in two-stage sampling or, in
the case of three-stage sampling, from selected subunits
or segments of the PSUs. The jackknife approach is used
directly by systematically removing each individual PSU,
recalculating the failure rate and estimating the variance*
using the sum of the squares of the differences from the
full sample estimate.
Impact of inability to include left-truncated
episodes of contraceptive use
Although we include right-censored episodes of contraceptive use that did not end before the date of interview,
!
we are unable to include the left-truncated episodes that
𝑛𝑛 − 1
𝑉𝑉𝑉𝑉𝑉𝑉 = (𝑥𝑥! − 𝑥𝑥. )! *The variance is calculated as !
𝑛𝑛
began
before
the calendar period started because we
!!!
𝑛𝑛 − 1
_
𝑉𝑉𝑉𝑉𝑉𝑉 =do
not know
(𝑥𝑥! −when
𝑥𝑥. )! the episode began, and thus we do
where n is the total number of PSUs, c is the failure rate calcu𝑛𝑛
_
!!!
: 𝑥𝑥. ±the
1.96full
𝑉𝑉𝑉𝑉𝑉𝑉.sample,
lated from
and
not know the duration of use. To understand how omis c1 is the failure rate c1 from the
sample excluding PSU i. Using
this approach, the confidence
sion of these episodes might affect contraceptive failure
intervals were calculated as: : 𝑥𝑥. ± 1.96 𝑉𝑉𝑉𝑉𝑉𝑉. rates, we performed sensitivity analyses by reestimating
40
Guttmacher Institute
the rates including these left-truncated episodes under
various scenarios: assuming all such episodes began
in the month the calendar began and in three-month
increments up to 36 months before the beginning of the
calendar.* Failure rates were reestimated for 12-, 24-, and
36-month durations. We anticipated that the impact of
left-truncation would be larger on failure rates of longer
durations because of the way the window of observation and late entry conditions are set. In many surveys,
the time between the beginning of the calendar and the
beginning of the window of observation (MI minus 62 in
Figure A1) is 10 or more months. In the scenario where
left-truncated episodes are considered as having started
in the first month of the calendar, with a 10-month gap
between the beginning of the calendar and the beginning
of the window of observation, left-truncated episodes of
use would enter the life table at month 10. In the other
scenarios the episodes enter the life table even later. In
all scenarios, these episodes would therefore clearly have
a minimal impact on 12-month life tables, and contribute
more to the 24- and 36-month life tables.
Results of these sensitivity analyses suggested that
inclusion of left-truncated episodes more often decreased
failure rates than increased them, but this pattern was not
consistent across all countries (Appendix Table 3, page
69). The relative difference between averaged rates of
failure, comparing the standard calculation with calculations including left-truncated episodes, was greater for
longer-term modern methods (IUDs and implants) and traditional methods than for shorter-term modern methods.
This indicates that longer-term and traditional methods are
more commonly reported as ongoing when the calendar
began. It makes sense: Episodes of use that were ongoing at the time the calendar began tend to be longer durations of use, and longer-term methods tend to have longer
durations of use. Overall, the exclusion of left-truncated
episodes of contraceptive use seems to have a relatively
small impact on failure rates. On average, including lefttruncated episodes tends to decrease the contraceptive
failure rates, but this is not the case for all countries. In
some countries, doing so actually increases the failure
rate. For example, for the 36-month pill failure rates in
Turkey and Tajikistan, including left-truncated episodes
increases the pill failure rate by up to 1.6 failures per 100
episodes of use. This indicates that in these countries,
left-truncated episodes of use were more likely to end in
failure than nontruncated episodes.
Taken as a whole, results from our sensitivity analyses
generally show that the impact of excluding left-truncated
episodes is minimal for 12-month failure rates, but has
a slightly larger effect on 24- and 36-month failure rates.
Note that the tests shown here do not address other
potential biases associated with these exclusions, such as
the fact that left-truncated episodes may be disproportionately more common among older women who are less
fecund and thus less likely to experience failures. On the
basis of the results presented here, however, we believe
that any such biases are likely to have a minimal impact
on the failure rates presented. On average, excluding lefttruncated episodes biases failure rates slightly upward,
suggesting that the results presented here may overestimate failure rates, but the impact is likely to be small.
*Specifically, failure rates were reestimated assuming the
left-truncated episodes began 0, 3, 6 and 9 months before the
beginning of the calendar for the 12-month rates; 0, 3, 6, 9, 12,
15, 18 and 21 months before the 24-month rates; and 0, 3, 6, 9,
12, 15, 18, 21, 24, 27, 30 and 33 months before the beginning
of the calendar for the 36-month rates. Appendix Table 3 shows
the minimum and maximum values from these calculations, and
compares these values with the failure rates calculated using the
standard of dropping left-truncated episodes, which is equivalent
to the left-truncated episodes entering the 12-, 24- and 36-month
life tables at 12, 24 or 36 months, respectively.
41
Appendix B: Median Failure Rates Versus
Pooled Failure Rates
We assessed contraceptive failure rates across the 43 included countries in two ways: by ascertaining the median
failure rate by method across all countries (Table 5) and by
calculating a pooled failure rate across all countries (Table
8). Table B1 displays differences in results from these two
methods. The reason for the differences relates to the
fact that countries with fewer than 125 episodes of use
for a particular method do not contribute to the median
estimate, whereas all data from all countries (including
those having fewer than 125 episodes of use for a given
method) are included in the pooled failure rates.
In this report, we chose to focus on median values
as the overall summary measure when discussing failure
rates across all 43 countries. Conversely, when discussing
overall subregional failure rates, we focus on pooled rates
for each subregion. Each country (including those with
fewer than 125 episodes of use) contributes equal weight
in pooled estimates, so we felt it more justifiable to pool
countries within a subregion (given similarities between
them) than to pool equally weighted countries globally,
given a much greater range of differences in factors that
can affect contraceptive effectiveness. Using median estimates also makes our estimates more easily comparable
to those of previous analyses, such as that by Ali et al.14
TABLE B1. Comparison of 12-month failure rates calculated with two techniques, by method,
for 43 countries
Method
12-month failure rate (95% CI)*
Median
Pooled
Implant
0.6 (0.0–2.4)
0.6 (0.3–0.9)
IUD
1.4 (0.0–2.4)
1.5 (1.2–1.8)
Injectables
1.7 (0.6–2.9)
2.3 (2.0–2.5)
Pill
5.5 (3.5–7.3)
5.7 (5.4–6.0)
Male condom
5.4 (2.3–8.7)
6.8 (6.3–7.3)
Withdrawal
13.4 (9.1–17.1)
14.9 (14.2–15.6)
Periodic abstinence
13.9 (9.2–19.3)
16.4 (15.5–17.3)
*Number of failures per 100 episodes of use. Note: CI=confidence interval.
42
Guttmacher Institute
TABLE 1. Basic demographic and socioeconomic indicators, 43 countries
Among all women 15–49:
Subregion and country
Eastern Africa
Burundi
Comoros
Ethiopia
Kenya
Malawi
Mozambique
Rwanda
Tanzania
Uganda
Zimbabwe
Western Africa
Benin
Burkina Faso
Niger
Nigeria
Senegal
Northern Africa and Western Asia
Armenia
Azerbaijan
Egypt*
Jordan*
Morocco
Turkey*
Eastern Europe and Central Asia
Kazakhstan
Kyrgyz Republic
Moldova
Tajikistan
Ukraine
Southern Asia
Bangladesh*
India
Maldives*
Nepal
Pakistan*
Southeastern Asia
Cambodia
Indonesia
Philippines
Viet Nam*
Latin America and the Caribbean
Bolivia
Brazil
Colombia
Dominican Republic
Guatemala
Honduras
Paraguay
Peru
Under-5
Population, in GNI per capita, Atlas
000s
method, US$ mortality rate
% urban
% with secondary
education or higher
10,483
752
96,506
45,546
16,829
26,473
12,100
50,757
38,845
14,599
260
840
470
1,160
270
610
630
840
600
860
96
50
88
74
112
97
76
81
90
84
10.7
33.1
23.9
25.4
18.7
34.7
15.0
28.5
19.8
38.7
12.1
49.1
11.2
34.3
20.0
18.5
16.2
16.2
27.7
69.7
10,600
17,420
18,535
178,517
14,548
790
660
410
2,690
1,050
70
129
127
128
72
46.5
27.1
18.8
42.1
49.3
23.0
12.4
8.5
44.9
20.4
2,984
9,515
83,387
7,505
33,493
75,837
3,800
7,350
3,140
4,940
3,030
10,980
16
50
28
28
47
52
61.5
56.5
41.2
84.0
60.5
66.5
93.9
97.5
55.5
90.1
30.2
30.3
16,607
5,625
3,461
8,409
44,941
11,560
1,220
2,470
990
3,760
71
31
14
43
17
55.6
37.4
42.9
25.0
71.4
99.4
99.5
99.3
94.1
99.9
158,513
1,267,402
352
28,121
185,133
1,010
1,560
6,850
720
1,360
53
74
17
54
89
26.0
32.8
33.2
14.4
33.5
42.3
44.7
40.9
42.8
27.0
15,408
252,812
100,096
92,548
950
3,760
3,270
1,740
54
40
34
24
21.0
52.2
55.7
19.1
34.7
63.5
79.3
66.9
10,848
202,034
48,930
10,529
15,860
8,261
6,918
30,769
2,550
12,550
7,610
5,770
3,340
2,120
3,980
6,270
63
49
19
37
59
29
43
21
66.0
82.0
78.8
71.8
68.8
45.0
56.3
74.8
54.3
61.9
76.1
59.1
25.4
45.9
36.1
75.2
*Data for percent urban and percent with secondary or higher education are based on ever-married women, as opposed to all
women for other countries. Note: GNI=gross national income. Sources: Population size—2014 population projections, from: UN
DESA Population Division, Population Estimates and Projections Section. World Population Prospects: the 2012 Revision,
http://esa.un.org/wpp/Excel-Data/population.htm. GNI per capita—Data from 2013. The World Bank,
http://data.worldbank.org/indicator/NY.GNP.PCAP.CD. Under-5 mortality rate, percent urban, and percent with secondary
education or higher—Data from most recent available Demographic and Health Survey, MEASURE DHS STATcompiler. Under-5
mortality rates are for 0–4 years preceding the survey (excluding the month of interview from analysis).
Guttmacher Institute
1
43
TABLE 2. Selected sexual and reproductive characteristics of women aged 15–49, in 43 countries, 1990–2013
TFR
% of married women* who:
Want no
Want to space
% who received
Subregion, country and
more antenatal care from
their next
survey year
children§ a skilled provider**
Actual Wanted
birth‡
Eastern Africa
Burundi 2010
6.4
4.5
52.7
32.6
99.1
Comoros 2012
4.3
3.8
47.0
19.8
92.1*†
Ethiopia 2005
5.4
4.0
39.6
42.1
28.0*†
Kenya 2003
4.9
3.6
33.5
48.7
88.1*†
Malawi 2004
6.0
4.9
43.6
40.9
93.2*†
Mozambique 2011
5.9
5.2
33.7
28.4
90.7
Rwanda 2010
4.6
3.2
37.8
52.9
98.3
Tanzania 2004–05
5.7
4.9
44.4
29.5
94.3*†
Uganda 2011
6.2
4.7
41.3
42.5
94.9
Zimbabwe 2010–11
4.1
3.5
40.5
40.5
88.5
Western Africa
Benin 2011–12
4.9
4.0
40.0
27.5
86.2
Burkina Faso 2010
6.0
5.4
53.7
23.7
95.7
Niger 2012
7.6
7.4
56.3
8.5
84.1
Nigeria 2013
5.5
5.2
44.4
18.6
60.6*†
Senegal 2010–11
5.0
4.3
45.7
21.6
97.1
Northern Africa and Western Asia
Armenia 2010
1.7
1.6
24.0
57.9
99.3
Azerbaijan 2006
2.0
1.8
11.6
71.7
79.5
Egypt 2008†‡
3.0
2.4
20.6
62.9
76.1
Jordan 2012†‡
3.5
2.5
25.6
52.8
99.1
Morocco 2003–04
2.5
1.8
25.9
53.7
67.6
Turkey 2003†‡
2.2
1.6
17.5
69.2
80.1
Eastern Europe and Central Asia
Kazakhstan 1999
2.0
1.9
25.1
58.2
94.4*†
Kyrgyz Republic 2012
3.6
3.4
46.9
26.1
97.4
Moldova 2005
1.7
na
19.3
64.1
98.3
Tajikistan 2012
3.8
3.3
32.6
44.0
80.4
Ukraine 2007
1.2
1.1
25.5
57.8
99.5
Southern Asia
Bangladesh 2011†‡
2.3
1.6
21.7
64.9
54.7
India 2005–06
2.7
1.9
14.0
70.5
75.9*†
Maldives 2009†‡
2.5
2.2
32.8
47.8
99.8
Nepal 2011
2.6
1.8
17.0
72.7
59.4
Pakistan 2012–13†‡
3.8
3.0
24.2
51.2
75.0
Southeastern Asia
Cambodia 2010
3.0
2.6
30.4
56.3
90.6
Indonesia 2012
2.6
2.2
33.7
50.1
96.2
Philippines 2003
3.5
2.5
24.3
61.2
87.6*†
Viet Nam 2002†‡
1.9
1.6
17.3
75.4
86.8
Latin America and the Caribbean
Bolivia 1994
4.8
2.7
15.8
72.2
52.5
Brazil 1996
2.5
1.8
14.9
74.4
89.3
Colombia 2010
2.1
1.6
17.1
70.1
96.7
Dominican Republic 2002
3.0
2.3
18.8
66.2
98.3*†
Guatemala 1998–99
5.0
4.1
28.5
58.4
59.6*†
Honduras 2011–12
2.9
2.2
31.3
55.2
96.6
Paraguay 1990
4.7
4.0
32.5
43.6
83.9*†
Peru 2012
2.6
1.8
24.1
62.0
96.1
Most recent survey for countries that have the calendar data for an older survey
Ethiopia 2011
4.8
3.8
44.1
37.0
41.9
Kenya 2008–09
4.6
3.4
31.7
53.6
91.5
Malawi 2010
5.7
4.5
39.3
46.9
94.6
Tanzania 2010
5.4
4.7
46.4
30.0
95.8
Philippines 2008
3.3
2.4
24.5
62.7
91.0
Bolivia 2008
3.5
2.0
17.8
69.8
90.1
Dominican Republic 2007
2.4
1.9
20.6
65.7
99.4
% with unmet need for contraception† among:
% ever
married††
% sexually active‡‡
among unmarried
women Married women*
Sexually active‡‡
All sexually
unmarried women active women§§
66.7
67.7
75.1
70.3
83.1
81.6
61.3
77.1
75.6
76.1
5.0
7.5
2.3
18.1
17.2
40.4
8.0
30.7
20.9
15.9
32.4
32.3
36.1
27.4
30.3
28.5
20.8
24.3
34.3
14.6
46.5
41.6
40.0
43.1
55.6
42.4
49.1
35.2
39.5
33.0
32.9
32.8
36.1
29.1
32.0
30.7
22.9
25.7
34.8
16.2
75.9
82.5
92.1
77.1
70.8
31.3
18.6
3.8
24.1
6.1
32.6
24.5
16.0
16.1
30.1
49.6
38.8
53.5
27.7
64.3
34.5
25.2
16.2
17.1
31.1
67.7
69.1
69.3
57.1
57.9
70.1
na*‡
na*‡
na
na
na*§
na
13.5
15.4
11.6
11.7
11.9
9.5
na*‡
na*‡
na
na
na*§
na
na*‡
na*‡
na
na
na*§
na
74.7
72.8
75.0
72.5
77.4
22.4
6.3
20.2
na*‡
30.5
11.9
18.0
11.4
22.9
10.1
32.1
52.7
32.9
na*‡
10.6
14.2
19.2
13.4
na*‡
10.2
85.3
79.5
68.6
78.6
66.7
na
na*‡
na
na*‡
na
13.5
13.9
28.6
27.5
24.4
na
na†*
na
na*‡
na
na
na†*
na
na*‡
na
69.2
78.4
67.8
68.0
na*‡
na*‡
2.1
na*§
16.9
11.4
22.5
6.6
na*‡
na*‡
55.8
na*§
na*‡
na*‡
22.9
na*§
69.6
69.4
68.4
76.9
73.8
71.5
67.1
67.2
9.0
25.9
44.1
25.3
3.7
18.5
20.3
24.2
28.9
10.8
8.0
12.4
26.8
10.7
17.4
9.3
34.4
25.1
20.1
30.1
49.4
30.1
na†*
20.7
29.2
12.9
11.4
15.0
27.3
13.1
na†*
11.1
72.9
68.8
80.3
74.9
66.7
68.3
76.0
6.8
22.4
16.7
33.7
4.5
17.3
33.2
26.3
25.6
26.2
22.3
22.0
20.1
11.1
35.3
44.7
44.6
35.5
47.3
31.2
29.6
26.6
28.3
27.6
24.5
22.7
21.3
14.9
*Married women or women living in union. †Women with unmet need are defined as those who are sexually active and fecund, and want to delay or stop childbearing, but are not using any method of
contraception (modern or traditional) (<http://dhsprogram.com/pubs/pdf/AS25/AS25%5B12June2012%5D.pdf>). ‡Women who are undecided if/when they want a/another birth. §Includes women who
are sterilized or whose husband/partner is sterilized. **Measured among women who gave birth in the last 3 years unless otherwise noted. Skilled provider: a doctor, nurse or midwife. ††Women formally
married, living together as if married, widowed, divorced or not living together (i.e., separated). ‡‡Had sex in the past 3 months. §§Married women are assumed to be sexually active *†Measured in the last
5 years. *‡No more than 1.5% of unmarried women reported being sexually active. *§Questions on sexual activity were not asked. †*Questions related to unmet need were not asked for women who were
not currently married. †‡Data are based on ever-married women as opposed to all women for other countries. Notes: na=not applicable because survey included only ever-married women. TFR=total
fertility rate.
2
44
Guttmacher Institute
Guttmacher Institute
TABLE 3. Percentages and percent distributions of women according to current use of contraception by method, among married and sexually active unmarried women 15–49, in 43 countries, 1990–2013
Modern methods
Subregion, country and survey
year
Eastern Africa
Burundi 2010
Comoros 2012
Ethiopia 2005
Kenya 2003
Malawi 2004
Mozambique 2011
Rwanda 2010
Tanzania 2004–05
Uganda 2011
Zimbabwe 2010–11
Western Africa
Benin 2011–12
Burkina Faso 2010
Niger 2012
Nigeria 2013
Senegal 2010–11
Northern Africa and Western Asia
Armenia 2010
Azerbaijan 2006
Egypt 2008
Jordan 2012
Morocco 2003–04
Turkey 2003
Eastern Europe and Central Asia
Kazakhstan 1999
Kyrgyz Republic 2012
Moldova 2005
Tajikistan 2012
Ukraine 2007
Southern Asia
Bangladesh 2011
India 2005–06
Maldives 2009
Nepal 2011
Pakistan 2012–13
Southeastern Asia
Cambodia 2010
Indonesia 2012
Philippines 2003
Viet Nam 2002
Latin America and the Caribbean
Bolivia 1994
Brazil 1996
Colombia 2010
Dominican Republic 2002
Guatemala 1998–99
Honduras 2011–12
Paraguay 1990
Peru 2012
Any
method
Any reversible
modern
Any
method
Female
Male
modern
(excludes
method
sterilization) sterilization sterilization
Pill
Traditional methods
IUD Injectables Implants
Other
Male
modern
condom methods*
Any
traditional
method
Periodic
abstinence
Withdrawal
Lactational
Amenorrhea
Method
Other
traditional
methods
Not using
a method
Total†
No. of
women
21.9
20.5
14.9
39.7
32.0
14.3
50.4
27.9
31.5
57.8
17.8
13.9
13.9
31.9
27.8
13.9
43.9
21.3
27.3
56.4
17.3
13.1
13.7
27.9
22.2
13.7
43.0
18.9
24.6
55.3
0.6
0.8
0.2
4.0
5.5
0.2
0.8
2.4
2.7
1.1
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.1
0.0
2.4
3.0
3.1
7.2
1.9
5.1
6.9
6.0
3.0
39.0
2.7
0.1
0.2
2.3
0.1
0.2
0.4
0.2
0.5
0.2
10.3
5.5
9.9
14.4
17.6
5.0
25.7
8.7
14.3
8.3
0.6
1.6
0.2
1.6
0.5
0.0
6.2
0.5
2.5
2.7
1.2
2.9
0.3
2.3
2.2
3.3
3.3
3.6
4.3
4.8
0.0
0.0
0.0
0.0
0.0
0.1
0.6
0.0
0.0
0.4
4.0
6.7
1.1
7.8
4.2
0.4
6.5
6.6
4.2
1.4
1.8
3.4
0.6
6.4
0.5
0.1
2.7
2.3
1.5
0.1
2.2
2.4
0.3
0.6
2.0
0.1
3.3
2.7
2.1
0.9
0.0
0.8
0.2
0.0
0.0
0.2
0.5
0.5
0.2
0.2
0.0
0.1
0.0
0.8
1.7
0.1
0.1
1.2
0.5
0.2
78.1
79.5
85.1
60.3
68.0
85.7
49.6
72.1
68.5
42.2
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
5,621
3,417
9,179
5,513
8,895
11,113
7,439
7,986
6,098
6,253
15.2
17.9
14.0
19.3
13.4
9.3
16.6
8.4
12.9
12.2
9.2
16.5
8.3
12.6
11.9
0.1
0.2
0.1
0.3
0.2
0.0
0.0
0.0
0.0
0.0
1.5
3.3
5.6
2.3
4.1
0.5
0.3
0.1
1.0
0.6
2.0
6.1
2.2
3.1
5.2
0.9
3.4
0.3
0.4
1.2
3.5
3.4
0.1
5.1
0.8
0.7
0.1
0.0
0.6
0.0
5.9
1.2
5.6
6.3
1.2
3.3
1.0
0.1
2.4
0.3
0.9
0.1
0.0
2.7
0.2
0.4
0.1
3.9
0.4
0.2
1.3
0.0
1.6
0.8
0.5
84.8
82.1
86.0
80.7
86.6
100.0
100.0
100.0
100.0
100.0
13,220
14,219
9,930
30,508
10,675
54.9
51.1
60.3
61.2
63.0
72.2
26.4
13.2
57.6
41.0
52.0
43.2
26.2
12.8
56.6
38.8
49.2
37.3
0.2
0.4
1.0
2.2
2.7
5.7
0.0
0.0
0.0
0.0
0.0
0.1
1.5
1.1
11.9
8.1
40.1
5.0
9.6
9.2
36.1
21.3
5.4
21.0
0.0
0.0
7.4
0.9
2.1
0.4
0.0
0.0
0.5
0.3
0.0
0.0
14.6
2.2
0.7
7.9
1.5
10.3
0.5
0.2
0.0
0.2
0.1
0.7
28.4
38.0
2.7
20.2
11.0
29.1
2.4
4.0
0.4
3.5
3.8
1.1
24.5
32.5
0.2
14.3
4.4
27.0
0.8
1.1
0.0
1.3
2.8
0.7
0.8
0.3
2.0
1.0
0.1
0.4
45.1
48.9
39.7
38.8
37.0
27.8
100.0
100.0
100.0
100.0
100.0
100.0
3,626
5,269
15,396
10,801
8,782
3,902
64.9
36.2
66.8
27.9
69.0
53.5
33.4
42.4
25.7
51.6
50.9
31.8
37.9
25.2
51.0
2.5
1.6
4.4
0.6
0.6
0.0
0.0
0.0
0.0
0.0
3.0
1.6
3.7
2.3
5.1
39.9
21.6
23.7
18.5
16.4
0.6
0.5
0.1
2.0
0.0
0.0
0.0
0.0
0.0
0.0
5.6
8.0
8.9
2.2
28.7
1.9
0.1
1.6
0.0
0.9
11.5
2.8
24.4
2.2
17.4
4.6
0.2
3.4
0.1
6.6
2.9
2.3
18.9
1.9
9.3
0.0
0.2
1.2
0.1
0.0
4.1
0.1
0.9
0.0
1.4
35.1
63.8
33.2
72.1
31.0
100.0
100.0
100.0
100.0
100.0
3,416
5,443
5,442
6,504
4,947
61.2
56.3
34.7
49.7
35.4
52.1
48.5
27.0
43.2
24.6
45.8
10.2
16.4
20.1
15.7
5.0
37.3
10.1
15.2
8.7
1.2
1.0
0.5
7.8
0.3
27.2
3.1
4.6
4.1
1.6
0.7
1.7
0.8
1.3
2.3
11.2
0.1
1.2
9.2
2.8
1.1
0.0
0.5
1.2
0.1
5.5
5.2
9.3
4.3
8.8
0.0
0.0
0.0
0.0
0.1
9.2
7.8
7.8
6.5
10.8
6.9
4.9
3.4
1.1
0.7
1.9
2.5
4.2
5.4
8.5
0.0
0.0
0.0
0.0
1.5
0.4
0.3
0.1
0.0
0.1
38.8
43.7
65.3
50.3
64.6
100.0
100.0
100.0
100.0
100.0
16,635
93,089
6,500
9,608
12,937
50.5
61.9
48.6
78.5
34.9
57.8
32.8
56.7
32.4
54.5
22.3
50.3
2.4
3.2
10.4
5.9
0.0
0.2
0.1
0.5
15.4
13.6
13.1
6.3
3.1
3.9
4.1
37.7
10.4
31.9
3.0
0.4
0.4
3.3
0.0
0.0
2.7
1.8
1.9
5.8
0.4
0.0
0.2
0.0
15.7
4.1
15.7
21.8
3.9
1.3
6.7
7.5
11.7
2.3
8.2
14.3
0.0
0.0
0.3
0.0
0.1
0.4
0.6
0.1
49.5
38.1
51.4
21.5
100.0
100.0
100.0
100.0
11,626
33,465
8,773
5,338
45.5
75.3
77.1
67.6
38.2
71.3
46.8
74.5
17.7
69.2
71.2
63.0
30.9
62.2
33.7
51.7
13.2
30.7
39.6
20.4
13.5
40.9
27.0
43.9
4.4
36.2
29.1
42.5
16.6
21.0
6.7
7.3
0.0
2.3
2.6
0.1
0.8
0.3
0.0
0.4
2.9
22.0
8.5
13.1
5.1
11.5
12.7
9.2
7.8
1.1
6.9
2.4
2.2
6.6
5.2
2.6
0.8
1.5
10.3
2.0
3.9
17.2
5.8
17.2
0.0
0.0
3.5
0.5
0.0
0.0
0.0
0.0
1.5
6.0
10.2
2.4
2.3
5.6
2.5
14.5
0.1
0.1
0.1
0.0
0.0
0.1
0.7
0.5
27.8
6.1
5.9
4.5
7.2
9.2
13.1
22.9
22.4
2.9
2.1
1.5
5.6
2.8
5.5
14.5
1.7
3.0
3.4
1.8
1.5
6.2
2.7
7.4
0.0
0.0
0.1
0.4
0.0
0.0
0.0
0.1
3.7
0.3
0.3
0.8
0.1
0.1
5.0
1.0
54.5
24.7
22.9
32.4
61.8
28.7
53.2
25.5
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
5,627
8,886
36,648
16,368
4,041
14,677
4,031
16,113
*The diaphragm, female condom, foam/jelly/spermicides, (in Burkina Faso, Ethiopia, Honduras, Nigeria, Pakistan, the Philippines and Rwanda); emergency contraception (Peru and the Philippines); Fertility wheel calculator (Armenia); and Mucus/Billings/Basal body/Symptothermal
method (the Philippines). †Sum of any modern method, any traditional method and not using a method. Notes : Denominator is women who are currently married and/or had sex in the past 3 months. For surveys among ever-married women (indicated by "na" in Table 2), the
denominator is married women.
45
Guttmacher Institute
3
46
TABLE 4. Percentages and percent distributions according to contraceptive method among married or sexually active current contraceptive users 15–49, in 43 countries, 1990–2013
Modern methods
Any reversible
modern
method
(excludes
Any modern
Female
Male
method sterilization) sterilization sterilization
Guttmacher Institute
Subregion, country and survey
year
Eastern Africa
Burundi 2010
Comoros 2012
Ethiopia 2005
Kenya 2003
Malawi 2004
Mozambique 2011
Rwanda 2010
Tanzania 2004–05
Uganda 2011
Zimbabwe 2010–11
Western Africa
Benin 2011–12
Burkina Faso 2010
Niger 2012
Nigeria 2013
Senegal 2010–11
Northern Africa and Western Asia
Armenia 2010
Azerbaijan 2006
Egypt 2008
Jordan 2012
Morocco 2003–04
Turkey 2003
Eastern Europe and Central Asia
Kazakhstan 1999
Kyrgyz Republic 2012
Moldova 2005
Tajikistan 2012
Ukraine 2007
Southern Asia
Bangladesh 2011
India 2005–06
Maldives 2009
Nepal 2011
Pakistan 2012–13
Southeastern Asia
Cambodia 2010
Indonesia 2012
Philippines 2003
Viet Nam 2002
Latin America and the Caribbean
Bolivia 1994
Brazil 1996
Colombia 2010
Dominican Republic 2002
Guatemala 1998–99
Honduras 2011–12
Paraguay 1990
Peru 2012
Pill
Traditional methods
IUD Injectables Implants
Male
condom
Other
modern
methods*
Any traditional
method
Periodic
abstinence
Withdrawal
Lactational
Amenorrhea
Method
Other
traditional
methods
Total†
Number of sexually
active contraceptive
users
81.6
67.6
92.8
80.3
87.0
96.9
87.1
76.3
86.5
97.6
79.0
63.7
91.7
70.3
69.6
95.5
85.4
67.5
77.9
95.8
2.6
3.9
1.1
10.1
17.3
1.4
1.6
8.7
8.4
1.9
0.0
0.0
0.0
0.0
0.1
0.0
0.1
0.1
0.2
0.0
11.0
14.8
20.6
18.1
6.1
35.4
13.6
21.3
9.4
67.5
12.4
0.3
1.4
5.7
0.4
1.2
0.9
0.6
1.6
0.3
47.2
27.0
66.3
36.4
55.0
34.8
50.9
31.1
45.2
14.3
2.7
7.6
1.2
4.1
1.4
0.1
12.2
1.8
8.1
4.7
5.5
14.1
2.2
5.9
6.7
23.3
6.5
12.7
13.6
8.3
0.2
0.1
0.0
0.1
0.0
0.8
1.2
0.0
0.0
0.6
18.4
32.4
7.2
19.7
13.0
3.1
12.9
23.7
13.5
2.4
8.3
16.5
4.3
16.1
1.5
0.7
5.4
8.1
4.6
0.1
10.1
11.6
1.7
1.6
6.3
0.5
6.5
9.7
6.7
1.6
0.1
3.9
1.2
0.0
0.0
1.1
0.9
1.6
0.5
0.3
0.0
0.5
0.0
1.9
5.2
0.9
0.1
4.3
1.6
0.3
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
1,228
702
1,372
2,187
2,843
1,591
3,747
2,232
1,923
3,614
61.3
93.2
60.1
67.1
91.0
60.4
92.2
59.2
65.4
89.3
0.9
0.9
1.0
1.7
1.7
0.0
0.0
0.0
0.0
0.0
10.1
18.4
40.1
12.0
30.4
3.2
1.5
0.5
5.4
4.5
13.4
34.0
15.5
16.1
39.0
6.1
18.8
2.2
1.9
8.9
22.7
19.0
0.7
26.6
6.2
4.9
0.6
0.3
3.3
0.3
38.7
6.8
39.9
32.9
9.0
21.6
5.7
0.7
12.7
2.6
5.7
0.4
0.1
14.0
1.6
2.7
0.4
27.8
2.1
1.2
8.6
0.3
11.3
4.1
3.6
100.0
100.0
100.0
100.0
100.0
2,008
2,541
1,388
5,875
1,427
48.2
25.7
95.5
67.0
82.5
59.8
47.7
24.9
93.9
63.4
78.2
51.7
0.4
0.8
1.7
3.6
4.4
7.9
0.0
0.0
0.0
0.0
0.0
0.1
2.8
2.2
19.7
13.3
63.6
6.9
17.4
17.9
59.9
34.8
8.5
29.1
0.0
0.0
12.3
1.5
3.4
0.5
0.0
0.0
0.8
0.5
0.0
0.0
26.5
4.3
1.2
12.9
2.4
14.3
1.0
0.4
0.0
0.3
0.2
1.0
51.8
74.3
4.5
33.0
17.5
40.2
4.4
7.9
0.7
5.8
6.0
1.5
44.6
63.6
0.4
23.4
7.0
37.4
1.4
2.2
0.0
2.2
4.5
0.9
1.4
0.6
3.3
1.6
0.1
0.5
100.0
100.0
100.0
100.0
100.0
100.0
1,990
2,694
9,282
6,607
5,531
2,818
82.3
92.2
63.5
92.2
74.8
78.4
87.8
56.8
90.1
74.0
3.9
4.3
6.6
2.1
0.9
0.0
0.0
0.0
0.0
0.0
4.6
4.5
5.6
8.2
7.3
61.5
59.6
35.4
66.4
23.7
0.9
1.3
0.1
7.1
0.0
0.0
0.0
0.0
0.2
0.0
8.5
22.2
13.4
8.0
41.6
2.9
0.2
2.4
0.1
1.3
17.7
7.8
36.5
7.8
25.2
7.0
0.7
5.1
0.4
9.6
4.4
6.4
28.4
6.9
13.5
0.0
0.6
1.7
0.3
0.0
6.2
0.1
1.3
0.1
2.1
100.0
100.0
100.0
100.0
100.0
2,219
1,972
3,635
1,816
3,412
85.0
86.2
77.7
86.8
69.4
74.9
18.1
47.4
40.5
44.2
8.1
66.2
29.0
30.5
24.4
2.0
1.8
1.3
15.8
0.7
44.5
5.5
13.4
8.3
4.5
1.2
3.1
2.4
2.6
6.5
18.3
0.2
3.5
18.5
7.8
1.9
0.0
1.4
2.4
0.2
9.0
9.3
26.7
8.7
24.9
0.0
0.1
0.0
0.0
0.4
15.0
13.8
22.3
13.2
30.6
11.3
8.8
9.9
2.3
1.9
3.0
4.5
12.2
10.8
24.1
0.0
0.0
0.0
0.0
4.3
0.6
0.6
0.3
0.1
0.3
100.0
100.0
100.0
100.0
100.0
10,183
52,438
2,258
4,774
4,581
69.0
93.5
67.6
72.2
64.2
88.0
46.0
64.0
4.7
5.2
21.4
7.6
0.1
0.3
0.3
0.6
30.4
21.9
26.9
8.0
6.1
6.3
8.4
48.1
20.6
51.6
6.3
0.5
0.9
5.4
0.0
0.0
5.4
2.8
4.0
7.4
0.8
0.0
0.4
0.0
31.0
6.5
32.4
27.8
7.7
2.1
13.8
9.5
23.2
3.7
16.8
18.2
0.0
0.1
0.6
0.0
0.1
0.6
1.2
0.1
100.0
100.0
100.0
100.0
5,876
20,704
4,261
4,192
38.9
91.8
92.4
93.3
81.1
87.2
72.0
69.3
29.1
40.7
51.3
30.2
35.4
57.3
57.6
59.0
9.7
48.1
37.7
62.9
43.6
29.5
14.4
9.8
0.1
3.0
3.4
0.2
2.0
0.4
0.1
0.6
6.4
29.2
11.1
19.4
13.4
16.1
27.2
12.3
17.3
1.5
9.0
3.5
5.6
9.2
11.1
3.5
1.7
2.0
13.3
3.0
10.2
24.1
12.4
23.0
0.1
0.0
4.6
0.7
0.0
0.0
0.0
0.1
3.4
7.9
13.2
3.5
6.1
7.8
5.4
19.4
0.3
0.1
0.1
0.0
0.1
0.1
1.5
0.6
61.1
8.2
7.6
6.7
18.9
12.8
28.0
30.7
49.3
3.8
2.7
2.2
14.7
3.9
11.7
19.4
3.7
4.0
4.4
2.7
3.9
8.8
5.7
9.9
0.0
0.0
0.2
0.5
0.0
0.0
0.0
0.1
8.1
0.4
0.4
1.2
0.4
0.2
10.6
1.3
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
2,558
6,691
28,262
11,059
1,542
10,470
1,887
12,007
*The diaphragm, female condom, foam/jelly/spermicides, (in Burkina Faso, Ethiopia, Honduras, Nigeria, Pakistan, the Philippines and Rwanda); emergency contraception (Peru and the Philippines); Fertility wheel calculator (Armenia); and Mucus/Billings/Basal
body/Symptothermal method (the Philippines). †Sum of any modern method and any traditional method. Note: Denominator is women who are married and/or had sex in the past 3 months and are using contraception. In surveys that included only ever-married women
(those indicated by "na" in Table 2), the denominator is married women using contraception.
4
Guttmacher Institute
TABLE 5. Twelve-month contraceptive failure rates by method, for each country's most recent survey with calendar data, 43 countries, 1990–2013
Modern method failure rates, no. of failures per 100 episodes of use
Subregion, country and survey year
Eastern Africa
Burundi 2010
Comoros 2012
Ethiopia 2005
Kenya 2003
Malawi 2004
Mozambique 2011
Rwanda 2010
Tanzania 2004–05
Uganda 2011
Zimbabwe 2010–11
Western Africa
Benin 2011–12
Burkina Faso 2010
Niger 2012
Nigeria 2013
Senegal 2010–11
Northern Africa and Western Asia
Armenia 2010
Azerbaijan 2006
Egypt 2008
Jordan 2012
Morocco 2003–04
Turkey 2003
Eastern Europe and Central Asia
Kazakhstan 1999
Kyrgyz Republic 2012
Moldova 2005
Tajikistan 2012
Ukraine 2007
Southern Asia
Bangladesh 2011
India 2005–06
Maldives 2009
Nepal 2011
Pakistan 2012–13
Southeastern Asia
Cambodia 2010
Indonesia 2012
Philippines 2003
Viet Nam 2002
Latin America and the Caribbean
Bolivia 1994
Brazil 1996
Colombia 2010
Dominican Republic 2002
Guatemala 1998–99
Honduras 2011–12
Paraguay 1990
Peru 2012
Summary statistics
Averages
Medians†
Minimum
Maximum
Pill 95% CI (–/+)
IUD 95% CI (–/+)
Injectables 95% CI (–/+)
Implants
Traditional method failure rates, no. of failures per 100 episodes of use
Male
condom
95% CI (–/+)
95% CI (–/+)
Periodic
abstinence
Withdrawal
95% CI (–/+)
95% CI (–/+)
11.8
(2.1)
4.4
5.8
9.3
4.3
5.3
5.1
12.6
2.8
5.9
0.0
1.8
3.7
5.1
2.8
3.4
3.2
7.8
2.1
17.6
5.0
7.0
7.8
13.4
5.8
7.2
7.0
17.3
3.6
(4.1)
*
*
*
*
*
*
*
*
*
0.0
*
*
*
*
*
*
*
*
*
10.4
*
*
*
*
*
*
*
*
*
2.2
(1.6)
0.3
1.1
1.7
1.7
1.4
1.1
4.4
1.7
0.9
0.0
0.0
0.4
0.9
0.5
0.9
0.3
3.1
0.6
3.5
4.1
0.7
1.8
2.5
2.9
1.9
2.0
5.7
2.9
*
*
*
*
*
*
0.3
*
(0.8)
(0.3)
*
*
*
*
*
*
0.0
*
0.0
0.0
*
*
*
*
*
*
1.0
*
2.4
0.9
(2.7)
*
(1.9)
6.5
5.1
2.8
5.9
2.5
5.4
2.3
0.0
*
0.0
1.8
1.3
1.2
2.4
0.6
2.1
0.9
6.7
*
4.6
11.2
9.0
4.4
9.5
4.3
8.7
3.7
(19.2)
(8.0)
(6.2)
17.3
*
*
13.7
6.7
(10.4)
*
11.0
0.0
0.0
13.5
*
*
9.0
2.8
0.8
*
27.5
16.0
12.5
21.1
*
*
18.3
10.6
20.0
*
(21.4)
*
*
*
12.4
*
15.1
12.8
(25.4)
*
9.0
*
*
*
9.1
*
10.0
8.5
17.7
*
33.8
*
*
*
15.8
*
20.2
17.1
33.1
*
5.2
2.1
1.2
5.9
7.7
2.1
0.9
0.4
4.0
3.9
8.3
3.3
2.1
7.7
11.6
*
*
*
1.0
*
*
*
*
0.0
*
*
*
*
2.4
*
2.3
0.3
0.2
1.9
1.4
0.1
0.0
0.0
0.9
0.4
4.5
0.6
0.6
2.9
2.4
(3.7)
0.0
*
*
(1.1)
0.4
*
*
*
0.0
7.1
*
*
*
3.3
2.2
1.8
*
2.1
(3.8)
0.8
0.0
*
1.3
0.0
3.7
3.8
*
3.0
7.7
6.0
(11.2)
*
6.9
*
3.0
4.9
*
4.4
*
8.9
17.5
*
9.4
*
(10.8)
*
*
7.7
*
5.1
*
*
5.5
*
16.5
*
*
10.0
*
*
*
7.9
8.0
5.2
7.8
*
*
*
*
6.5
9.2
9.8
6.3
4.5
5.9
4.6 11.0
(0.0)
0.9
1.0
1.6
1.4
1.6
*
0.0
0.6
0.8
0.3
0.7
*
1.9
1.3
2.4
2.5
2.5
*
*
1.1
2.8
1.5
(5.3)
*
*
0.5
0.0
0.1
0.8
*
*
1.8
6.2
3.0
9.8
*
*
(1.9)
*
*
*
*
*
0.0
*
*
*
*
*
4.8
*
*
*
3.2
(12.3)
(9.5)
13.8
(4.2)
7.6
1.2
4.3
3.0
10.8
1.0
5.6
5.2
20.3
16.0
16.8
7.3
9.6
*
(14.4)
*
22.9
22.8
(23.6)
*
6.4
*
16.1
18.5
14.1
*
22.4
*
29.7
27.0
33.1
15.3
19.6
*
15.3
11.2
15.9
11.3
16.2
*
12.6
8.0
13.9
19.4
22.9
*
17.9
14.5
18.0
15.3
(12.9)
7.2
(6.2)
2.6
9.7
0.0
4.1
0.9
0.7
20.9
26.3
10.3
11.5
4.5
3.2
0.3
1.3
0.4
0.5
1.3
0.0
0.5
0.0
0.0
5.0
0.7
2.1
0.9
1.4
*
*
*
(0.0)
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
14.6
12.8
6.5
6.0
3.3
10.5
7.8
4.1
2.3
2.0
18.7
17.7
8.9
9.8
4.6
24.1
*
(13.2)
*
9.3
15.3
*
7.9
*
5.5
32.9
*
18.5
*
13.0
(24.8)
(7.0)
14.8
(7.1)
9.3
18.0
2.0
12.0
1.5
6.2
31.6
12.1
17.5
12.7
12.4
5.5
3.6
3.6
6.0
10.0
4.7
2.7
0.0
3.5
5.2
6.3
4.4
7.1
8.5
14.9
(1.8)
1.0
*
*
1.6
0.0
0.4
*
*
0.0
3.8
1.7
*
*
3.4
1.5
(6.1)
(0.3)
0.8
2.7
0.8
1.1
0.0
0.3
1.0
(1.2)
*
*
*
*
0.0
*
*
*
*
3.4
*
*
*
*
10.1
4.6
5.4
7.2
8.9
7.9
3.7
3.4
4.2
6.8
12.4
5.5
7.4
10.2
11.1
5.8
8.9
(3.9)
*
*
4.2
7.5
0.4
*
*
7.4
10.2
7.3
*
*
9.2
8.4
7.3
10.7
10.1
5.3
6.5
3.9
7.2
7.5
13.1
10.2
10.6
14.2
12.7
2.6
4.2
4.8
7.1
1.6
3.2
3.6
4.0
3.6
5.2
6.0
10.2
0.3
0.2
0.6
2.1
0.0
0.0
0.0
1.0
1.0
0.4
1.5
3.3
1.8
0.5
1.9
*
0.7
0.3
0.5
*
*
0.2
*
*
*
0.0
*
*
*
0.4
*
*
4.2
2.3
10.9
9.8
0.7
0.7
6.6
5.8
7.6
4.0
15.2
13.8
3.9
4.9
14.1
16.5
1.4
2.5
11.0
11.3
6.3
7.4
17.2
21.7
8.1
6.0
20.4
15.0
5.7
2.9
17.5
12.0
10.5
9.2
23.2
18.0
7.4
6.5
6.4
9.4
3.3
4.4
4.6
4.2
4.3
5.3
5.5
8.3
0.3
3.3
2.7
3.2
10.5
7.6
7.3
10.6
6.2
5.4
6.4
5.2
1.7
*
3.0
2.3
*
3.0
(2.4)
0.2
0.2
*
2.1
1.0
*
1.7
0.0
0.0
3.2
*
4.0
3.7
*
4.4
4.8
0.7
(8.3)
8.0
5.0
8.2
5.0
2.1
13.6
1.3
0.7
3.5
4.2
4.5
0.4
1.6
9.3
0.8
15.9
12.4
5.7
11.9
9.7
2.6
17.8
1.7
*
*
0.2
*
*
*
*
*
*
*
0.0
*
*
*
*
*
*
*
0.5
*
*
*
*
*
(9.5)
8.1
5.5
4.8
(3.7)
2.7
8.9
9.0
2.9
5.7
4.6
2.2
0.0
1.7
3.3
7.6
16.2
10.4
6.3
7.4
8.1
3.8
14.4
10.5
22.2
23.7
20.2
23.0
20.4
12.3
23.9
18.8
19.8
18.7
17.2
18.3
10.3
9.4
18.3
16.9
24.5
28.7
23.1
27.6
30.5
15.3
29.5
20.6
21.2
24.0
15.0
19.9
*
11.9
(13.3)
18.7
14.0
18.8
13.0
15.0
*
9.8
6.4
16.0
28.4
29.3
16.9
24.8
*
14.0
20.3
21.4
6.15
5.50
1.2
15.3
na
3.5
na
na
na
7.3
na
na
1.46
1.37
0.0
4.1
na
0.0
na
na
na
2.4
na
na
2.81
1.71
0.0
13.6
na
0.6
na
na
na
2.9
na
na
na
0.0
na
na
na
2.4
na
na
6.21
5.40
1.8
14.6
na
2.3
na
na
na
8.7
na
na
14.32
13.89
3.9
24.1
na
9.2
na
na
na
19.2
na
na
14.10
13.35
6.0
25.4
na
9.1
na
na
na
17.1
na
na
2.1
11.1
1.0
1.4
4.4
2.9
0.7
3.2
*
0.98
0.57
0.0
3.7
*Not reported because there were fewer than 125 episodes of use for that method. †Median CIs are calculated as a median of all CIs. Notes : CI=confidence interval. na=not applicable. Failure rates were calculated with the single-decrement approach.
Values in parentheses indicate calculations were based on 125–249 episodes of use for that method.
47
Guttmacher Institute
5
48
TABLE 6. Twelve-, 24- and 36-month contraceptive failure rates, by method, for each country's most recent survey with calendar data, 43 countries, 1990–2013
Subregion, country and survey year
Eastern Africa
Burundi 2010
Comoros 2012
Ethiopia 2005
Kenya 2003
Malawi 2004
Mozambique 2011
Rwanda 2010
Tanzania 2004–05
Uganda 2011
Zimbabwe 2010–11
Western Africa
Benin 2011–12
Burkina Faso 2010
Niger 2012
Nigeria 2013
Senegal 2010–11
Northern Africa and Western Asia
Armenia 2010
Azerbaijan 2006
Egypt 2008
Jordan 2012
Morocco 2003–04
Turkey 2003
Eastern Europe and Central Asia
Kazakhstan 1999
Kyrgyz Republic 2012
Moldova 2005
Tajikistan 2012
Ukraine 2007
Southern Asia
Bangladesh 2011
India 2005–06
Maldives 2009
Nepal 2011
Pakistan 2012–13
Southeastern Asia
Cambodia 2010
Indonesia 2012
Philippines 2003
Viet Nam 2002
Latin America and the Caribbean
Bolivia 1994
Brazil 1996
Colombia 2010
Dominican Republic 2002
Guatemala 1998–99
Honduras 2011–12
Paraguay 1990
Peru 2012
Guttmacher Institute
Summary statistics
Averages
Medians
Minimum
Maximum
Modern method failure rates, no. of failures per 100 episodes of use
IUD
Injectables
Implants
24 month 36 month 12 month 24 month 36 month 12 month 24 month
12 month
36 month
12 month
11.8
(2.1)
4.4
5.8
9.3
4.3
5.3
5.1
12.6
2.8
26.3
(11.6)
9.4
11.9
14.9
7.6
13.1
9.8
18.2
8.1
48.3
(18.5)
14.8
15.5
16.7
14.9
19.2
13.4
20.7
12.5
(4.1)
*
*
*
*
*
*
*
*
*
(8.9)
*
*
*
*
*
*
*
*
*
(8.9)
*
*
*
*
*
*
*
*
*
2.2
(1.6)
0.3
1.1
1.7
1.7
1.4
1.1
4.4
1.7
4.1
(5.0)
1.4
2.7
4.7
1.7
3.1
2.0
8.3
3.1
6.8
(7.0)
3.2
5.5
7.8
3.5
5.1
4.1
9.5
5.1
*
*
*
*
*
*
0.3
*
(0.8)
(0.3)
*
*
*
*
*
*
0.3
*
(1.2)
(0.3)
*
*
*
*
*
*
0.3
*
(6.4)
(0.3)
(2.7)
*
(1.9)
6.5
5.1
2.8
5.9
2.5
5.4
2.3
(2.7)
*
(13.3)
13.7
16.7
5.3
10.3
8.0
14.0
5.1
(9.2)
*
(23.8)
24.3
26.6
6.8
11.8
13.3
16.4
6.6
(19.2)
(8.0)
(6.2)
17.3
*
*
13.7
6.7
(10.4)
*
(27.3)
(8.4)
(19.9)
36.2
*
*
24.2
22.8
(20.4)
*
(32.3)
(9.7)
(22.7)
48.1
*
*
32.5
31.5
(24.9)
*
(21.4)
*
*
*
12.4
*
15.1
12.8
(25.4)
*
(39.1)
*
*
*
40.1
*
27.4
33.0
(39.9)
*
(51.3)
*
*
*
51.8
*
33.9
51.9
(42.8)
*
5.2
2.1
1.2
5.9
7.7
6.1
4.0
4.6
9.6
11.6
9.6
7.2
6.8
15.1
14.0
*
*
*
1.0
*
*
*
*
1.0
*
*
*
*
1.0
*
2.3
0.3
0.2
1.9
1.4
4.1
0.9
1.8
5.5
1.4
4.1
0.9
1.8
7.9
1.8
(3.7)
0.0
*
*
(1.1)
(3.7)
0.0
*
*
(1.1)
(5.8)
0.0
*
*
(1.1)
2.2
1.8
*
2.1
(3.8)
3.0
3.1
*
4.8
(18.0)
5.6
4.0
*
6.3
(18.0)
6.0
(11.2)
*
6.9
*
10.3
(20.2)
*
12.4
*
13.0
(21.7)
*
15.4
*
(10.8)
*
*
7.7
*
(18.4)
*
*
20.3
*
(19.5)
*
*
27.2
*
*
*
7.9
8.0
5.2
7.8
*
*
15.0
16.9
11.3
13.2
*
*
19.1
22.3
15.5
15.8
(0.0)
0.9
1.0
1.6
1.4
1.6
(0.0)
1.3
2.4
3.3
1.8
2.3
(0.8)
1.5
3.5
4.6
1.8
2.4
*
*
1.1
2.8
1.5
(5.3)
*
*
1.8
6.2
2.3
(7.7)
*
*
2.4
6.2
2.3
(32.0)
*
*
(1.9)
*
*
*
*
*
(3.0)
*
*
*
*
*
(3.0)
*
*
*
3.2
(12.3)
(9.5)
13.8
(4.2)
7.6
8.1
(17.8)
(16.1)
24.3
(12.8)
15.4
11.6
(35.9)
(16.1)
39.3
(14.3)
20.5
*
(14.4)
*
22.9
22.8
(23.6)
*
(35.6)
*
30.0
36.5
(30.7)
*
(41.5)
*
34.7
45.1
(33.5)
15.3
19.6
*
15.3
11.2
15.9
30.0
34.9
*
26.9
19.6
28.7
36.6
43.7
*
37.2
32.3
36.2
15.3
(12.9)
7.2
(6.2)
2.6
24.4
(18.6)
15.2
(9.8)
4.2
26.9
(20.5)
19.8
(13.2)
4.9
3.2
0.3
1.3
0.4
0.5
5.6
1.9
2.6
1.3
1.1
6.1
3.4
4.0
1.7
1.1
*
*
*
(0.0)
*
*
*
*
(0.4)
*
*
*
*
(5.6)
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
14.6
12.8
6.5
6.0
3.3
27.0
23.0
13.2
12.5
5.2
41.2
29.1
20.4
13.1
8.1
24.1
*
(13.2)
*
9.3
39.3
*
(24.2)
*
14.7
48.1
*
(32.1)
*
19.0
(24.8)
(7.0)
14.8
(7.1)
9.3
(40.1)
(23.2)
29.7
(15.2)
15.6
(40.1)
(34.9)
39.7
(24.2)
23.9
5.5
3.6
3.6
6.0
10.0
10.4
5.9
7.2
10.9
14.7
15.7
8.4
10.7
16.4
24.3
(1.8)
1.0
*
*
1.6
(1.8)
1.7
*
*
2.2
(1.8)
1.9
*
*
5.2
1.5
(6.1)
(0.3)
0.8
2.7
3.1
(10.8)
(0.3)
1.6
7.2
4.2
(10.8)
(0.3)
2.0
11.3
(1.2)
*
*
*
*
(1.2)
*
*
*
*
(1.2)
*
*
*
*
10.1
4.6
5.4
7.2
8.9
17.8
7.7
10.9
14.8
16.4
22.2
9.7
15.3
19.8
22.6
5.8
8.9
(3.9)
*
*
15.4
18.4
(9.5)
*
*
21.1
24.9
(11.2)
*
*
9.2
8.4
7.3
10.7
10.1
19.9
14.8
14.9
16.7
17.0
25.7
22.4
19.4
25.0
24.6
2.6
4.2
4.8
7.1
4.1
7.1
9.0
12.4
6.7
9.9
12.0
16.5
0.3
0.2
0.6
2.1
0.3
0.7
0.6
4.1
0.3
1.7
0.6
5.2
1.8
0.5
1.9
*
3.2
1.4
4.2
*
4.9
2.7
5.4
*
*
0.2
*
*
*
0.9
*
*
*
1.1
*
*
4.2
2.3
10.9
9.8
14.7
4.2
17.3
17.1
16.0
9.9
27.4
19.6
3.9
4.9
14.1
16.5
10.6
13.3
28.3
27.9
19.9
23.3
34.6
39.9
8.1
6.0
20.4
15.0
17.0
14.0
38.7
28.3
23.2
21.8
47.5
38.1
7.4
6.5
6.4
9.4
3.3
4.4
4.6
4.2
15.8
12.1
10.8
18.7
5.0
7.1
8.7
6.8
21.9
15.7
14.2
23.9
7.5
9.1
13.3
9.2
1.7
*
3.0
2.3
*
3.0
(2.4)
0.2
1.9
*
5.1
3.7
*
5.5
(4.3)
1.4
1.9
*
6.6
3.7
*
6.5
(5.9)
1.7
(8.3)
8.0
5.0
8.2
5.0
2.1
13.6
1.3
(15.0)
10.8
9.5
10.9
5.3
4.5
17.0
2.3
(15.0)
19.3
13.1
15.0
8.0
6.0
21.2
3.6
*
*
0.2
*
*
*
*
*
*
*
0.2
*
*
*
*
*
*
*
0.2
*
*
*
*
*
(9.5)
8.1
5.5
4.8
(3.7)
2.7
8.9
9.0
(9.5)
15.2
10.0
7.6
(13.3)
5.4
13.3
13.5
(15.9)
21.0
13.2
13.1
(13.9)
10.0
22.0
18.3
22.2
23.7
20.2
23.0
20.4
12.3
23.9
18.8
41.3
35.6
30.0
38.0
33.9
18.2
44.7
28.3
48.3
43.4
37.3
50.8
46.6
25.1
48.5
34.9
21.2
24.0
15.0
19.9
*
11.9
(13.3)
18.7
39.6
41.9
30.0
35.0
*
22.0
(21.4)
29.9
50.4
51.0
36.5
43.8
*
26.8
(32.3)
35.7
6.15
5.50
1.2
15.3
11.27
10.78
4.0
26.3
15.63
15.11
4.9
48.3
1.46
1.37
0.0
4.1
2.56
1.88
0.0
8.9
3.23
2.14
0.3
8.9
2.81
1.71
0.0
13.6
4.87
3.61
0.3
17.0
7.39
5.47
0.3
32.0
6.21
5.40
1.8
14.6
12.25
13.30
2.7
27.0
17.37
15.95
4.0
41.2
14.32
13.89
3.9
24.1
25.21
25.78
8.4
44.7
31.73
32.38
9.7
50.8
14.10
13.35
6.0
25.4
26.77
27.37
14.0
41.9
34.89
35.67
19.4
51.9
0.98
0.57
0.0
3.7
1.19
1.01
0.0
3.7
36 month
1.94
1.12
0.0
6.4
Male condom
12 month 24 month 36 month
Traditional method failure rates, no. of failures per 100 episodes of use
Periodic abstinence
Withdrawal
12 month 24 month 36 month 12 month 24 month 36 month
Pill
24 month
*Not reported because there were fewer than 125 episodes of use for that method. Notes : Failure rates were calculated with the single-decrement approach. Values in parentheses indicate calculations were based on 125–249 episodes of use for that method.
6
Guttmacher Institute
TABLE 7. Contraceptive failure rates by method, median across 43 countries, for each country’s most
recent DHS survey with calendar data, 43 countries, 1990–2013
Method
Median failure rate* during:
First year of use
(12 months)
Second year
of use
(24 months)
Differences in rates:
Third year
of use
(36 months)
24 vs.
12 mos.
36 vs.
24 mos.
36 vs.
12 mos.
Implants
0.6
1.0
1.1
0.4
0.1
0.5
IUD
1.4
1.9
2.1
0.5
0.2
0.7
Injectables
1.7
3.6
5.5
1.9
1.9
3.8
Pill
5.5
10.8
15.1
5.3
4.3
9.6
Male condom
5.4
13.3
16.0
7.9
2.7
10.6
Withdrawal
13.4
27.4
35.7
14.0
8.3
22.3
Periodic abstinence
13.9
25.8
32.4
11.9
6.6
18.5
*Number of failures per 100 episodes of use.
49
50
TABLE 8. Twelve-, 24- and 36-month contraceptive failure rates, all countries and by subregion, pooled estimates, 43 countries, 1990–2013
Method
Pill
IUD
Implants
Injectables
Male condom
Periodic abstinence
Withdrawal
Period
12 month
24 month
36 month
12 month
24 month
36 month
12 month
24 month
36 month
12 month
24 month
36 month
12 month
24 month
36 month
12 month
24 month
36 month
12 month
24 month
36 month
All-country pooled estimate
Failure
rate†
95% CI (–/+)
5.7
5.4
6.0
11.0
10.5
11.5
15.1
14.4
15.7
1.5
1.2
1.8
3.0
2.5
3.4
3.9
3.4
4.4
0.6
0.3
0.9
0.8
0.4
1.1
1.1
0.5
1.6
2.3
2.0
2.5
4.1
3.8
4.4
6.0
5.5
6.5
6.8
6.3
7.3
12.6
11.8
13.4
17.6
16.4
18.8
16.4
15.5
17.3
28.9
27.6
30.2
36.3
34.7
37.8
14.9
14.1
15.6
27.5
26.5
28.5
35.7
34.5
37.0
Eastern Africa
Failure
rate†
95% CI (–/+)
4.7
4.1
5.4
10.3
9.2
11.3
14.8
13.4
16.1
1.2
0.0
2.9
4.3
1.1
7.6
7.9
2.3
13.6
0.6
0.0
1.1
0.6
0.1
1.2
1.2
0.0
2.3
1.9
1.5
2.2
4.0
3.4
4.6
6.2
5.2
7.2
3.5
2.6
4.4
8.5
6.6
10.3
11.9
9.1
14.7
13.0
10.9
15.2
26.5
23.0
29.9
34.6
30.4
38.9
14.6
12.3
16.8
32.6
28.8
36.3
41.0
36.1
45.9
Subregion
Northern Africa and Western
Western Africa
Asia
Failure
Failure
rate†
rate†
95% CI (–/+)
95% CI (–/+)
3.6
2.6
4.6
7.0
6.3
7.7
6.6
5.2
8.0
13.9
12.6
15.3
9.7
7.5
11.9
18.4
16.7
20.0
0.9
0.0
2.0
1.2
0.9
1.6
0.9
0.0
2.0
2.4
1.9
2.9
2.7
0.0
6.5
3.2
2.4
4.0
0.9
0.2
1.7
(1.3)
0.0
3.4
0.9
0.2
1.7
(2.1)
0.0
4.7
1.2
0.3
2.1
(2.1)
0.0
4.7
1.0
0.6
1.4
1.8
1.0
2.6
2.2
1.5
2.9
2.9
1.7
4.0
2.8
1.9
3.8
4.0
2.2
5.8
2.2
1.5
3.0
8.7
7.3
10.2
4.8
3.1
6.5
16.4
14.1
18.7
6.2
4.3
8.2
24.1
20.0
28.1
8.1
5.8
10.3
20.3
17.1
23.5
13.7
10.5
16.9
33.4
28.9
37.8
17.5
13.6
21.5
40.9
35.9
45.9
7.8
5.8
9.9
16.4
15.0
17.7
19.4
15.2
23.7
29.7
27.9
31.4
24.1
19.4
28.8
38.0
35.9
40.1
Eastern Europe and Central
Asia
Failure
rate†
95% CI (–/+)
8.5
6.2
10.8
13.8
10.5
17.1
16.2
12.6
19.8
1.6
0.9
2.3
3.1
2.2
4.0
3.9
2.9
4.8
‡
‡
‡
‡
‡
‡
‡
‡
‡
3.0
0.2
5.8
3.3
0.4
6.1
9.5
1.5
17.4
7.2
5.9
8.6
12.7
10.8
14.6
17.7
15.1
20.2
16.0
11.8
20.2
26.0
20.4
31.6
32.3
26.1
38.5
13.6
11.7
15.5
25.8
22.8
28.8
34.4
31.0
37.9
*The Family Planning 2020 (FP2020) initiative launched out of the London Summit of Family Planning in 2012 identified 69 priority countries, defined as having a per capita gross national income less than or
equal to US$2,500 in 2010. Of the 43 countries in this study, 27 countries are included in this category and 15 countries that are not. Specifically, gross national income is ≤US$2,500 in Bangladesh, Benin,
Bolivia, Burkina Faso, Burundi, Cambodia, Comoros, Egypt, Ethiopia, Honduras, India, Indonesia, Kenya, Kyrgyz Republic, Malawi, Mozambique, Nepal, Niger, Nigeria, Pakistan, Philippines, Rwanda, Senegal,
Tajikistan, Tanzania, Uganda, Viet Nam and Zimbabwe. Gross national income is >US$2,500 in Armenia, Azerbaijan, Brazil, Colombia, Dominican Republic, Guatemala, Jordan, Kazakhstan, Maldives, Moldova,
Morocco, Paraguay, Peru, Turkey and Ukraine. †Number of failures per 100 episodes of use. ‡Not reported because there were fewer than 125 episodes of use for that method. Notes : Failure rates were
calculated with the single-decrement approach. Values in parentheses indicate calculations were based on 125–249 episodes of use for that method.
Guttmacher Institute
TABLE 8. Twelve-, 24- and 36-month contraceptive failure rates, all countries and by subregion, pooled estimates, 43 countries, 1990–2013
Among the 69 poorest countries according to FP2020*
Subregion
Method
Pill
IUD
Implants
Injectables
Male condom
Periodic abstinence
Withdrawal
Period
12 month
24 month
36 month
12 month
24 month
36 month
12 month
24 month
36 month
12 month
24 month
36 month
12 month
24 month
36 month
12 month
24 month
36 month
12 month
24 month
36 month
Southern Asia
Failure
rate†
95% CI (–/+)
5.5
4.7
6.3
10.1
9.0
11.2
15.2
13.7
16.8
1.2
0.3
2.0
1.6
0.6
2.6
3.2
1.1
5.2
0.5
0.0
1.4
0.5
0.0
1.4
0.5
0.0
1.4
1.4
1.0
1.8
3.1
2.3
3.9
4.3
3.1
5.5
7.4
6.4
8.5
13.9
12.1
15.7
18.7
16.3
21.1
6.1
5.0
7.1
14.2
12.2
16.2
19.2
16.7
21.7
9.4
7.9
11.0
16.6
14.3
18.9
23.4
20.3
26.5
Southeastern Asia
Failure
rate†
95% CI (–/+)
4.5
3.7
5.3
7.9
6.6
9.1
10.9
9.2
12.5
1.8
0.8
2.8
3.4
2.2
4.6
4.4
3.1
5.7
0.7
0.0
1.4
1.3
0.1
2.6
1.5
0.3
2.8
0.9
0.6
1.2
2.0
1.5
2.5
3.4
2.6
4.2
8.3
5.9
10.8
15.4
11.5
19.3
19.1
14.8
23.5
13.3
10.6
16.0
24.8
20.9
28.6
34.4
29.1
39.8
14.2
12.6
15.9
27.2
24.8
29.7
35.8
32.7
38.9
Latin America and the
Caribbean
Failure
rate†
95% CI (–/+)
6.2
5.6
6.7
11.5
10.6
12.3
15.2
13.9
16.4
2.2
1.6
2.8
4.4
3.1
5.6
5.3
3.9
6.7
0.2
0.0
0.4
0.2
0.0
0.4
0.2
0.0
0.4
4.2
3.5
4.8
6.6
5.8
7.3
8.9
7.8
10.0
6.7
6.0
7.4
11.5
10.1
12.9
16.1
14.2
18.0
20.9
19.4
22.4
35.8
33.7
37.9
43.3
40.9
45.7
17.1
15.7
18.6
29.4
27.4
31.5
37.4
34.4
40.4
Yes
Failure
rate†
5.1
9.8
14.0
1.2
2.6
3.8
0.7
0.9
1.2
1.6
3.4
5.2
6.3
12.1
16.1
14.1
27.0
34.5
12.7
25.2
33.2
95% CI (–/+)
4.7
5.4
9.2
10.4
13.2
14.7
0.9
1.5
2.1
3.1
3.2
4.4
0.4
1.1
0.5
1.3
0.6
1.8
1.4
1.8
3.1
3.8
4.6
5.7
5.5
7.0
11.0
13.3
14.6
17.6
13.1
15.2
25.4
28.6
32.5
36.5
11.8
13.6
23.8
26.6
31.3
35.0
No
Failure
rate†
6.6
12.6
16.6
1.8
3.3
4.0
0.1
0.1
0.1
4.6
6.9
9.5
7.2
12.9
18.6
19.1
31.2
38.3
16.1
28.8
37.1
95% CI (–/+)
6.1
7.1
11.7
13.4
15.5
17.7
1.3
2.3
2.6
3.9
3.2
4.8
0.0
0.3
0.0
0.3
0.0
0.3
3.9
5.4
5.9
7.8
8.1
10.9
6.5
7.8
11.8
14.0
16.9
20.4
17.5
20.7
29.0
33.4
35.9
40.8
15.1
17.1
27.5
30.2
35.5
38.7
*The Family Planning 2020 (FP2020) initiative launched out of the London Summit of Family Planning in 2012 identified 69 priority countries, defined as having a per capita gross national income less than or
equal to US$2,500 in 2010. Of the 43 countries in this study, 27 countries are included in this category and 15 countries that are not. Specifically, gross national income is ≤US$2,500 in Bangladesh, Benin,
Bolivia, Burkina Faso, Burundi, Cambodia, Comoros, Egypt, Ethiopia, Honduras, India, Indonesia, Kenya, Kyrgyz Republic, Malawi, Mozambique, Nepal, Niger, Nigeria, Pakistan, Philippines, Rwanda, Senegal,
Tajikistan, Tanzania, Uganda, Viet Nam and Zimbabwe. Gross national income is >US$2,500 in Armenia, Azerbaijan, Brazil, Colombia, Dominican Republic, Guatemala, Jordan, Kazakhstan, Maldives, Moldova,
Morocco, Paraguay, Peru, Turkey and Ukraine. †Number of failures per 100 episodes of use. ‡Not reported because there were fewer than 125 episodes of use for that method. Notes : Failure rates were
calculated with the single-decrement approach. Values in parentheses indicate calculations were based on 125–249 episodes of use for that method.
51
TABLE 9. Twelve-month failure rates by method, according to demographic and socioeconomic characteristics, for subregions (countries pooled by subregion), 43 countries, 1990–2013
Subregion
Eastern Africa
Failure
rate†
95% CI (–/+)
All countries
Method and characteristic*
Pill
Age
<25
≥25
Marital status
Never married
Ever married
Parity
0–2 children
≥3 children
Contraceptive intention
For spacing
For limiting
Wealth
Lower three quintiles
Upper two quintiles
Residence
Urban
Rural
Education
Completed primary or less
Secondary or more
IUD
Age
<25
≥25
Marital status
Never married
Ever married
Parity
0–2 children
≥3 children
Contraceptive intention
For spacing
For limiting
Wealth
Lower three quintiles
Upper two quintiles
Residence
Urban
Rural
Education
Completed primary or less
Secondary or more
Injectables
Age
<25
≥25
Marital status
Never married
Ever married
Parity
0–2 children
≥3 children
Contraceptive intention
For spacing
For limiting
Wealth
Lower three quintiles
Upper two quintiles
Residence
Urban
Rural
Education
Completed primary or less
Secondary or more
Implants
Age
<25
≥25
Marital status
Never married
Ever married
Parity
0–2 children
≥3 children
Contraceptive intention
For spacing
For limiting
Wealth
Lower three quintiles
Upper two quintiles
Residence
Urban
Rural
Education
Completed primary or less
Secondary or more
52
Guttmacher Institute
Failure rate†
95% CI (–/+)
Western Africa
Failure rate†
95% CI (–/+)
Northern Africa and Western Asia
Eastern Europe and Central Asia
Failure rate†
Failure rate†
11.4
5.6
95% CI (–/+)
8.3
4.4
7.7
4.0
8.9
4.7
6.8
3.7
5.5
3.0
8.1
4.4
3.2
3.7
1.6
2.6
4.8
4.9
9.6
4.8
6.3
5.7
5.0
5.4
7.6
6.0
9.1
4.5
4.3
3.9
14.0
5.1
1.9
3.7
0.4
2.6
3.5
4.7
‡
7.0
‡
6.3
6.2
5.0
5.8
4.5
6.6
5.5
5.3
4.1
4.4
3.2
6.1
5.0
3.8
3.4
2.2
2.2
5.5
4.6
7.7
6.3
6.0
5.4
5.6
4.9
6.4
5.8
4.7
4.8
4.0
3.7
5.5
5.9
3.5
4.1
2.4
1.7
4.6
6.5
6.5
4.9
6.1
4.4
6.9
5.3
4.6
4.9
3.7
4.0
5.4
5.8
4.1
3.4
2.7
2.1
5.9
5.5
5.5
5.1
6.3
5.9
4.6
4.8
3.7
4.0
5.6
5.6
3.7
3.4
5.6
5.9
5.2
5.5
6.0
6.3
5.0
4.4
4.2
3.5
5.9
5.3
3.2
1.1
2.4
0.9
4.1
1.4
‡
0.5
‡
0.0
6.1
1.5
0.0
1.2
12.4
1.8
‡
1.3
1.9
0.9
1.5
0.6
2.4
1.2
1.8
1.3
1.3
1.0
1.4
1.6
13.3
6.3
95% CI (–/+)
8.8
8.3
4.9
5.5
12.8
11.1
‡
7.7
(3.7)
9.1
0.0
6.5
7.4
11.7
6.6
5.3
8.8
7.3
8.0
11.0
5.6
4.9
10.3
17.0
7.5
6.5
6.5
5.4
8.5
7.6
9.5
7.5
5.7
4.8
13.3
10.2
5.4
4.6
8.2
5.2
7.3
4.1
9.2
6.2
7.8
9.0
4.1
6.0
11.4
12.0
2.2
2.3
5.2
4.5
6.6
7.6
5.6
6.7
7.6
8.6
7.6
10.4
5.2
5.4
9.9
15.5
3.2
4.6
2.2
2.2
4.2
6.9
6.6
7.4
5.7
6.3
7.6
8.5
‡
8.5
‡
6.2
‡
10.9
‡
1.1
‡
1.0
‡
0.0
‡
2.3
2.4
1.0
1.3
0.7
3.5
1.3
4.0
1.1
1.6
0.5
6.4
1.7
‡
0.0
‡
2.9
‡
0.9
‡
0.0
‡
2.1
‡
1.2
‡
0.9
‡
1.6
‡
1.5
‡
0.8
‡
2.2
(2.7)
(0.1)
0.0
0.0
6.4
0.2
‡
1.1
‡
0.0
‡
2.7
1.6
0.9
1.1
0.5
2.1
1.3
2.0
0.8
1.0
0.2
3.0
1.4
2.3
1.6
1.4
(1.0)
0.0
0.0
4.1
2.4
(0.2)
(1.6)
0.0
0.0
0.4
4.0
1.4
1.1
0.9
0.7
1.9
1.6
1.9
1.2
0.6
0.5
3.1
1.9
1.1
1.1
1.8
2.1
‡
0.6
‡
0.0
‡
1.4
‡
0.8
‡
0.0
‡
2.1
1.3
1.1
0.9
0.6
1.8
1.6
1.2
2.0
0.5
0.7
1.9
3.3
1.8
1.2
1.4
0.8
2.3
1.5
(0.9)
(1.6)
0.0
0.0
2.2
4.6
1.1
(0.2)
0.0
0.0
2.7
0.5
1.4
1.0
0.9
0.6
1.8
1.4
2.5
0.8
1.1
0.3
3.9
1.2
1.5
1.5
0.9
1.2
2.1
1.9
(1.7)
(0.9)
0.0
0.0
5.0
2.0
(0.9)
(0.8)
0.0
0.0
2.7
2.0
1.4
1.2
0.7
0.8
2.0
1.6
‡
1.6
‡
0.9
2.3
3.5
1.6
3.1
1.4
4.0
1.9
3.1
1.3
2.3
1.0
3.9
1.7
1.5
0.9
0.3
0.5
2.6
1.3
1.8
1.8
0.1
0.9
3.6
2.7
‡
3.3
‡
0.2
‡
6.4
3.6
2.2
2.6
1.9
4.6
2.4
2.4
1.8
0.7
1.5
4.1
2.2
(0.0)
1.0
0.0
0.6
0.0
1.4
‡
1.8
‡
1.0
‡
2.6
‡
3.1
‡
0.2
‡
5.9
2.8
1.7
2.4
1.4
3.1
2.0
2.6
1.4
2.0
1.0
3.2
1.8
1.0
1.0
0.2
0.5
1.9
1.4
2.0
1.7
0.6
0.8
3.3
2.7
‡
(2.2)
‡
0.0
‡
4.8
2.6
1.8
2.2
1.5
2.9
2.1
2.2
1.4
1.7
0.9
2.7
1.8
1.0
1.0
0.5
0.4
1.5
1.7
1.6
1.9
0.4
0.9
2.8
3.0
‡
(0.8)
‡
0.0
‡
2.3
2.2
2.3
1.9
1.9
2.5
2.7
2.2
1.6
1.7
1.1
2.7
2.0
1.0
1.0
0.5
0.4
1.6
1.5
1.7
2.1
0.8
0.3
2.6
3.9
(3.7)
‡
0.0
‡
7.5
‡
3.0
1.8
2.6
1.5
3.5
2.0
1.8
1.9
1.0
1.5
2.5
2.3
1.4
0.7
0.6
0.3
2.1
1.1
2.7
1.2
1.0
0.6
4.3
1.8
‡
(2.9)
‡
0.0
‡
6.3
2.0
2.7
1.7
2.3
2.3
3.1
1.9
1.7
1.6
1.0
2.3
2.4
0.9
1.4
0.5
0.2
1.3
2.5
1.3
2.6
0.6
0.9
1.9
4.3
‡
3.2
‡
0.2
‡
6.1
0.6
0.6
0.0
0.3
1.3
1.0
(1.5)
0.4
0.0
0.0
3.8
0.8
(0.0)
1.1
0.0
0.2
0.0
2.0
‡
(1.3)
‡
0.0
‡
3.5
‡
‡
‡
‡
‡
‡
0.6
0.6
0.0
0.3
1.7
0.9
‡
0.6
‡
0.0
‡
1.1
‡
0.8
‡
0.1
‡
1.5
‡
(1.3)
‡
0.0
‡
3.4
‡
‡
‡
‡
‡
‡
0.7
0.6
0.1
0.2
1.2
1.0
1.1
0.3
0.0
0.0
2.5
0.7
0.3
1.2
0.0
0.2
0.8
2.3
‡
(1.3)
‡
0.0
‡
3.8
‡
‡
‡
‡
‡
‡
0.9
0.4
0.3
0.1
1.4
0.7
1.0
0.1
0.0
0.0
2.1
0.3
1.0
0.8
0.1
0.0
1.9
2.0
‡
‡
‡
‡
‡
‡
‡
‡
‡
‡
‡
‡
0.6
0.6
0.2
0.2
1.0
1.1
0.1
0.9
0.0
0.0
0.4
1.8
1.8
0.5
0.0
0.0
3.6
1.1
(1.6)
‡
0.0
‡
4.3
‡
‡
‡
‡
‡
‡
‡
0.4
0.8
0.0
0.3
0.7
1.3
0.7
0.5
0.0
0.0
1.6
1.2
0.7
1.2
0.0
0.0
1.6
2.4
‡
‡
‡
‡
‡
‡
‡
‡
‡
‡
‡
‡
0.5
0.7
0.2
0.2
0.9
1.3
0.1
1.3
0.0
0.0
0.2
2.7
1.1
(0.4)
0.2
0.0
2.0
1.2
‡
(1.7)
‡
0.0
‡
5.2
‡
‡
‡
‡
‡
‡
-
Guttmacher Institute
9
TABLE 9. Twelve-month failure rates by method, according to demographic and socioeconomic characteristics, for subregions (countries pooled by subregion), 43 countries, 1990–2013 (Continued)
Among the 69 poorest countries according to FP2020
Subregion
Southern Asia
Method and characteristic*
Pill
Age
<25
≥25
Marital status
Never married
Ever married
Parity
0–2 children
≥3 children
Contraceptive intention
For spacing
For limiting
Wealth
Lower three quintiles
Upper two quintiles
Residence
Urban
Rural
Education
Completed primary or less
Secondary or more
IUD
Age
<25
≥25
Marital status
Never married
Ever married
Parity
0–2 children
≥3 children
Contraceptive intention
For spacing
For limiting
Wealth
Lower three quintiles
Upper two quintiles
Residence
Urban
Rural
Education
Completed primary or less
Secondary or more
Injectables
Age
<25
≥25
Marital status
Never married
Ever married
Parity
0–2 children
≥3 children
Contraceptive intention
For spacing
For limiting
Wealth
Lower three quintiles
Upper two quintiles
Residence
Urban
Rural
Education
Completed primary or less
Secondary or more
Implants
Age
<25
≥25
Marital status
Never married
Ever married
Parity
0–2 children
≥3 children
Contraceptive intention
For spacing
For limiting
Wealth
Lower three quintiles
Upper two quintiles
Residence
Urban
Rural
Education
Completed primary or less
Secondary or more
Failure rate†
Southeastern Asia
Failure rate†
95% CI (–/+)
Latin America and the Caribbean
Failure rate†
95% CI (–/+)
7.1
4.2
5.9
3.2
8.2
5.2
8.1
3.4
6.0
2.6
(22.7)
5.4
3.2
4.7
42.2
6.2
‡
4.4
‡
3.6
6.1
4.4
5.1
3.3
7.1
5.4
5.1
3.4
7.0
4.3
5.7
3.5
8.4
5.1
5.7
5.2
4.8
3.9
6.2
5.2
10.2
4.2
Yes
Failure rate†
95% CI (–/+)
No
Failure
rate†
95% CI (–/+)
95% CI (–/+)
9.2
3.8
8.3
3.2
10.1
4.4
7.1
4.0
6.4
3.6
7.8
4.4
9.9
4.9
8.9
4.3
10.8
5.4
‡
5.1
5.5
6.2
4.3
5.7
6.8
6.8
8.0
5.0
5.0
4.6
11.1
5.3
5.4
6.7
4.2
6.2
6.7
7.2
4.1
2.2
6.1
4.6
6.2
5.9
5.7
4.8
6.8
7.0
5.7
4.2
5.2
3.7
6.2
4.8
6.7
6.3
6.1
5.5
7.3
7.2
5.7
3.2
4.5
2.2
6.8
4.2
6.1
6.2
5.5
5.2
6.8
7.1
5.5
4.4
5.0
3.9
6.0
5.0
6.6
6.6
6.0
5.8
7.2
7.4
6.6
6.6
4.7
4.1
3.6
3.1
5.7
5.2
7.8
4.3
7.0
3.6
8.6
4.9
5.4
4.7
5.0
4.2
5.9
5.2
7.8
5.1
7.1
4.4
8.5
5.8
4.3
4.5
8.2
6.0
4.9
4.2
3.8
3.2
6.0
5.3
6.3
5.8
5.7
4.8
6.9
6.9
5.0
5.1
4.5
4.6
5.6
5.6
6.6
6.7
6.0
5.8
7.2
7.6
5.4
5.6
4.4
4.4
6.4
6.7
4.0
4.9
2.9
3.8
5.2
5.9
6.8
5.7
5.9
5.1
7.7
6.3
4.8
5.3
4.4
4.8
5.3
5.9
6.8
6.5
6.0
5.8
7.5
7.2
3.1
0.8
0.0
0.1
6.8
1.4
3.6
1.4
0.8
0.6
6.3
2.2
3.5
1.7
2.2
1.0
4.8
2.4
2.2
1.0
1.3
0.7
3.1
1.3
4.5
1.3
2.9
0.8
6.0
1.7
‡
1.2
‡
0.3
‡
2.0
‡
1.8
‡
0.8
‡
2.8
5.1
2.1
0.0
1.5
10.2
2.7
2.5
1.2
0.0
0.9
6.4
1.5
6.9
1.7
0.0
1.2
14.6
2.2
1.4
1.0
0.0
0.1
3.1
1.8
2.2
0.9
1.2
0.0
3.3
2.2
2.4
1.8
1.6
0.7
3.2
2.9
1.6
0.7
1.2
0.4
2.1
1.1
2.2
1.2
1.5
0.7
2.9
1.7
1.9
0.9
0.0
0.2
4.3
1.5
2.3
1.5
0.8
0.5
3.8
2.5
2.4
2.0
1.5
1.1
3.2
2.8
1.4
1.0
1.0
0.7
1.9
1.4
2.2
1.5
1.3
1.0
3.2
2.0
0.5
1.7
0.1
0.2
1.0
3.2
2.1
1.4
0.7
0.3
3.4
2.4
2.1
2.3
1.4
1.4
2.8
3.2
1.3
1.2
0.7
0.8
1.8
1.6
1.6
2.0
1.1
1.2
2.2
2.8
1.1
1.2
0.2
0.0
2.0
2.5
1.0
2.0
0.0
0.8
2.0
3.2
2.3
1.7
1.6
0.9
3.1
2.5
1.3
1.2
0.9
0.8
1.6
1.7
2.1
1.2
1.4
0.6
2.7
1.7
0.6
1.8
0.0
0.2
1.3
3.4
2.0
1.7
0.0
0.8
4.3
2.6
2.0
2.3
0.8
1.5
3.2
3.0
1.4
1.2
0.6
0.8
2.2
1.5
1.6
1.8
0.8
1.3
2.5
2.4
1.9
1.1
1.1
0.7
2.7
1.6
1.3
0.8
0.6
0.5
1.9
1.1
5.5
3.1
4.6
2.2
6.5
3.9
2.6
1.2
2.2
1.0
3.1
1.4
6.2
3.5
5.0
2.5
7.4
4.5
‡
1.4
‡
1.0
‡
1.8
64.5
0.9
0.0
0.6
194.9
1.2
4.4
4.2
3.1
3.5
5.7
4.9
2.5
1.6
1.2
1.4
3.9
1.8
4.5
4.7
3.0
3.8
5.9
5.5
1.4
1.4
0.8
0.8
2.0
2.0
0.9
0.9
0.6
0.4
1.3
1.3
4.3
3.8
3.6
2.3
5.0
5.3
2.0
1.3
1.7
1.1
2.3
1.6
4.7
4.4
3.9
2.6
5.6
6.2
1.4
1.4
0.7
0.9
2.1
1.9
1.1
0.7
0.7
0.3
1.5
1.1
4.5
3.6
3.7
2.6
5.3
4.6
1.9
1.3
1.6
1.1
2.2
1.6
5.1
3.9
4.0
2.7
6.1
5.1
1.7
0.8
1.1
0.3
2.3
1.3
1.0
0.8
0.6
0.4
1.4
1.2
3.3
5.4
2.7
4.1
3.9
6.7
1.7
1.6
1.4
1.3
2.0
1.9
4.0
5.5
3.3
4.0
4.8
7.1
1.3
1.4
0.5
0.9
2.0
1.9
0.9
0.9
0.5
0.5
1.3
1.3
4.9
2.8
4.1
1.8
5.8
3.8
1.8
1.6
1.4
1.4
2.2
1.8
5.2
3.4
4.2
2.0
6.1
4.8
1.6
1.0
1.0
0.5
2.2
1.6
1.0
0.8
0.5
0.5
1.5
1.1
3.6
4.6
2.5
3.9
4.7
5.4
1.6
1.7
1.4
1.3
1.9
2.0
4.6
4.7
3.1
3.8
6.1
5.5
‡
(0.6)
‡
0.0
‡
1.9
0.0
0.8
0.0
0.0
0.0
1.6
0.2
0.1
0.0
0.0
0.5
0.3
0.8
0.7
0.0
0.3
1.9
1.1
0.2
0.1
0.0
0.0
0.5
0.2
‡
0.5
‡
0.0
‡
1.4
‡
0.7
‡
0.0
‡
1.4
0.1
0.2
0.0
0.0
0.3
0.4
1.3
0.7
0.0
0.3
4.0
1.1
0.1
0.1
0.0
0.0
0.3
0.3
(0.9)
(0.0)
0.0
0.0
2.6
0.0
0.6
0.8
0.0
0.0
1.6
2.0
0.1
0.4
0.0
0.0
0.3
1.2
0.9
0.6
0.2
0.2
1.6
1.0
0.1
0.2
0.0
0.0
0.3
0.6
‡
0.6
‡
0.0
‡
1.8
0.8
0.7
0.0
0.0
2.0
1.5
0.1
0.2
0.0
0.0
0.4
0.5
1.0
0.4
0.4
0.1
1.7
0.8
0.1
0.1
0.0
0.0
0.3
0.3
(0.9)
‡
0.0
‡
2.6
‡
0.5
1.1
0.0
0.0
1.3
2.8
0.2
0.1
0.0
0.0
0.6
0.3
0.7
0.7
0.2
0.2
1.2
1.3
0.2
0.1
0.0
0.0
0.5
0.2
‡
(0.7)
‡
0.0
‡
2.1
0.0
1.1
0.0
0.0
0.0
2.3
0.1
0.6
0.0
0.0
0.2
1.8
0.5
0.8
0.0
0.3
1.0
1.3
0.1
0.4
0.0
0.0
0.2
1.2
(0.7)
‡
0.0
‡
2.1
‡
0.7
0.7
0.0
0.0
1.9
1.6
0.6
0.1
0.0
0.0
1.7
0.2
0.5
1.0
0.2
0.2
0.9
1.9
0.3
0.1
0.0
0.0
1.0
0.2
53
10
Guttmacher Institute
TABLE 9. Twelve-month failure rates by method, according to demographic and socioeconomic characteristics, for subregions (countries pooled by subregion), 43 countries, 1990–2013 (Continued)
Subregion
Eastern Africa
Failure
rate†
95% CI (–/+)
All countries
Method and characteristic*
Male condom
Age
<25
≥25
Marital status
Never married
Ever married
Parity
0–2 children
≥3 children
Contraceptive intention
For spacing
For limiting
Wealth
Lower three quintiles
Upper two quintiles
Residence
Urban
Rural
Education
Completed primary or less
Secondary or more
Periodic abstinence
Age
<25
≥25
Marital status
Never married
Ever married
Parity
0–2 children
≥3 children
Contraceptive intention
For spacing
For limiting
Wealth
Lower three quintiles
Upper two quintiles
Residence
Urban
Rural
Education
Completed primary or less
Secondary or more
Withdrawal
Age
<25
≥25
Marital status
Never married
Ever married
Parity
0–2 children
≥3 children
Contraceptive intention
For spacing
For limiting
Wealth
Lower three quintiles
Upper two quintiles
Residence
Urban
Rural
Education
Completed primary or less
Secondary or more
Failure rate†
95% CI (–/+)
Western Africa
Failure rate†
95% CI (–/+)
8.9
5.4
8.1
4.8
9.8
6.0
4.2
2.8
2.8
1.7
5.6
4.0
1.4
3.5
0.6
2.1
2.2
4.9
4.7
7.3
4.0
6.7
5.4
7.9
2.1
4.4
1.1
3.1
3.0
5.7
0.9
3.9
0.3
2.4
1.5
5.4
7.0
6.0
6.4
5.2
7.6
6.9
3.4
3.8
2.4
1.9
4.4
5.7
2.0
3.4
1.3
1.1
2.7
5.6
7.3
5.9
6.7
5.2
8.0
6.6
3.5
3.8
2.5
1.5
4.4
6.1
2.2
2.3
1.4
0.0
8.2
5.9
7.4
5.3
9.0
6.5
6.0
2.4
3.8
1.6
8.2
3.2
1.9
2.3
6.5
7.3
5.9
6.4
7.1
8.1
1.9
5.2
1.2
3.6
2.7
6.8
6.5
6.9
5.6
6.3
7.4
7.4
4.9
2.3
3.3
1.4
24.6
13.3
22.6
12.3
26.6
14.4
18.7
10.3
17.2
16.3
14.7
15.3
19.7
17.3
18.7
12.7
17.4
11.5
18.1
14.2
Northern Africa and Western Asia
Eastern Europe and Central Asia
Failure rate†
Failure rate†
15.9
6.9
95% CI (–/+)
20.5
8.3
9.0
6.1
6.7
4.7
11.2
7.6
‡
7.2
‡
10.1
3.8
8.1
1.9
6.6
5.8
9.7
10.1
6.1
8.0
4.3
12.2
7.9
7.2
7.6
5.7
4.7
8.6
10.5
3.0
4.7
10.7
7.1
8.1
5.5
13.3
8.8
8.2
5.9
6.3
4.3
10.1
7.4
0.6
1.4
3.3
3.3
10.8
7.0
8.3
5.2
13.3
8.9
6.2
7.9
4.5
6.1
7.8
9.7
2.5
1.7
1.4
0.7
3.5
2.6
8.5
9.9
6.9
6.8
10.1
13.0
7.2
7.4
5.6
5.1
8.7
9.8
6.5
3.2
1.9
2.4
0.6
1.5
3.2
3.3
9.7
8.5
6.3
6.8
13.0
10.2
‡
7.2
‡
5.9
‡
8.6
14.6
8.1
22.8
12.5
7.6
8.3
4.2
5.9
11.0
10.6
30.4
18.1
20.3
14.7
40.5
21.4
(20.6)
14.9
12.8
9.8
28.3
20.1
13.6
12.9
7.6
10.6
19.7
15.2
0.7
9.7
0.0
7.0
2.0
12.4
‡
20.1
‡
16.9
‡
23.3
‡
16.4
‡
11.9
‡
20.9
20.0
13.8
15.1
10.8
11.9
8.2
18.3
13.4
7.9
8.3
4.7
5.6
11.1
11.0
25.1
13.7
20.6
9.4
29.6
18.1
16.5
‡
11.8
‡
21.2
‡
16.8
12.8
19.3
15.7
13.8
11.6
11.0
8.1
16.5
15.1
8.7
6.1
6.0
2.7
11.3
9.5
22.7
17.4
18.1
13.0
27.3
21.8
21.3
10.5
14.1
7.1
28.6
14.0
18.3
14.6
17.1
13.2
19.5
16.0
17.5
9.0
13.9
6.6
21.1
11.5
11.0
6.8
5.8
4.5
16.2
9.0
21.1
19.5
16.8
15.1
25.5
23.9
17.7
14.8
12.3
8.6
23.2
21.0
16.8
15.9
15.5
14.5
18.1
17.3
5.2
16.4
2.7
13.5
7.7
19.2
7.5
9.0
4.5
5.7
10.5
12.4
21.3
16.7
17.4
12.0
25.2
21.4
16.4
15.1
10.9
9.0
21.9
21.3
15.2
17.1
14.0
15.8
16.5
18.3
14.0
11.1
11.4
7.5
16.7
14.7
10.0
5.7
6.5
3.6
13.5
7.9
19.5
20.4
14.7
16.7
24.3
24.1
‡
15.7
‡
11.5
‡
19.9
22.7
11.7
21.1
10.9
24.2
12.4
17.8
13.0
14.0
10.3
21.6
15.7
10.4
6.8
6.0
4.7
14.7
8.9
26.6
13.0
23.2
11.6
30.0
14.4
18.9
10.8
15.3
8.7
22.5
12.9
19.8
14.6
16.9
13.8
22.7
15.3
‡
14.6
‡
12.2
‡
16.9
(2.7)
8.7
0.3
6.4
5.2
11.0
‡
16.3
‡
15.0
‡
17.7
11.2
13.8
5.7
11.8
16.8
15.8
16.3
12.2
15.4
11.1
17.3
13.4
14.8
14.3
11.4
11.3
18.2
17.4
7.3
8.3
4.6
5.4
9.9
11.3
18.1
13.8
16.3
11.7
19.8
15.8
14.2
10.2
12.1
5.9
16.3
14.6
16.7
13.1
15.7
12.1
17.7
14.1
14.7
14.3
11.9
10.4
17.4
18.2
8.0
7.1
5.8
3.0
10.3
11.2
18.2
15.0
16.2
13.3
20.2
16.7
15.5
12.6
11.8
10.4
19.2
14.8
16.0
13.3
15.1
12.2
17.0
14.3
15.8
13.2
12.7
10.2
18.8
16.2
12.1
6.0
7.5
4.0
16.7
8.0
17.3
14.8
15.6
12.6
19.1
17.0
14.2
12.9
11.7
10.1
16.7
15.6
15.1
14.6
14.1
13.6
16.2
15.6
11.9
15.3
7.4
12.7
16.4
17.9
6.8
9.9
4.4
6.1
9.2
13.6
16.4
16.4
14.6
14.3
18.1
18.5
13.2
14.0
10.6
11.3
15.8
16.7
13.5
15.5
12.6
14.6
14.5
16.5
14.9
13.5
12.4
8.4
17.4
18.5
9.7
6.6
5.9
4.4
13.6
8.7
14.8
17.0
12.9
15.3
16.7
18.8
‡
13.5
‡
11.7
‡
15.4
‡
8.7
11.3
5.4
95% CI (–/+)
*Age, parity, marital status and contraceptive intention were measured at the end of the episode of contraceptive use; wealth, education and residence were measured at the time of the survey interview.
†Number of failures per 100 episodes of use. ‡Not reported because there were fewer than 125 episodes of use of that method. Notes: FP2020=Family Planning 2020 (see footnote in Table 8 for details).
Failure rates were calculated using the single-decrement approach. Values in parentheses indicate calculations were based on 125–249 episodes of use for that method.
54
Guttmacher Institute
Guttmacher Institute
11
TABLE 9. Twelve-month failure rates by method, according to demographic and socioeconomic characteristics, for subregions (countries pooled by subregion), 43 countries, 1990–2013 (Continued)
Among the 69 poorest countries according to FP2020
Subregion
Southern Asia
Method and characteristic*
Male condom
Age
<25
≥25
Marital status
Never married
Ever married
Parity
0–2 children
≥3 children
Contraceptive intention
For spacing
For limiting
Wealth
Lower three quintiles
Upper two quintiles
Residence
Urban
Rural
Education
Completed primary or less
Secondary or more
Periodic abstinence
Age
<25
≥25
Marital status
Never married
Ever married
Parity
0–2 children
≥3 children
Contraceptive intention
For spacing
For limiting
Wealth
Lower three quintiles
Upper two quintiles
Residence
Urban
Rural
Education
Completed primary or less
Secondary or more
Withdrawal
Age
<25
≥25
Marital status
Never married
Ever married
Parity
0–2 children
≥3 children
Contraceptive intention
For spacing
For limiting
Wealth
Lower three quintiles
Upper two quintiles
Residence
Urban
Rural
Education
Completed primary or less
Secondary or more
Failure rate†
Southeastern Asia
Failure rate†
95% CI (–/+)
Latin America and the Caribbean
95% CI (–/+)
Failure rate†
Yes
Failure rate†
95% CI (–/+)
No
Failure
rate†
95% CI (–/+)
95% CI (–/+)
13.1
4.6
10.8
3.5
15.3
5.7
13.8
7.2
6.6
4.5
20.9
9.9
9.0
4.5
7.8
3.7
10.2
5.4
7.5
5.4
6.3
4.6
8.7
6.3
10.0
5.4
8.8
4.6
11.3
6.2
25.9
7.2
2.9
6.2
49.0
8.3
12.2
8.3
0.0
5.8
32.6
10.8
7.2
6.4
6.1
5.4
8.4
7.3
2.2
7.3
1.5
6.4
2.8
8.2
6.5
7.3
5.4
6.5
7.6
8.1
7.9
6.5
6.6
4.8
9.2
8.3
8.5
8.0
5.3
3.7
11.7
12.3
6.9
5.8
6.1
3.8
7.6
7.9
6.3
6.2
5.3
5.1
7.2
7.3
7.4
5.8
6.7
4.5
8.2
7.2
8.7
5.9
7.3
4.3
10.2
7.4
10.4
6.5
6.6
2.9
14.1
10.0
7.3
5.1
6.4
3.8
8.2
6.4
6.6
5.5
5.7
4.3
7.6
6.6
7.8
6.1
7.0
5.2
8.7
7.1
8.0
7.1
6.4
5.7
9.7
8.4
9.9
7.3
5.1
4.5
14.8
10.2
9.5
4.8
8.2
4.0
10.9
5.6
7.3
5.8
6.0
4.9
8.5
6.7
8.7
6.0
7.7
5.2
9.8
6.9
7.6
7.3
5.9
6.0
9.3
8.6
6.7
9.6
3.8
5.8
9.6
13.3
6.3
8.8
5.5
6.5
7.0
11.0
5.9
6.7
4.9
5.6
6.9
7.8
6.9
8.2
6.1
6.9
7.6
9.5
6.9
7.8
5.3
6.4
8.5
9.1
6.2
9.0
1.0
6.1
11.4
11.9
7.3
6.6
5.3
5.8
9.3
7.3
5.8
6.5
4.7
5.6
6.8
7.5
7.8
7.1
6.0
6.4
9.5
7.8
10.5
3.8
8.5
2.7
12.5
5.0
28.2
11.0
19.0
8.1
37.3
14.0
31.9
16.1
28.6
14.4
35.2
17.8
22.1
10.9
19.9
9.8
24.3
12.0
28.1
16.1
24.4
14.3
31.7
17.9
‡
6.1
‡
5.0
‡
7.2
5.4
13.3
0.0
10.6
13.1
16.1
22.1
20.7
18.9
19.0
25.2
22.3
13.6
14.1
10.2
13.0
17.1
15.2
20.4
18.9
16.9
17.2
23.8
20.6
6.9
4.8
5.5
3.5
8.4
6.2
16.2
9.2
12.0
6.4
20.4
12.0
23.3
17.0
21.4
14.9
25.2
19.1
16.3
11.6
14.7
10.3
17.9
12.8
20.9
14.8
19.0
12.4
22.8
17.2
7.1
5.2
5.3
4.1
8.8
6.4
14.8
12.2
11.1
8.1
18.5
16.3
22.2
19.2
20.3
16.5
24.0
21.9
15.2
13.0
13.7
11.4
16.6
14.5
21.1
16.1
19.1
13.4
23.2
18.8
6.7
5.0
5.4
3.3
8.0
6.8
16.5
10.0
12.5
6.4
20.6
13.6
22.6
19.3
20.9
16.7
24.3
21.8
17.2
10.9
15.6
9.6
18.8
12.3
19.8
18.5
18.0
16.0
21.5
21.1
5.4
6.3
3.3
5.1
7.5
7.6
13.7
13.0
9.2
9.6
18.2
16.5
19.8
23.2
18.2
20.2
21.5
26.3
13.5
14.6
12.0
13.2
15.0
16.1
19.4
18.5
17.4
15.5
21.3
21.6
5.3
7.0
4.3
5.1
6.4
9.0
15.0
12.8
7.6
9.9
22.5
15.7
19.8
21.6
17.7
19.5
22.0
23.7
14.3
14.0
12.8
12.5
15.8
15.4
17.8
19.5
15.3
17.5
20.3
21.5
13.7
7.7
10.6
5.9
16.7
9.4
24.0
11.7
20.0
9.9
28.0
13.5
25.5
11.0
22.8
9.4
28.2
12.6
18.5
10.5
16.7
9.5
20.3
11.6
24.8
12.3
22.7
11.3
27.0
13.4
‡
7.7
‡
10.8
41.5
14.0
23.2
12.3
59.7
15.6
24.9
15.3
21.1
13.7
28.8
16.9
17.2
12.5
12.8
11.6
21.7
13.4
20.8
15.8
17.2
14.8
24.4
16.8
11.1
7.2
8.9
5.0
13.2
9.4
15.6
11.9
13.6
9.2
17.7
14.6
19.3
11.9
17.5
9.6
21.2
14.2
14.2
10.9
13.0
9.5
15.4
12.2
17.3
13.4
16.1
11.7
18.5
15.1
12.4
6.4
9.9
4.5
14.9
8.3
15.7
12.9
13.4
10.3
17.9
15.4
19.8
12.1
17.7
10.0
21.8
14.1
14.3
10.8
13.0
9.3
15.5
12.2
18.4
14.2
16.9
12.9
19.9
15.5
10.0
8.9
7.8
6.7
12.2
11.1
16.1
11.5
13.7
9.3
18.4
13.7
17.7
16.3
16.1
13.5
19.3
19.1
14.3
10.9
13.0
9.7
15.7
12.1
16.9
14.9
15.6
13.3
18.1
16.5
7.8
10.3
5.5
8.3
10.0
12.3
14.4
14.1
11.8
12.0
17.0
16.2
17.4
16.5
15.5
14.2
19.4
18.8
11.9
13.2
10.5
12.0
13.2
14.4
16.2
15.9
14.9
14.4
17.5
17.4
8.6
10.3
6.5
8.2
10.7
12.4
12.0
15.4
9.6
13.2
14.4
17.6
15.3
18.5
13.3
16.4
17.2
20.6
12.5
12.9
11.2
11.6
13.7
14.3
14.8
16.6
13.2
15.3
16.3
17.8
‡
9.2
*Age, parity, marital status and contraceptive intention were measured at the end of the episode of contraceptive use; wealth, education and residence were measured at the time of the survey interview.
†Number of failures per 100 episodes of use. ‡Not reported because there were fewer than 125 episodes of use of that method. Notes: FP2020=Family Planning 2020 (see footnote in Table 8 for details).
Failure rates were calculated using the single-decrement approach. Values in parentheses indicate calculations were based on 125–249 episodes of use for that method.
55
12
Guttmacher Institute
TABLE 10. Twelve-month failure rates by method, according to combinations of demographic and socioeconomic characteristics, for subregions (countries pooled by subregion), 43 countries, 1990–2013
Among the 69 poorest countries according
to FP2020
Subregion
Method and combination of characteristics*
Pill
Wealth
Lower three quintiles
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
Upper two quintiles
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
Residence
Urban
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Rural
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Secondary or more
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Parity
0–2 children
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
≥3 children
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
Contraceptive intention
For spacing
Age
<25
≥25
For limiting
Age
<25
≥25
56
Guttmacher Institute
Total
Eastern Africa
Northern Africa
Western Africa and Western Asia
Eastern Europe
and Central Asia
Southern Asia
Southeastern
Asia
Latin America
and the
Caribbean
Yes
No
9.6
4.7
6.9
3.3
3.5
4.3
12.5
6.6
(11.1)
6.7
8.0
3.8
8.8
3.2
10.9
5.0
8.1
4.0
11.4
5.6
6.7
6.3
4.6
4.4
4.2
3.7
7.9
8.5
8.7
6.9
7.1
4.7
5.8
3.5
7.8
7.8
6.1
4.6
7.4
8.3
6.1
7.0
5.1
3.6
3.8
(6.6)
7.4
9.5
†
7.8
5.3
6.5
4.0
5.6
7.7
7.9
5.1
6.0
7.6
8.1
6.6
4.1
6.7
4.1
3.1
3.6
9.2
4.1
7.6
9.4
5.7
4.8
6.1
3.7
6.7
2.6
6.0
4.1
7.5
4.0
5.3
4.2
4.8
5.2
3.2
4.3
7.0
3.3
10.0
7.9
6.9
3.7
5.4
2.6
4.4
3.9
4.9
4.2
5.7
4.1
4.4
5.1
4.9
4.9
2.9
4.3
4.3
5.5
†
9.0
5.9
4.9
4.1
4.2
4.5
4.2
4.4
4.9
4.5
5.3
8.5
4.5
6.7
3.6
2.9
4.0
12.2
5.0
7.4
7.4
6.0
6.4
8.7
3.8
9.1
4.1
6.7
4.2
9.8
4.8
6.1
5.7
4.4
5.3
3.6
4.3
7.6
5.6
7.6
7.5
8.2
4.4
5.6
3.9
6.2
6.5
5.1
4.9
6.8
6.2
8.1
4.2
6.9
3.8
3.6
3.4
10.5
6.5
(13.3)
9.8
7.5
3.5
7.7
3.2
9.4
3.1
7.4
3.9
10.0
5.0
5.9
5.1
4.9
4.6
3.3
3.7
7.3
8.0
(14.5)
7.4
6.5
4.3
5.7
2.8
6.0
5.5
5.8
4.2
6.2
7.3
8.6
4.2
7.2
4.0
1.8
3.7
9.6
5.7
†
†
7.1
4.6
9.0
2.6
11.3
3.8
6.8
3.9
11.3
4.6
5.6
5.5
5.0
5.2
2.9
4.4
6.7
6.6
†
†
7.0
4.7
5.3
2.9
6.6
7.0
5.0
4.6
6.6
6.9
8.1
4.6
6.3
3.4
6.2
3.8
13.2
5.5
8.8
8.3
7.0
3.6
7.3
4.1
7.8
3.8
7.4
4.1
8.9
5.1
6.3
5.2
4.5
4.2
4.8
(3.0)
8.1
6.5
9.5
7.5
7.0
3.8
6.0
3.5
5.8
5.3
5.9
4.2
6.6
6.3
8.0
4.3
6.4
3.8
3.6
4.1
10.5
5.6
8.6
7.5
6.9
4.6
7.8
3.7
8.9
3.1
6.9
4.2
9.3
4.3
6.4
5.4
5.2
5.9
3.9
†
8.0
6.9
9.1
6.5
7.3
4.3
5.9
3.1
6.4
5.6
6.0
4.5
6.9
6.3
6.4
6.1
5.9
4.8
2.8
5.2
7.1
8.1
†
8.0
6.5
5.9
4.7
5.3
7.6
5.6
5.5
5.8
7.6
6.3
12.4
4.5
12.0
3.6
(1.0)
3.6
21.7
5.6
†
10.7
8.6
3.9
†
3.1
14.1
4.9
8.8
3.9
19.1
5.4
4.3
5.4
3.6
4.5
3.1
4.2
6.1
6.3
†
(10.7)
4.9
4.3
4.1
3.2
4.1
6.7
4.0
4.4
5.1
6.8
4.8
5.3
4.4
3.5
3.4
3.4
6.2
6.3
†
11.0
4.5
3.9
3.2
3.7
5.7
6.4
4.3
4.1
5.8
7.2
7.9
4.2
6.7
3.1
3.2
3.7
10.2
5.7
9.6
9.2
7.3
6.1
8.2
4.2
8.7
3.1
7.1
4.1
9.1
4.3
9.9
4.6
8.0
4.5
†
4.0
16.3
5.5
(7.4)
7.5
6.4
3.7
7.6
2.8
11.4
4.6
7.3
4.0
12.8
5.4
Guttmacher Institute
13
TABLE 10. Twelve-month failure rates by method, according to combinations of demographic and socioeconomic characteristics, for subregions (countries pooled by subregion), 43 countries, 1990–2013 (Continued)
Among the 69 poorest countries according
to FP2020
Subregion
Method and combination of characteristics*
IUD
Wealth
Lower three quintiles
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
Upper two quintiles
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
Residence
Urban
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Rural
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Secondary or more
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Parity
0–2 children
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
≥3 children
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
Contraceptive intention
For spacing
Age
<25
≥25
For limiting
Age
<25
≥25
14
Northern Africa
Western Africa and Western Asia
Eastern Europe
and Central Asia
Southeastern
Asia
Total
Eastern Africa
3.4
0.9
†
†
†
†
2.9
0.9
3.6
0.8
1.1
0.4
4.0
1.4
1.8
1.2
†
†
†
†
1.8
1.0
1.1
1.2
0.5
0.6
1.7
1.3
†
†
†
†
1.7
1.1
†
1.2
3.0
1.3
†
0.6
†
0.9
1.7
1.0
1.8
1.4
(0.0)
(1.4)
(0.2)
(1.5)
1.1
1.7
†
(0.9)
3.8
1.4
Southern Asia
Latin America
and the
Caribbean
Yes
No
3.8
1.2
2.5
0.9
4.5
1.0
2.8
1.5
2.5
1.6
1.6
1.0
2.0
1.4
0.4
1.3
2.1
2.1
1.7
2.5
1.6
1.0
1.7
1.6
4.5
1.6
4.5
1.0
(2.2)
1.3
3.3
2.0
1.6
1.1
4.4
1.5
0.9
1.3
2.8
1.2
2.9
1.1
1.2
1.5
2.3
2.2
1.3
1.1
2.4
1.6
(1.4)
(0.2)
0.5
1.3
†
2.0
1.2
1.9
(1.7)
1.3
2.5
2.2
0.8
1.3
1.4
2.0
†
(1.0)
†
1.3
3.1
1.1
6.4
1.8
2.1
0.9
(0.0)
1.2
3.5
1.9
1.7
1.2
5.0
1.5
2.0
1.6
(0.0)
†
(0.1)
(2.4)
1.4
1.3
3.0
2.0
1.3
1.0
1.0
1.0
2.4
2.3
1.3
1.2
2.4
1.8
2.7
0.8
†
(0.0)
†
†
1.6
0.8
2.0
0.5
3.6
0.7
4.1
1.4
3.5
1.0
2.4
0.9
3.3
0.7
1.5
0.9
†
†
†
†
1.3
0.7
0.9
0.7
2.4
0.8
2.6
1.6
2.4
0.9
1.5
0.9
1.6
0.9
4.0
0.8
†
(0.0)
†
(1.0)
4.0
0.7
†
†
0.4
0.7
(5.4)
0.8
2.8
1.7
3.5
0.8
4.9
0.9
2.5
1.0
†
†
†
†
2.3
0.9
†
†
0.0
0.8
3.0
1.4
3.4
0.8
2.0
1.0
3.5
0.9
2.9
1.2
†
(0.9)
†
(1.0)
1.6
1.1
4.1
1.1
5.0
0.9
2.2
1.6
3.8
1.7
1.6
1.1
4.3
1.4
1.6
1.4
(0.0)
†
(0.4)
†
1.1
1.3
1.9
1.2
3.6
0.9
1.9
1.6
2.0
2.7
1.3
1.0
2.0
1.7
3.2
1.4
†
(1.3)
†
†
2.6
1.1
3.6
1.5
3.5
0.2
3.7
1.7
3.5
1.8
2.3
1.3
4.4
1.5
2.2
1.6
(2.1)
†
†
†
1.7
1.4
2.4
1.5
3.0
0.2
2.5
1.9
2.5
2.3
1.7
1.5
2.7
1.7
2.4
1.8
†
(1.4)
†
†
2.0
1.4
†
2.0
0.0
2.1
2.5
2.1
4.0
2.0
2.1
1.5
2.7
2.1
3.2
0.9
†
(0.0)
†
1.1
(1.0)
0.9
†
0.6
†
1.0
†
0.9
3.9
1.6
1.2
0.7
4.9
1.0
0.7
1.0
†
(0.1)
(0.0)
(1.7)
0.6
1.0
0.7
0.8
(0.0)
1.2
(0.0)
1.0
1.9
1.8
0.6
0.8
0.8
1.3
0.8
1.0
(0.0)
†
(1.1)
(1.0)
0.8
0.9
†
0.8
0.8
1.4
1.3
0.5
0.4
3.1
0.9
0.7
0.7
1.3
3.1
1.3
†
(0.0)
†
(0.2)
2.2
1.0
3.7
1.4
5.4
0.2
4.0
1.1
3.2
1.8
2.3
1.0
4.5
1.5
3.5
1.1
†
(1.0)
†
(1.6)
3.1
1.0
4.5
0.9
0.4
0.9
(2.0)
1.5
4.4
1.6
1.9
1.0
4.4
1.1
57
Guttmacher Institute
TABLE 10. Twelve-month failure rates by method, according to combinations of demographic and socioeconomic characteristics, for subregions (countries pooled by subregion), 43 countries, 1990–2013 (Continued)
Among the 69 poorest countries according
to FP2020
Subregion
Method and combination of characteristics*
Injectables
Wealth
Lower three quintiles
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
Upper two quintiles
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
Residence
Urban
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Rural
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Secondary or more
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Parity
0–2 children
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
≥3 children
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
Contraceptive intention
For spacing
Age
<25
≥25
For limiting
Age
<25
≥25
58
Guttmacher Institute
Total
Eastern Africa
Northern Africa
Western Africa and Western Asia
Eastern Europe
and Central Asia
Southern Asia
Southeastern
Asia
Latin America
and the
Caribbean
Yes
No
3.4
1.6
3.3
1.7
1.1
1.0
1.4
1.8
†
(4.1)
2.5
1.4
1.3
0.9
4.9
2.0
2.5
1.4
6.1
2.6
2.6
1.7
2.7
1.4
0.9
1.4
1.5
1.8
†
(1.1)
1.8
1.7
1.2
0.7
3.7
2.7
2.1
1.3
4.6
3.3
1.9
2.9
2.1
2.4
1.1
0.9
0.9
3.3
†
(3.9)
1.8
1.4
1.0
0.9
2.5
4.3
1.7
1.6
3.1
4.8
3.7
1.6
2.9
0.9
1.7
0.8
(3.4)
1.9
†
†
0.9
0.7
1.2
0.7
6.4
4.6
2.8
1.0
6.3
4.9
2.5
2.0
1.7
1.3
1.0
0.7
(2.2)
2.2
†
†
0.6
0.9
0.8
0.8
5.4
5.5
1.7
1.4
5.6
5.3
2.1
2.5
1.6
1.5
0.8
1.5
(3.8)
1.4
†
†
0.8
0.8
1.1
0.7
6.9
4.9
1.5
1.7
8.7
4.6
4.4
2.2
2.1
1.5
1.8
1.2
(1.8)
2.9
†
†
2.0
0.8
1.6
0.7
6.5
3.5
2.6
1.4
6.8
3.8
3.3
2.5
1.9
1.6
1.4
1.3
1.5
3.2
†
†
1.0
1.4
1.1
0.7
5.4
3.9
1.9
1.6
5.7
4.1
2.9
1.3
3.5
1.3
1.3
0.6
1.9
1.1
†
(3.1)
1.9
1.2
1.1
0.9
3.5
2.3
2.7
1.1
4.5
2.8
2.0
1.4
2.3
1.3
0.7
0.8
1.7
0.9
†
(0.0)
1.5
1.4
1.0
0.7
2.5
3.2
1.9
1.2
3.3
3.5
3.3
1.5
3.3
1.3
1.7
0.7
0.7
1.4
†
†
2.2
1.4
1.2
0.9
5.0
2.6
2.7
1.2
7.0
3.4
2.2
1.7
2.2
1.5
0.8
1.1
0.9
1.4
†
†
1.6
1.6
1.2
0.8
4.1
2.9
1.8
1.4
5.9
3.3
3.9
1.9
2.5
1.3
0.7
1.6
3.3
2.5
†
(3.5)
1.5
0.6
1.3
0.7
5.8
3.5
2.5
1.2
5.9
3.6
3.0
2.1
2.2
0.5
1.6
0.7
2.4
2.8
†
(0.8)
1.1
1.0
1.0
0.6
4.7
4.4
2.1
1.0
4.8
4.4
3.7
1.6
3.3
1.3
0.9
1.3
2.0
2.0
†
†
1.9
0.6
1.3
0.7
5.5
2.6
2.7
1.1
6.2
2.9
2.9
2.2
2.7
1.3
1.0
†
1.9
2.1
†
†
1.5
1.4
1.1
0.4
4.4
4.0
2.2
1.3
4.9
4.1
2.8
2.8
2.9
1.9
0.6
2.0
1.5
2.4
†
†
1.8
1.0
1.1
0.9
4.4
4.3
2.2
1.8
6.1
4.3
2.6
1.6
1.9
1.3
(3.3)
0.8
†
1.8
†
(2.2)
(2.1)
1.4
0.0
0.9
5.8
3.7
2.2
1.2
6.1
4.3
1.7
1.7
1.4
1.4
0.9
1.0
1.1
1.9
†
(1.0)
0.9
1.5
0.7
0.9
5.0
3.4
1.3
1.3
6.4
3.7
1.5
2.5
1.4
1.4
1.0
0.8
1.1
2.8
†
(2.4)
1.5
1.1
0.9
0.8
2.5
6.7
1.3
1.4
3.0
6.6
3.5
1.7
3.2
1.3
1.5
0.8
2.5
1.1
†
†
1.5
1.2
1.4
0.9
5.3
3.4
2.7
1.2
6.1
3.9
3.6
1.5
1.8
1.3
†
1.0
(0.9)
2.1
†
(0.8)
2.5
1.1
0.4
0.7
6.4
2.7
2.3
1.2
6.6
3.2
Guttmacher Institute
15
TABLE 10. Twelve-month failure rates by method, according to combinations of demographic and socioeconomic characteristics, for subregions (countries pooled by subregion), 43 countries, 1990–2013 (Continued)
Among the 69 poorest countries according
to FP2020
Subregion
Method and combination of characteristics*
Implants
Wealth
Lower three quintiles
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
Upper two quintiles
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
Residence
Urban
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Rural
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Secondary or more
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Parity
0–2 children
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
≥3 children
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
Contraceptive intention
For spacing
Age
<25
≥25
For limiting
Age
<25
≥25
16
Northern Africa
Western Africa and Western Asia
Eastern Europe
and Central Asia
Southern Asia
†
†
†
†
†
(1.1)
0.0
0.6
(2.4)
(1.1)
†
†
†
†
†
(1.1)
0.1
†
1.9
†
†
†
†
†
0.9
0.5
†
0.5
(0.0)
0.6
†
†
1.0
0.2
1.6
0.0
0.4
(0.7)
0.4
0.8
0.0
1.7
0.2
0.4
Total
Eastern Africa
0.2
0.7
†
0.1
†
2.1
0.7
0.5
(0.0)
0.2
0.7
0.5
Southeastern
Asia
Latin America
and the
Caribbean
Yes
No
0.4
0.0
0.1
0.8
0.4
0.0
0.0
0.9
0.3
0.1
0.8
0.6
0.3
0.1
(1.1)
†
0.2
1.0
0.7
0.1
0.7
0.9
0.6
0.0
†
†
†
†
0.0
1.2
0.0
0.2
1.3
0.6
0.0
0.1
†
†
†
†
†
†
2.3
0.0
0.0
0.3
1.2
0.2
0.0
0.2
0.5
(0.5)
†
†
†
†
†
†
3.8
0.2
0.0
0.1
0.4
1.1
0.0
0.1
†
0.5
†
0.9
†
†
†
†
†
†
0.0
0.0
0.0
0.1
0.5
0.5
0.0
0.1
0.6
0.1
(1.1)
(0.0)
1.1
(0.0)
†
†
†
†
†
†
0.0
0.0
0.0
0.2
0.9
0.0
0.0
0.1
1.0
0.8
(1.7)
0.3
†
1.4
†
†
†
†
†
(1.0)
0.0
1.3
1.2
0.0
0.9
0.8
1.1
0.0
1.1
0.6
1.0
0.1
(0.9)
(1.7)
†
†
†
†
†
(0.9)
1.1
1.1
1.0
0.0
1.1
0.6
0.7
0.0
0.2
0.6
†
0.1
(0.0)
1.3
†
†
†
†
†
(0.9)
0.0
0.8
1.2
0.0
0.1
0.6
1.0
0.0
0.6
0.5
0.0
0.1
1.2
0.9
†
†
†
†
†
(0.9)
1.5
0.3
1.1
0.0
0.6
0.5
0.6
0.0
0.8
0.7
†
0.8
†
(0.5)
†
†
†
†
†
†
0.0
0.8
0.0
0.1
1.7
0.8
0.0
0.1
1.1
0.2
2.2
(0.0)
(0.5)
†
†
†
†
†
†
†
0.2
1.1
0.0
0.2
1.6
0.3
0.0
0.2
0.6
0.7
(2.0)
0.6
(0.0)
(0.5)
†
†
†
†
†
†
0.0
0.8
0.2
0.0
0.9
0.8
0.2
0.0
0.8
0.4
1.4
†
0.3
†
†
†
†
†
†
†
1.0
0.2
0.1
0.1
1.0
0.7
0.1
0.1
0.6
0.7
(0.0)
(1.9)
(0.0)
(0.7)
†
†
†
†
†
†
1.1
0.3
0.9
0.0
0.6
1.1
0.6
0.0
0.0
0.6
†
0.3
†
1.3
†
(1.3)
†
†
†
(0.0)
0.0
0.8
0.0
0.4
0.0
0.6
0.0
0.2
1.0
0.4
(0.5)
0.1
1.7
0.9
†
†
†
†
†
(0.0)
0.0
1.0
0.0
0.5
1.1
0.4
0.0
0.3
0.5
0.9
0.1
(0.7)
1.4
†
†
†
†
†
(0.0)
†
0.4
1.4
0.0
0.7
0.5
1.0
0.0
0.3
0.7
0.9
(1.8)
0.7
(0.0)
1.4
†
†
†
†
†
†
0.0
1.0
0.2
0.0
1.0
1.0
0.2
0.0
0.1
0.4
†
0.1
†
0.9
†
†
†
†
†
(0.8)
0.0
0.7
0.1
0.2
0.0
0.4
0.1
0.1
59
Guttmacher Institute
TABLE 10. Twelve-month failure rates by method, according to combinations of demographic and socioeconomic characteristics, for subregions (countries pooled by subregion), 43 countries, 1990–2013 (Continued)
Among the 69 poorest countries according
to FP2020
Subregion
Method and combination of characteristics*
Male condom
Wealth
Lower three quintiles
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
Upper two quintiles
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
Residence
Urban
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Rural
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Secondary or more
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Parity
0–2 children
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
≥3 children
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
Contraceptive intention
For spacing
Age
<25
≥25
For limiting
Age
<25
≥25
60
Guttmacher Institute
Total
Eastern Africa
Northern Africa
Western Africa and Western Asia
Eastern Europe
and Central Asia
Southern Asia
Southeastern
Asia
Latin America
and the
Caribbean
Yes
No
11.2
6.2
7.5
4.6
2.2
1.5
18.5
8.4
9.3
4.4
13.5
4.7
13.2
9.1
11.4
7.4
8.9
6.2
12.5
6.2
9.1
6.8
6.2
(5.1)
1.9
†
15.1
7.2
6.6
5.6
9.4
6.3
10.3
9.5
10.2
8.1
7.2
7.3
10.2
6.6
8.3
8.1
7.5
3.1
1.9
2.0
12.5
10.1
†
6.2
6.9
10.1
8.7
10.7
9.7
9.4
7.3
7.2
9.6
8.5
7.5
4.9
2.8
2.0
1.1
4.2
12.9
5.8
8.8
7.2
12.7
4.5
14.5
6.0
7.1
2.9
6.8
5.1
8.1
4.8
6.3
5.2
2.2
3.2
2.3
(2.4)
7.1
7.0
9.2
6.0
8.3
5.6
10.4
4.1
5.6
2.4
6.4
4.4
6.2
5.8
4.1
6.3
2.9
2.1
1.9
2.5
5.6
7.3
†
7.9
7.1
7.1
1.4
8.2
2.6
5.1
4.0
6.3
4.4
6.2
8.2
5.4
2.0
1.7
1.8
3.5
16.4
6.6
8.1
6.4
13.6
5.2
8.6
6.4
8.5
4.2
6.3
5.6
9.3
5.3
6.9
5.8
1.9
2.2
2.6
(0.4)
10.3
6.9
7.7
6.3
8.4
6.7
9.6
3.1
6.9
4.6
6.3
5.0
7.3
6.1
10.3
5.4
6.9
3.7
0.4
3.6
(13.8)
8.5
11.5
5.5
12.8
4.0
16.2
7.9
11.7
6.1
9.0
5.3
12.4
5.6
8.1
6.1
5.3
4.8
1.2
†
12.6
8.1
9.5
5.1
9.0
5.2
11.1
8.3
9.8
6.9
7.2
5.9
9.8
6.3
8.3
5.6
6.0
3.9
1.7
2.1
15.2
7.6
†
†
11.0
5.6
10.8
5.3
8.9
6.4
6.4
5.3
12.8
5.9
6.4
6.6
4.9
4.9
2.1
†
14.9
7.9
†
†
7.3
6.6
4.0
7.3
8.0
6.5
5.2
6.7
9.5
6.5
9.1
5.4
2.8
1.7
1.3
4.5
16.1
6.7
9.0
6.1
13.9
3.7
14.5
7.8
9.1
4.0
8.0
5.5
9.7
5.3
7.5
5.6
2.3
2.1
2.3
(4.1)
10.2
6.8
8.2
5.9
9.4
5.1
11.8
6.1
7.2
4.5
7.3
4.7
7.7
6.1
8.8
5.3
3.9
2.4
1.3
3.6
15.7
7.8
8.7
5.9
13.4
2.9
14.0
6.7
8.9
4.2
7.4
5.0
9.9
5.4
7.4
6.0
3.4
(3.9)
1.9
†
10.7
9.3
8.1
5.7
9.4
4.0
10.5
5.0
7.4
4.5
6.7
4.1
7.8
6.6
7.1
7.0
5.0
2.3
2.0
2.0
13.0
9.4
†
7.2
7.2
8.1
5.3
9.0
7.6
6.7
5.4
6.6
9.8
7.2
14.2
5.7
†
3.3
†
3.3
†
5.6
†
6.9
9.1
6.3
†
8.1
14.5
5.3
11.6
6.0
18.8
5.3
6.6
5.8
3.9
3.7
4.2
(1.7)
10.6
4.9
(9.0)
6.6
4.6
7.1
9.4
7.8
6.2
5.8
6.1
6.2
7.8
5.3
5.7
6.3
4.6
2.2
1.8
5.8
5.2
6.4
†
7.7
6.7
6.2
6.7
8.8
6.7
5.1
6.1
6.3
5.1
6.3
9.0
5.5
4.3
2.2
1.4
3.8
16.1
8.6
9.6
6.9
14.2
3.4
15.6
7.9
9.3
4.4
7.7
5.4
10.1
5.6
8.8
5.3
†
4.0
†
2.5
15.5
5.7
7.5
5.3
8.2
5.4
0.0
6.7
6.9
4.7
5.0
5.5
9.9
5.1
Guttmacher Institute
17
TABLE 10. Twelve-month failure rates by method, according to combinations of demographic and socioeconomic characteristics, for subregions (countries pooled by subregion), 43 countries, 1990–2013 (Continued)
Among the 69 poorest countries according
to FP2020
Subregion
Method and combination of characteristics*
Periodic abstinence
Wealth
Lower three quintiles
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
Upper two quintiles
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
Residence
Urban
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Rural
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Secondary or more
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Parity
0–2 children
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
≥3 children
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
Contraceptive intention
For spacing
Age
<25
≥25
For limiting
Age
<25
≥25
18
Total
Eastern Africa
Northern Africa
Western Africa and Western Asia
Eastern Europe
and Central Asia
Southern Asia
Southeastern
Asia
Latin America
and the
Caribbean
Yes
No
27.3
14.5
26.0
13.5
(11.5)
10.7
(30.7)
18.7
†
17.0
10.6
4.6
34.9
12.9
33.9
17.0
26.3
13.2
28.8
16.2
21.0
15.7
19.8
13.7
11.5
†
24.6
17.8
(24.2)
(12.2)
7.1
6.5
20.4
14.3
24.8
20.3
19.5
15.4
22.7
16.2
17.0
19.9
16.8
(21.3)
12.7
(3.4)
(15.6)
22.4
†
17.5
5.8
9.4
17.1
16.2
21.9
23.6
16.3
19.3
18.9
20.3
21.5
12.3
11.9
7.6
5.4
7.3
(29.2)
17.5
(20.4)
13.6
10.4
2.8
16.3
9.4
29.6
15.3
17.0
8.7
27.3
16.0
15.9
12.5
8.8
9.4
7.3
5.0
21.4
16.9
(19.6)
9.2
7.1
2.9
10.6
9.4
20.2
17.5
11.9
9.5
20.0
15.9
11.3
15.5
10.0
8.1
7.7
6.1
(23.6)
18.8
†
14.5
3.5
5.7
5.2
10.5
13.8
20.6
9.6
11.5
15.5
19.0
24.1
14.2
6.1
4.6
(7.6)
7.4
(34.4)
18.6
(20.6)
15.5
8.5
4.2
30.3
11.2
28.7
16.0
21.3
10.3
26.7
17.0
17.8
15.2
3.6
(10.1)
8.5
(4.4)
24.6
17.2
20.7
11.2
7.1
3.8
12.4
15.0
20.8
18.3
13.1
14.0
21.3
16.2
25.2
12.2
24.0
12.8
(7.5)
9.8
†
15.9
†
(13.7)
11.2
3.7
27.2
10.9
38.4
16.3
22.7
11.4
30.9
13.8
18.4
13.3
19.2
12.0
8.9
(9.6)
(15.6)
(17.9)
(22.9)
(9.5)
7.1
5.8
16.8
10.8
26.0
20.7
17.3
12.3
20.8
15.9
24.7
12.0
19.8
11.3
(13.1)
8.8
†
16.8
†
†
11.0
3.1
45.8
9.9
34.3
15.4
22.6
11.2
32.0
14.0
17.5
13.3
16.4
10.3
11.0
(7.1)
(24.7)
(16.4)
†
†
5.8
5.1
18.5
13.6
23.0
17.7
16.1
12.8
21.4
14.6
24.4
14.2
16.4
8.4
2.2
7.5
(30.3)
18.3
(20.6)
14.5
9.9
5.0
21.9
11.4
30.8
16.6
21.4
10.7
27.2
16.8
18.3
15.0
9.4
(15.3)
6.0
(4.5)
22.5
17.7
20.9
10.3
8.0
5.5
14.0
11.7
21.9
20.9
14.5
13.1
21.1
16.7
24.5
14.7
18.0
11.2
7.2
8.7
32.1
22.2
(21.0)
15.3
10.1
3.6
26.1
13.7
32.1
16.1
21.4
11.5
28.6
17.0
19.0
17.8
14.3
†
8.0
†
24.6
(26.1)
21.7
10.3
7.6
5.5
15.0
18.3
23.2
23.8
16.0
17.5
21.9
18.0
19.4
18.5
16.9
12.8
10.9
5.3
(28.1)
24.8
†
16.2
7.0
6.9
25.8
14.8
25.9
22.5
17.9
15.4
23.3
20.5
25.5
12.0
†
10.0
†
8.1
†
14.0
†
†
14.4
4.0
63.0
8.0
29.2
16.1
27.9
10.5
18.1
14.6
13.8
12.3
12.3
10.0
10.0
6.1
(16.8)
12.4
†
†
(2.7)
5.1
13.9
8.2
16.5
17.1
12.4
11.3
16.1
14.3
12.6
12.8
11.8
7.7
9.3
6.5
(14.3)
13.6
†
†
4.2
7.4
9.9
8.7
16.5
17.9
12.1
10.6
14.1
15.5
23.3
14.5
17.9
10.2
7.5
9.3
(27.3)
21.0
(22.9)
21.1
9.1
4.6
25.2
11.0
30.5
15.8
20.2
11.0
27.6
17.7
30.6
12.3
†
10.4
†
5.9
†
15.3
†
10.0
14.9
3.6
50.9
11.1
37.2
16.3
31.0
10.8
30.3
14.4
61
Guttmacher Institute
TABLE 10. Twelve-month failure rates by method, according to combinations of demographic and socioeconomic characteristics, for subregions (countries pooled by subregion), 43 countries, 1990–2013 (Continued)
Among the 69 poorest countries according
to FP2020
Subregion
Method and combination of characteristics*
Withdrawal
Wealth
Lower three quintiles
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
Upper two quintiles
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
Residence
Urban
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Rural
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Secondary or more
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Parity
0–2 children
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
≥3 children
Age
<25
≥25
Contraceptive intention
For spacing
For limiting
Education
Completed primary or less
Secondary or more
Contraceptive intention
For spacing
Age
<25
≥25
For limiting
Age
<25
≥25
Total
Eastern Africa
Northern Africa
Western Africa and Western Asia
Eastern Europe
and Central Asia
Southern Asia
Southeastern
Asia
Latin America
and the
Caribbean
Yes
No
23.6
12.8
18.5
14.3
(16.4)
10.0
26.5
14.1
19.5
11.4
14.7
7.8
27.3
12.9
25.7
12.0
20.8
11.8
25.0
13.3
17.7
14.6
15.2
16.8
12.1
†
18.5
16.6
16.9
13.0
12.6
7.4
17.5
14.9
20.9
12.9
15.8
12.7
18.9
15.4
14.3
17.2
16.4
†
11.7
(13.0)
15.3
18.3
†
14.0
9.1
12.4
12.5
18.9
16.2
19.6
13.3
15.9
15.4
17.5
21.2
10.1
16.9
11.6
7.3
5.5
26.8
11.3
18.0
9.9
12.5
7.6
18.2
9.9
25.0
9.4
15.6
9.1
24.6
10.9
15.5
10.5
14.1
11.3
6.3
(4.6)
17.7
12.0
14.1
12.0
12.2
5.4
13.4
9.2
18.4
9.8
12.8
8.1
17.7
11.9
11.7
13.8
12.7
14.4
(7.6)
5.4
13.6
15.2
†
12.9
7.2
9.5
10.6
11.7
11.4
17.6
10.7
11.0
13.1
15.3
23.8
11.6
(10.7)
12.2
6.9
6.8
29.0
12.4
17.4
10.9
8.8
7.5
22.2
12.0
25.1
11.2
15.6
10.2
26.4
12.0
17.3
12.7
12.6
†
6.7
(7.2)
18.4
14.6
15.4
11.4
11.2
4.1
17.2
10.3
19.8
12.1
14.1
8.1
18.6
13.8
21.5
11.8
19.9
13.2
(17.0)
6.8
22.7
14.1
20.3
10.7
15.6
7.8
24.8
11.6
26.0
10.7
20.1
10.7
22.6
12.9
15.9
13.5
15.3
15.2
10.7
†
17.6
15.6
15.8
13.4
13.1
7.5
14.7
13.7
19.5
12.0
14.4
11.8
18.0
14.7
20.5
10.9
18.9
13.1
†
8.4
22.2
11.9
†
†
15.4
6.3
19.3
10.2
24.5
11.1
17.9
10.4
23.4
11.4
14.9
12.5
14.7
15.2
9.6
(10.1)
16.0
14.4
†
†
12.0
6.2
13.0
11.2
18.1
12.2
14.2
10.5
16.2
14.1
23.7
12.1
(14.9)
12.5
8.8
5.7
28.7
13.4
19.0
10.6
12.3
9.2
26.6
12.5
25.9
10.9
19.0
10.6
25.2
12.7
17.4
13.5
14.6
†
7.1
(4.2)
18.6
15.4
15.5
12.5
12.7
6.6
17.0
13.8
20.6
11.8
14.3
11.0
18.9
14.3
22.3
11.8
16.8
11.0
7.9
6.6
26.1
13.1
18.6
11.2
13.9
8.6
23.5
11.9
25.3
11.3
18.3
10.8
24.3
12.3
17.6
14.2
14.9
†
7.2
†
19.7
15.9
15.8
13.3
12.8
6.8
15.8
15.4
20.7
12.9
14.7
12.5
19.4
14.6
15.4
16.6
16.6
11.4
(8.3)
6.9
16.0
18.8
†
14.2
11.0
11.2
13.3
16.6
18.4
19.7
14.2
14.2
16.5
17.5
28.3
11.5
†
13.6
†
6.9
(34.7)
12.9
†
9.3
(10.8)
6.9
37.2
11.4
27.5
10.6
20.7
10.3
35.5
12.4
12.7
12.1
14.3
14.5
9.2
6.9
12.1
14.2
†
9.7
10.9
6.2
14.6
11.3
12.9
11.5
12.8
10.0
12.5
13.6
11.9
12.6
13.9
(17.2)
10.3
6.1
13.5
13.9
†
10.1
7.2
7.4
10.8
12.9
12.3
10.8
11.2
10.3
12.8
13.8
22.7
12.4
17.6
12.3
9.8
7.0
26.1
13.6
20.9
12.4
14.2
10.9
22.6
11.8
26.0
11.7
18.3
11.2
25.8
13.2
22.6
11.2
†
13.9
†
6.1
27.4
12.6
17.7
10.0
11.5
5.7
30.0
11.6
21.7
10.3
19.4
10.0
23.2
11.8
*Age and contraception intention were measured at the end of the episode of contraceptive use; wealth, education and residence were measured at the time of the survey interview. †Not reported because there were fewer than 125
episodes of use for that method. Note: Values in parentheses indicate calculations were based on 125–249 episodes of use for that method. Note : FP2020=Family Planning 2020 (see footnote in Table 8 for details).
62
Guttmacher Institute
Guttmacher Institute
19
TABLE 11. Twelve-month failure rates according to method, by residence and age, 43 countries,
1990–2013
Residence
and age
12-month failure rate*
Implants
IUD
Injectables
Pill
Male
condom
Withdrawal
Periodic
abstinence
Urban
<25 y
0.2
3.8
4.4
8.5
8.2
23.8
24.1
≥25 y
0.4
1.4
2.2
4.5
5.4
11.6
14.2
<25 y
1.0
2.7
2.9
8.1
10.3
20.5
25.2
≥25 y
0.8
0.8
1.3
4.2
5.4
10.9
12.2
Rural
*Number of failures per 100 episodes of use.
TABLE 12. Twelve-month failure rates according to study or other data source
Method
Median 12-month failure rate* (95% CI)
Current study†
Study of Ali et al.
na
14
12-month typical-use failure rate*
estimated from U.S. data (95% CI)27
Implant
0.6 (0.0–2.4)
IUD
1.4 (0.0–2.4)
1.1
0.8 (0.4–1.2) (ParaGard)§
0.05 (Implanon) ‡
Injectable
1.7 (0.6–2.9)
1.5
6 (Depo-Provera)**
Pill
5.5 (3.5–7.3)
5.6
9 (COC, POP)**
Male condom
5.4 (2.3–8.7)
7.6
18**
Withdrawal
13.4 (9.1–17.1)
15.3
22**
Periodic abstinence
(largely calendar rhythm)
13.9 (9.2–19.3)
17.4
24** (largely calendar rhythm) ***
*Number of failures per 100 episodes of use. †Median CIs are calculated as a median of all CIs. ‡No clinical study has
reported an Implanon failure, but pregnancies during its use have been reported; thus typical-use (and perfect-use)
failure rates for this implant were arbitrarily set at 0.05; 95% CIs were not provided.27 §Estimate derived from 1979
study of 3,536 women using the TCu 380A IUD.28 95% CI calculated from one-year gross cumulative pregnancy rate per
100 women accepting the TCu 380A IUD (0.8) and the associated standard error (0.2) provided in Table 8 of the study
by Sivin and Stern.28 **Weighted averages of estimates derived from the 1995 and 2002 National Surveys of Family
Growth, corrected for abortion underreporting; 95% CIs were not provided.27 ***The overwhelming majority of women
using fertility awareness-based methods (FABMs) in the NSFG are believed to be using calendar rhythm, although this
could also include women using newer FABM methods such as Standard Days, TwoDay, Ovulation, or Symptothermal.
Notes: CI=confidence interval (when available). na=not available (method was not assessed). COC=combined oral
contraceptive pill. POP=progestin-only pill.
63
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unintended pregnancies worldwide in 2012 and recent
trends, Studies in Family Planning, 2014, 45(3):301–314.
13. Kost K et al., Estimates of contraceptive failure from
the 2002 National Survey of Family Growth, Contraception,
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Costs and Benefits of Investing in Sexual and Reproductive
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14. Ali MM, Cleland J and Shah I, Causes and
Consequences of Contraceptive Discontinuation: Evidence
From 60 Demographic and Health Surveys, Geneva: World
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17. Wachter K, Essential Demographic Methods,
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6. Sedgh G et al., Induced abortion: incidence and
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65
APPENDIX TABLE 1. Subregion populations and population coverage for pooled subregional failure
rates, 43 countries
Subregion and country
Eastern Africa
Burundi
Comoros
Ethiopia
Kenya
Malawi
Mozambique
Rwanda
Tanzania
Uganda
Zimbabwe
Population of women age 15-49 in regional countries in analysis
% population coverage
66
Population of women
15–49, 2015, in 000s
93,569
2,557
183
23,972
11,405
3,927
6,237
3,157
11,930
8,934
3,905
76,207
81
Western Africa
Benin
Burkina Faso
Niger
Nigeria
Senegal
Population of women age 15-49 in regional countries in analysis
% population coverage
80,710
2,612
4,177
3,996
41,363
3,644
55,791
69
Northern Africa and Western Asia
Armenia
Azerbaijan
Egypt
Jordan
Morocco
Turkey
Population of women age 15-49 in regional countries in analysis
% population coverage
120,956
721
2,690
21,659
2,069
9,254
20,663
57,057
47
Eastern Europe and Central Asia
Kazakhstan
Kyrgyz Republic
Moldova
Tajikistan
Ukraine
Population of women age 15-49 in regional countries in analysis
% population coverage
89,395
4,433
1,528
879
2,226
10,873
19,940
22
20
Guttmacher Institute
Guttmacher Institute
APPENDIX TABLE 1. Subregion populations and population coverage for pooled subregional failure
rates, 43 countries
Subregion and country
Southern Asia
Bangladesh
India
Maldives
Nepal
Pakistan
Population of women age 15-49 in regional countries in analysis
% population coverage
Population of women
15–49, 2015, in 000s
470,589
45,235
331,934
103
7,928
49,269
434,469
92
Southeastern Asia
Cambodia
Indonesia
Philippines
Viet Nam
Population of women age 15-49 in regional countries in analysis
% population coverage
170,976
4,204
68,145
26,314
26,074
124,737
73
Latin America and the Caribbean
Bolivia
Brazil
Colombia
Dominican Republic
Guatemala
Honduras
Paraguay
Peru
Population of women age 15-49 in regional countries in analysis
% population coverage
168,716
2,817
55,548
13,254
2,766
4,112
2,227
1,821
8,279
90,824
54
Guttmacher Institute
67
21
APPENDIX TABLE 2. Numbers of women and episodes of contraceptive use (unweighted), 43 countries, 1990–2013
No. of women
15–49
Subregion, country and survey year
Eastern Africa
Burundi 2010
9,389
Comoros 2012
5,329
Ethiopia 2005
14,070
Kenya 2003
8,195
Malawi 2004
11,698
Mozambique 2011
13,745
Rwanda 2010
13,671
Tanzania 2004–05
10,329
Uganda 2011
8,674
Zimbabwe 2010–11
9,171
Western Africa
Benin 2011–12
16,599
Burkina Faso 2010
17,087
Niger 2012
11,160
Nigeria 2013
38,948
Senegal 2010–11
15,688
Northern Africa and Western Asia
Armenia 2010
5,922
Azerbaijan 2006
8,444
Egypt 2008
16,527
Jordan 2012
11,352
Morocco 2003–04
16,798
Turkey 2003
8,075
Eastern Europe and Central Asia
Kazakhstan 1999
4,800
Kyrgyz Republic 2012
8,208
Moldova 2005
7,440
Tajikistan 2012
9,656
Ukraine 2007
6,841
Southern Asia
Bangladesh 2011
17,749
India 2005–06
124,385
Maldives 2009
7,131
Nepal 2011
12,674
Pakistan 2012–13
13,557
Southeastern Asia
Cambodia 2010
18,754
Indonesia 2012
45,607
Philippines 2003
13,633
Viet Nam 2002
5,665
Latin America and the Caribbean
Bolivia 1994
8,603
Brazil 1996
12,612
Colombia 2010
49,562
Dominican Republic 2002
23,384
Guatemala 1998–99
6,021
Honduras 2011–12
22,757
Paraguay 1990
5,827
Peru 2012
23,888
No. of episodes of contraceptive use
Male
Periodic
Injectables
Implants
condom
abstinence
Pill
IUD
Withdrawal
328
131
748
953
468
1,225
1,038
1,226
498
3,369
139
4
30
113
10
24
37
16
42
13
1,112
249
1,486
1,193
2,985
959
3,068
1,362
1,747
852
42
64
26
86
43
4
539
31
179
196
140
123
148
355
511
792
270
514
439
536
173
141
191
656
93
20
298
328
144
6
195
112
46
81
514
13
334
482
225
103
394
786
1,626
1,087
688
72
36
18
276
54
418
1,325
531
1,281
982
157
547
46
78
137
611
588
19
2,178
182
475
202
22
868
67
183
12
10
1,216
24
69
104
3,161
2,402
6,144
888
207
352
4,726
2,438
493
1,200
0
3
1,753
328
428
173
0
0
144
56
0
0
410
187
130
1,243
244
1,240
104
178
67
555
597
139
841
1,795
41
3,210
670
2,931
380
191
452
237
348
1,075
1,144
905
1,037
553
57
53
9
165
5
0
0
2
4
0
581
614
925
257
1,559
294
23
244
5
405
231
162
1,258
144
646
6,755
6,142
511
1,165
627
138
2,716
40
122
467
2,588
227
157
1,800
968
189
2
23
108
16
1,578
7,872
1,051
1,131
1,973
1,101
5,228
211
119
123
350
3,734
406
903
1,370
2,264
6,145
1,998
502
289
791
315
1,211
1,440
11,975
698
22
68
1,256
1
0
346
608
366
409
407
514
819
411
1,350
852
1,258
868
544
3,713
6,569
6,622
422
4,590
1,392
4,091
451
118
2,171
491
77
1,048
224
287
192
393
9,500
1,050
312
6,497
740
6,835
2
0
1,137
107
0
4
0
11
209
1,196
8,353
1,033
136
3,343
271
5,148
2,181
575
1,414
656
298
990
499
4,252
258
637
2,690
931
90
2,683
179
2,404
Note : Episodes presented are the number contributing to month 1 of the life table.
22
68
Guttmacher Institute
Guttmacher Institute
APPENDIX TABLE 3. Sensitivity analysis showing how failure rates are affected under different assumptions of the length of left-truncated episodes, 43 countries,
1990–2013
Method, subregion, country and
survey year
Pill
Eastern Africa
Burundi 2010
Comoros 2012
Ethiopia 2005
Kenya 2003
Malawi 2004
Mozambique 2011
Rwanda 2010
Tanzania 2004–05
Uganda 2011
Zimbabwe 2010–11
Western Africa
Benin 2011–12
Burkina Faso 2010
Niger 2012
Nigeria 2013
Senegal 2010–11
Northern Africa and Western Asia
Armenia 2010
Azerbaijan 2006
Egypt 2008
Jordan 2012
Morocco 2003–04
Turkey 2003
Eastern Europe and Central Asia
Kazakhstan 1999
Kyrgyz Republic 2012
Moldova 2005
Tajikistan 2012
Ukraine 2007
Southern Asia
Bangladesh 2011
India 2005–06
Maldives 2009
Nepal 2011
Pakistan 2012–13
Southeastern Asia
Cambodia 2010
Indonesia 2012
Philippines 2003
Viet Nam 2002
Latin America and the Caribbean
Bolivia 1994
Brazil 1996
Colombia 2010
Dominican Republic 2002
Guatemala 1998–99
Honduras 2011–12
Paraguay 1990
Peru 2012
Average difference
Max difference
Guttmacher Institute
12-month failure rates*
Absolute
difference
Min Standard
Max
Min
Max
Min
24-month failure rates*
Absolute
difference
Standard
Max
Min
Max
Min
36-month failure rates*
Absolute
difference
Standard
Max
Min
Max
7.3
1.8
2.6
3.8
6.8
3.1
3.8
7.6
1.9
2.8
4.0
6.8
3.3
3.8
7.6
2.1
2.8
4.2
6.8
3.3
3.8
-0.2
-0.1
-0.2
-0.2
0.0
-0.1
0.0
0.0
0.2
0.0
0.2
0.1
0.0
0.0
11.1
6.4
4.1
6.9
8.4
4.5
7.2
11.9
8.0
4.4
7.0
8.6
4.8
7.4
11.9
8.0
4.5
7.3
8.8
4.8
7.5
-0.8
-1.6
-0.3
0.0
-0.2
-0.3
-0.3
0.0
0.0
0.1
0.3
0.2
0.0
0.0
12.9
8.7
4.9
7.9
8.9
6.3
9.3
14.6
11.4
5.5
8.1
9.0
7.2
9.7
14.6
11.9
5.5
9.0
9.6
7.2
9.8
-1.7
-2.8
-0.7
-0.2
-0.1
-0.8
-0.4
0.0
0.5
0.0
0.8
0.6
0.0
0.1
8.8
9.4
9.4
-0.6
0.0
11.0
11.8
11.8
-0.7
0.0
12.2
12.5
12.9
-0.3
0.4
1.9
0.9
2.6
1.9
0.9
2.8
2.2
0.9
2.8
0.0
-0.1
-0.2
0.3
0.0
0.0
3.1
2.0
6.4
3.2
2.3
7.9
3.6
2.3
8.0
-0.2
-0.3
-1.5
0.4
0.0
0.1
4.1
2.3
8.9
4.7
2.7
10.6
5.1
2.7
10.7
-0.6
-0.4
-1.7
0.4
0.0
0.1
5.1
5.8
6.2
6.1
6.2
6.4
-1.1
-0.4
0.0
0.3
8.3
10.0
10.1
10.3
10.1
10.6
-1.8
-0.3
0.0
0.3
9.9
11.5
11.6
11.8
11.6
12.3
-1.7
-0.4
0.0
0.4
5.5
5.5
5.8
0.0
0.3
7.7
7.7
8.5
0.0
0.7
8.5
8.5
10.0
0.0
1.6
9.3
8.4
4.8
4.9
2.3
9.9
9.8
5.1
5.3
2.4
9.9
9.8
5.3
5.4
2.7
-0.5
-1.4
-0.3
-0.5
-0.1
0.0
0.0
0.2
0.1
0.3
11.7
12.4
7.7
7.3
3.1
12.7
13.1
8.9
7.3
3.4
13.1
14.2
9.0
8.8
3.6
-1.0
-0.7
-1.2
0.0
-0.2
0.4
1.1
0.1
1.5
0.3
12.5
13.3
9.5
8.9
3.6
13.2
13.7
10.2
8.9
3.8
13.7
15.9
10.4
10.5
4.4
-0.7
-0.4
-0.7
0.0
-0.2
0.5
2.2
0.2
1.6
0.7
3.9
4.3
4.3
-0.3
0.0
6.9
7.1
7.1
-0.3
0.0
9.0
9.5
9.6
-0.5
0.0
2.5
2.9
2.7
3.0
2.7
3.0
-0.2
-0.1
0.0
0.0
4.2
4.3
4.8
4.3
4.8
4.5
-0.6
0.0
0.0
0.1
5.3
5.1
6.5
5.4
6.5
5.5
-1.2
-0.3
0.0
0.1
1.9
3.0
3.5
2.2
3.2
3.7
2.2
3.2
3.7
-0.2
-0.2
-0.2
0.0
0.0
0.0
3.1
4.8
5.7
3.2
4.9
6.1
3.3
5.1
6.2
-0.1
-0.1
-0.3
0.1
0.2
0.1
4.1
6.1
7.1
4.5
6.1
7.4
4.5
6.5
7.6
-0.4
0.0
-0.3
0.0
0.3
0.3
5.1
4.2
4.8
6.8
5.1
4.8
5.0
6.9
5.8
4.8
5.0
7.0
0.0
-0.6
-0.2
-0.1
0.6
0.0
0.0
0.0
8.2
6.9
7.1
10.4
8.3
7.6
7.1
10.9
9.5
7.6
7.3
10.9
-0.2
-0.7
0.0
-0.6
1.2
0.0
0.1
0.0
9.6
8.5
8.3
11.7
9.8
8.9
8.3
12.4
10.8
9.1
8.7
12.5
-0.2
-0.4
0.0
-0.7
1.0
0.2
0.4
0.1
2.5
2.8
2.7
2.8
2.8
2.9
-0.2
0.0
0.1
0.1
3.7
3.7
4.2
3.7
4.3
4.0
-0.4
0.0
0.1
0.3
4.4
4.3
5.2
4.3
5.2
4.6
-0.8
0.0
0.0
0.3
-0.3
-1.4
0.1
0.6
-0.5
-1.8
0.3
1.5
-0.6
-2.8
0.4
2.2
23
69
APPENDIX TABLE 3. Sensitivity analysis showing how failure rates are affected under different assumptions of the length of left-truncated episodes, 43 countries,
1990–2013 (Continued)
Method, subregion, country and
survey year
IUD
Eastern Africa
Burundi 2010
Comoros 2012
Ethiopia 2005
Kenya 2003
Malawi 2004
Mozambique 2011
Rwanda 2010
Tanzania 2004–05
Uganda 2011
Zimbabwe 2010–11
Western Africa
Benin 2011–12
Burkina Faso 2010
Niger 2012
Nigeria 2013
Senegal 2010–11
Northern Africa and Western Asia
Armenia 2010
Azerbaijan 2006
Egypt 2008
Jordan 2012
Morocco 2003–04
Turkey 2003
Eastern Europe and the Caucasus
Kazakhstan 1999
Kyrgyz Republic 2012
Moldova 2005
Tajikistan 2012
Ukraine 2007
Southern Asia
Bangladesh 2011
India 2005–06
Maldives 2009
Nepal 2011
Pakistan 2012–13
Southeastern Asia
Cambodia 2010
Indonesia 2012
Philippines 2003
Viet Nam 2002
Latin America and the Caribbean
Bolivia 1994
Brazil 1996
Colombia 2010
Dominican Republic 2002
Guatemala 1998–99
Honduras 2011–12
Paraguay 1990
Peru 2012
Average difference
Max difference
24
70
12-month failure rates*
Absolute
difference
Min Standard
Max
Min
Max
Min
24-month failure rates*
Absolute
difference
Standard
Max
Min
Max
Min
36-month failure rates*
Absolute
difference
Standard
Max
Min
Max
3.1
3.7
3.7
-0.6
0.0
6.6
7.7
7.7
-1.1
0.0
7.1
7.7
8.2
-0.6
0.5
0.9
1.0
1.1
-0.1
0.2
1.0
1.0
1.5
0.0
0.5
1.0
1.0
1.5
0.0
0.5
0.0
0.9
0.6
1.5
0.0
0.9
0.9
1.5
0.5
1.1
0.9
1.7
0.0
0.0
-0.3
0.0
0.5
0.2
0.0
0.2
0.0
1.1
1.4
2.6
0.0
1.3
2.1
2.9
0.5
1.6
2.1
3.0
0.0
-0.1
-0.7
-0.3
0.5
0.4
0.0
0.1
0.7
1.4
1.9
3.3
0.7
1.4
2.8
3.7
1.2
1.9
2.8
3.9
0.0
0.0
-0.8
-0.4
0.5
0.4
0.0
0.2
1.1
1.5
1.5
-0.3
0.0
1.7
2.1
2.1
-0.3
0.0
2.0
2.1
2.5
-0.1
0.3
2.8
0.3
1.2
0.2
0.3
3.1
0.3
1.3
0.4
0.5
3.1
0.5
1.3
0.4
0.5
-0.3
0.0
-0.1
-0.2
-0.2
0.0
0.2
0.0
0.0
0.0
4.4
1.3
1.8
0.9
0.6
5.1
1.6
2.4
1.1
1.0
5.2
2.0
2.5
1.1
1.0
-0.7
-0.3
-0.7
-0.2
-0.4
0.0
0.3
0.1
0.0
0.0
5.2
2.4
2.6
1.2
1.0
5.6
2.8
3.7
1.5
1.0
6.3
2.9
3.8
1.6
1.2
-0.4
-0.4
-1.1
-0.3
0.0
0.7
0.1
0.1
0.1
0.2
1.4
1.6
1.6
-0.2
0.0
1.4
1.6
1.6
-0.2
0.0
1.4
1.6
1.6
-0.2
0.0
0.3
0.2
0.4
0.3
0.2
0.6
0.3
0.3
0.6
-0.1
0.0
-0.2
0.0
0.1
0.0
0.3
0.5
0.4
0.3
0.6
0.6
0.3
0.7
0.6
-0.1
-0.1
-0.2
0.0
0.1
0.0
0.3
0.9
0.6
0.3
1.5
0.6
0.3
1.6
1.1
-0.1
-0.6
0.0
0.0
0.1
0.5
1.1
1.6
1.6
-0.5
0.0
1.8
1.8
2.1
0.0
0.4
1.8
1.8
2.9
0.0
1.1
2.5
1.9
2.8
2.0
2.8
2.0
-0.3
-0.1
0.0
0.0
3.8
2.7
4.4
3.0
4.4
3.2
-0.6
-0.4
0.0
0.1
4.5
2.9
5.4
3.0
5.6
3.5
-0.9
-0.1
0.2
0.5
1.7
0.2
2.2
0.2
2.2
0.2
-0.5
0.0
0.0
0.0
2.7
0.6
3.7
1.1
3.7
1.1
-1.0
-0.5
0.0
0.0
3.4
0.9
4.8
1.3
4.8
1.4
-1.4
-0.4
0.0
0.1
-0.2
-0.6
0.1
0.5
-0.4
-1.1
0.1
0.5
-0.4
-1.4
0.3
1.1
Guttmacher Institute
Guttmacher Institute
APPENDIX TABLE 3. Sensitivity analysis showing how failure rates are affected under different assumptions of the length of left-truncated episodes, 43 countries,
1990–2013 (Continued)
Method, subregion, country and
survey year
Injectables
Eastern Africa
Burundi 2010
Comoros 2012
Ethiopia 2005
Kenya 2003
Malawi 2004
Mozambique 2011
Rwanda 2010
Tanzania 2004–05
Uganda 2011
Zimbabwe 2010–11
Western Africa
Benin 2011–12
Burkina Faso 2010
Niger 2012
Nigeria 2013
Senegal 2010–11
Northern Africa and Western Asia
Armenia 2010
Azerbaijan 2006
Egypt 2008
Jordan 2012
Morocco 2003–04
Turkey 2003
Eastern Europe and the Caucasus
Kazakhstan 1999
Kyrgyz Republic 2012
Moldova 2005
Tajikistan 2012
Ukraine 2007
Southern Asia
Bangladesh 2011
India 2005–06
Maldives 2009
Nepal 2011
Pakistan 2012–13
Southeastern Asia
Cambodia 2010
Indonesia 2012
Philippines 2003
Viet Nam 2002
Latin America and the Caribbean
Bolivia 1994
Brazil 1996
Colombia 2010
Dominican Republic 2002
Guatemala 1998–99
Honduras 2011–12
Paraguay 1990
Peru 2012
Average difference
Max difference
Guttmacher Institute
12-month failure rates*
Absolute
difference
Min Standard
Max
Min
Max
Min
24-month failure rates*
Absolute
difference
Standard
Max
Min
Max
Min
36-month failure rates*
Absolute
difference
Standard
Max
Min
Max
1.7
1.4
0.3
0.8
1.2
1.3
1.2
1.7
1.4
0.3
1.0
1.4
1.4
1.2
1.8
2.4
0.3
1.0
1.4
1.4
1.2
0.0
0.0
0.0
-0.1
-0.1
-0.1
0.0
0.0
1.0
0.0
0.0
0.0
0.0
0.0
2.7
3.9
0.9
1.6
2.7
1.3
2.3
2.7
3.9
1.0
1.9
3.0
1.4
2.4
3.3
5.3
1.0
1.9
3.0
1.4
2.4
0.0
0.0
-0.1
-0.3
-0.2
-0.1
-0.1
0.6
1.4
0.0
0.0
0.0
0.0
0.0
3.4
4.5
1.5
2.3
3.5
1.8
3.2
3.4
4.8
1.8
3.1
4.0
2.0
3.3
4.0
6.1
1.8
3.1
4.0
2.2
3.4
0.0
-0.3
-0.3
-0.8
-0.5
-0.3
-0.1
0.6
1.3
0.0
0.0
0.0
0.2
0.1
3.3
3.5
3.5
-0.3
0.0
4.9
5.4
5.4
-0.4
0.0
5.6
5.7
5.8
-0.1
0.1
0.2
0.1
1.6
0.3
0.2
1.7
0.3
0.2
1.9
0.0
0.0
-0.1
0.0
0.0
0.2
0.5
0.5
3.7
0.6
0.6
4.2
0.6
0.6
4.2
-0.1
-0.2
-0.5
0.0
0.0
0.0
0.5
0.5
0.5
0.6
0.6
5.5
0.6
0.6
0.6
-0.1
-0.2
-0.2
0.0
0.0
0.0
0.8
1.9
0.9
1.9
0.9
2.7
-0.1
0.0
0.0
0.8
1.3
3.3
1.3
3.3
1.6
4.4
-0.1
0.0
0.3
1.1
1.6
3.3
1.6
3.3
2.1
5.0
0.0
0.0
0.5
1.7
3.2
3.2
3.2
0.0
0.0
3.6
3.6
3.9
-0.1
0.3
4.1
4.9
4.9
-0.8
0.0
0.0
0.0
0.0
0.0
0.0
0.1
0.2
1.0
-0.1
0.8
1.4
2.6
2.6
-1.2
0.0
1.2
1.2
1.2
0.0
0.0
2.2
2.2
2.3
-0.1
0.1
2.7
2.7
3.0
0.0
0.3
0.3
0.5
0.3
0.6
0.3
0.6
0.0
-0.1
0.0
0.0
0.3
0.7
0.3
0.9
0.3
0.9
0.0
-0.1
0.0
0.0
0.3
0.9
0.3
1.0
0.3
1.1
0.0
-0.2
0.0
0.1
1.5
0.4
1.2
1.5
0.4
1.3
1.7
0.6
1.3
0.0
0.0
-0.1
0.2
0.2
0.0
2.4
1.0
1.9
2.4
1.0
2.1
2.8
1.2
2.5
0.0
0.0
-0.2
0.4
0.1
0.4
3.1
1.6
2.4
3.4
1.8
2.4
4.2
1.8
2.9
-0.3
-0.2
0.0
0.8
0.0
0.5
3.7
3.8
3.9
4.4
4.6
4.7
3.9
4.6
4.6
4.7
4.1
4.6
-0.9
-0.8
0.0
-0.2
0.0
0.0
0.2
0.0
4.8
5.1
5.9
5.2
5.9
5.8
5.9
5.3
5.9
6.0
6.3
5.7
-1.1
-0.7
0.0
-0.1
0.0
0.2
0.4
0.4
5.4
6.5
7.1
5.9
5.9
7.7
7.1
6.0
6.0
7.7
7.7
6.3
-0.5
-1.2
0.0
-0.1
0.1
0.0
0.7
0.3
7.3
1.0
7.9
1.0
7.9
1.0
-0.6
0.0
0.0
0.0
8.0
1.4
8.8
1.5
8.8
1.5
-0.8
0.0
0.0
0.0
8.5
1.8
9.5
1.9
9.5
1.9
-1.1
-0.1
0.0
0.0
-0.1
-0.9
0.1
1.0
-0.2
-1.1
0.2
1.4
-0.3
-1.2
0.3
1.7
25
71
APPENDIX TABLE 3. Sensitivity analysis showing how failure rates are affected under different assumptions of the length of left-truncated episodes, 43 countries,
1990–2013 (Continued)
Method, subregion, country and
survey year
Implants
Eastern Africa
Burundi 2010
Comoros 2012
Ethiopia 2005
Kenya 2003
Malawi 2004
Mozambique 2011
Rwanda 2010
Tanzania 2004–05
Uganda 2011
Zimbabwe 2010–11
Western Africa
Benin 2011–12
Burkina Faso 2010
Niger 2012
Nigeria 2013
Senegal 2010–11
Northern Africa and Western Asia
Armenia 2010
Azerbaijan 2006
Egypt 2008
Jordan 2012
Morocco 2003–04
Turkey 2003
Eastern Europe and the Caucasus
Kazakhstan 1999
Kyrgyz Republic 2012
Moldova 2005
Tajikistan 2012
Ukraine 2007
Southern Asia
Bangladesh 2011
India 2005–06
Maldives 2009
Nepal 2011
Pakistan 2012–13
Southeastern Asia
Cambodia 2010
Indonesia 2012
Philippines 2003
Viet Nam 2002
Latin America and the Caribbean
Bolivia 1994
Brazil 1996
Colombia 2010
Dominican Republic 2002
Guatemala 1998–99
Honduras 2011–12
Paraguay 1990
Peru 2012
Average difference
Max difference
26
72
12-month failure rates*
Absolute
difference
Min Standard
Max
Min
Max
Min
24-month failure rates*
Absolute
difference
Standard
Max
Min
Max
Min
36-month failure rates*
Absolute
difference
Standard
Max
Min
Max
0.3
0.3
0.3
0.0
0.0
0.3
0.3
0.3
0.0
0.0
0.3
0.3
0.3
0.0
0.0
0.7
0.8
0.8
0.0
0.0
1.0
1.1
2.2
-0.1
1.1
3.6
4.8
5.3
-1.2
0.5
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.9
1.6
1.6
-0.7
0.0
1.3
2.4
2.4
-1.1
0.0
1.7
2.4
2.6
-0.8
0.2
0.7
1.1
1.1
-0.4
0.0
0.7
1.1
1.1
-0.4
0.0
0.7
1.1
1.1
-0.4
0.0
0.2
0.2
0.3
0.0
0.1
0.6
0.8
0.8
-0.2
0.0
0.8
1.0
1.2
-0.2
0.1
0.2
0.2
0.3
0.0
0.1
0.2
0.2
0.6
0.0
0.4
0.2
0.2
0.9
0.0
0.7
-0.2
-0.7
0.0
0.1
-0.2
-1.1
0.2
1.1
-0.4
-1.2
0.2
0.7
0.0
Guttmacher Institute
Guttmacher Institute
APPENDIX TABLE 3. Sensitivity analysis showing how failure rates are affected under different assumptions of the length of left-truncated episodes, 43 countries,
1990–2013 (Continued)
Method, subregion, country and
survey year
Male condom
Eastern Africa
Burundi 2010
Comoros 2012
Ethiopia 2005
Kenya 2003
Malawi 2004
Mozambique 2011
Rwanda 2010
Tanzania 2004–05
Uganda 2011
Zimbabwe 2010–11
Western Africa
Benin 2011–12
Burkina Faso 2010
Niger 2012
Nigeria 2013
Senegal 2010–11
Northern Africa and Western Asia
Armenia 2010
Azerbaijan 2006
Egypt 2008
Jordan 2012
Morocco 2003–04
Turkey 2003
Eastern Europe and the Caucasus
Kazakhstan 1999
Kyrgyz Republic 2012
Moldova 2005
Tajikistan 2012
Ukraine 2007
Southern Asia
Bangladesh 2011
India 2005–06
Maldives 2009
Nepal 2011
Pakistan 2012–13
Southeastern Asia
Cambodia 2010
Indonesia 2012
Philippines 2003
Viet Nam 2002
Latin America and the Caribbean
Bolivia 1994
Brazil 1996
Colombia 2010
Dominican Republic 2002
Guatemala 1998–99
Honduras 2011–12
Paraguay 1990
Peru 2012
Average difference
Max difference
Guttmacher Institute
12-month failure rates*
Absolute
difference
Min Standard
Max
Min
Max
Min
24-month failure rates*
Absolute
difference
Standard
Max
Min
Max
Min
36-month failure rates*
Absolute
difference
Standard
Max
Min
Max
2.5
2.5
3.2
0.0
0.7
2.5
2.5
3.4
0.0
0.9
5.1
5.2
6.2
-0.1
1.0
1.0
3.2
2.3
2.2
5.2
1.3
3.7
2.5
2.3
5.2
1.3
3.7
2.5
2.3
5.5
-0.3
-0.5
-0.2
-0.1
-0.1
0.0
0.0
0.0
0.0
0.3
5.5
5.5
5.1
3.5
8.2
7.9
6.4
5.9
3.8
8.5
7.9
6.4
5.9
3.8
9.1
-2.4
-0.9
-0.8
-0.3
-0.3
0.0
0.0
0.0
0.0
0.5
9.1
7.6
5.9
4.1
9.1
11.7
9.5
7.1
4.6
9.6
11.8
9.5
7.1
4.6
10.4
-2.6
-2.0
-1.2
-0.4
-0.5
0.1
0.0
0.0
0.1
0.8
3.7
3.9
3.9
-0.2
0.0
8.5
9.0
10.1
-0.5
1.1
9.9
10.0
12.4
-0.2
2.3
1.3
1.6
1.6
-0.3
0.0
2.3
2.6
2.6
-0.3
0.0
2.9
3.2
3.4
-0.3
0.2
1.8
1.9
1.9
-0.1
0.0
3.6
3.9
3.9
-0.3
0.0
4.8
4.8
5.1
-0.1
0.3
2.7
7.3
7.1
11.2
3.0
9.7
8.2
11.9
3.0
9.7
8.8
11.9
-0.3
-2.4
-1.0
-0.7
0.0
0.0
0.7
0.0
6.7
9.7
10.7
16.8
6.8
12.5
12.7
18.4
8.3
12.5
13.5
18.4
-0.1
-2.8
-2.1
-1.6
1.5
0.0
0.7
0.0
8.5
12.9
12.7
21.4
9.1
19.3
12.7
25.2
11.3
19.3
14.6
25.2
-0.6
-6.4
0.0
-3.7
2.1
0.0
1.9
0.0
5.5
5.7
5.7
-0.1
0.0
8.8
9.8
9.8
-1.1
0.0
10.2
12.0
12.3
-1.9
0.3
10.0
10.2
4.4
5.3
2.8
10.5
11.5
5.0
5.3
3.0
10.5
11.5
5.0
5.9
3.0
-0.5
-1.3
-0.6
0.0
-0.2
0.0
0.0
0.0
0.7
0.0
14.6
17.8
7.7
8.9
4.1
15.3
19.1
8.8
9.3
4.4
15.4
19.4
8.8
9.8
4.6
-0.7
-1.3
-1.1
-0.4
-0.3
0.0
0.2
0.0
0.5
0.2
17.3
22.5
10.4
9.1
5.3
18.8
22.8
11.8
9.6
6.1
18.9
24.1
11.8
11.2
6.1
-1.4
-0.3
-1.4
-0.5
-0.8
0.2
1.3
0.0
1.5
0.0
7.8
7.8
8.1
0.0
0.3
11.9
11.9
12.3
0.0
0.5
13.7
13.7
14.8
0.0
1.0
4.0
3.6
4.1
4.0
4.1
4.0
-0.1
-0.4
0.0
0.0
6.3
5.8
7.0
6.6
7.0
6.6
-0.7
-0.8
0.0
0.0
8.0
6.6
8.9
8.0
8.9
8.0
-0.9
-1.4
0.0
0.1
2.9
1.9
7.7
3.5
2.1
7.7
3.5
2.1
8.7
-0.6
-0.2
0.0
0.0
0.0
1.0
7.7
2.9
10.4
10.7
3.3
10.4
10.7
3.8
11.5
-3.0
-0.4
0.0
0.0
0.5
1.1
8.7
4.9
12.9
11.5
6.4
13.8
11.5
6.6
14.1
-2.8
-1.5
-0.8
0.0
0.1
0.3
5.1
4.6
3.6
2.9
5.4
5.1
3.6
2.9
5.9
5.1
3.7
3.2
-0.3
-0.5
0.0
0.0
0.5
0.0
0.0
0.4
5.4
6.9
5.4
3.7
5.4
7.8
5.4
3.7
6.9
7.8
5.5
4.2
0.0
-0.9
0.0
0.0
1.5
0.0
0.1
0.6
6.6
8.7
6.3
4.8
6.9
9.6
6.3
4.8
8.2
9.7
6.5
5.5
-0.3
-0.9
0.0
0.0
1.3
0.0
0.2
0.8
3.7
5.8
4.2
6.0
4.2
6.1
-0.5
-0.2
0.0
0.1
4.8
7.8
5.5
7.9
5.5
8.1
-0.8
0.0
0.0
0.3
6.2
9.2
7.3
9.2
7.3
9.5
-1.1
0.0
0.0
0.3
-0.4
-2.4
0.1
1.0
-0.8
-3.0
0.3
1.5
-1.1
-6.4
0.5
2.3
27
73
APPENDIX TABLE 3. Sensitivity analysis showing how failure rates are affected under different assumptions of the length of left-truncated episodes, 43 countries,
1990–2013 (Continued)
Method, subregion, country and
survey year
Periodic abstinence
Eastern Africa
Burundi 2010
Comoros 2012
Ethiopia 2005
Kenya 2003
Malawi 2004
Mozambique 2011
Rwanda 2010
Tanzania 2004–05
Uganda 2011
Zimbabwe 2010–11
Western Africa
Benin 2011–12
Burkina Faso 2010
Niger 2012
Nigeria 2013
Senegal 2010–11
Northern Africa and Western Asia
Armenia 2010
Azerbaijan 2006
Egypt 2008
Jordan 2012
Morocco 2003–04
Turkey 2003
Eastern Europe and the Caucasus
Kazakhstan 1999
Kyrgyz Republic 2012
Moldova 2005
Tajikistan 2012
Ukraine 2007
Southern Asia
Bangladesh 2011
India 2005–06
Maldives 2009
Nepal 2011
Pakistan 2012–13
Southeastern Asia
Cambodia 2010
Indonesia 2012
Philippines 2003
Viet Nam 2002
Latin America and the Caribbean
Bolivia 1994
Brazil 1996
Colombia 2010
Dominican Republic 2002
Guatemala 1998–99
Honduras 2011–12
Paraguay 1990
Peru 2012
Average difference
Max difference
28
74
12-month failure rates*
Absolute
difference
Min Standard
Max
Min
Max
24-month failure rates*
Absolute
difference
Standard
Max
Min
Max
Min
16.6
6.4
5.1
14.2
16.6
7.6
5.4
15.4
17.1
7.6
5.4
15.4
0.0
-1.2
-0.3
-1.2
0.5
0.0
0.0
0.0
21.8
7.2
10.7
26.8
21.9
7.9
12.7
28.7
22.9
8.0
12.7
29.1
0.0
-0.7
-2.0
-2.0
1.0
0.1
0.0
0.3
23.6
7.7
11.5
33.5
24.4
8.8
13.9
35.1
26.8
9.0
14.2
35.6
-0.8
-1.1
-2.3
-1.6
2.4
0.2
0.3
0.5
11.9
12.7
12.7
-0.8
0.0
20.3
21.1
21.5
-0.8
0.4
24.8
26.4
26.7
-1.6
0.3
8.4
9.8
9.8
-1.3
0.0
16.6
18.0
18.0
-1.4
0.0
20.7
20.8
22.7
0.0
1.9
9.2
10.7
10.7
-1.6
0.0
14.3
18.0
18.0
-3.7
0.0
15.0
19.2
20.0
-4.2
0.9
5.3
6.5
6.5
-1.1
0.0
8.5
10.5
10.5
-2.1
0.0
10.6
12.3
12.5
-1.7
0.2
12.4
13.8
13.8
-1.5
0.0
23.5
31.8
31.8
-8.3
0.0
28.8
36.5
36.9
-7.7
0.5
18.3
20.5
20.5
-2.2
0.0
24.1
24.9
25.0
-0.8
0.2
25.6
26.9
28.0
-1.3
1.1
17.9
19.7
19.7
-1.8
0.0
22.6
23.8
24.1
-1.2
0.4
23.2
25.0
26.6
-1.8
1.6
20.0
21.1
21.1
-1.1
0.0
25.7
29.9
29.9
-4.2
0.0
28.1
33.6
34.0
-5.5
0.4
9.8
11.4
11.4
-1.6
0.0
14.8
18.8
18.8
-4.0
0.0
17.7
23.2
23.2
-5.5
0.0
6.8
8.4
8.4
-1.6
0.0
9.7
12.1
12.1
-2.4
0.0
11.7
14.4
14.6
-2.7
0.2
4.9
5.3
5.3
-0.4
0.0
10.1
12.7
12.7
-2.6
0.0
13.2
16.5
16.8
-3.4
0.3
3.6
3.7
3.7
-0.1
0.0
6.3
8.1
8.1
-1.9
0.0
7.9
9.1
9.1
-1.2
0.0
3.7
4.5
10.5
3.7
4.6
12.5
4.3
5.3
12.5
0.0
-0.1
-2.1
0.6
0.7
0.0
8.0
9.2
19.7
9.5
11.4
22.9
9.5
12.2
22.9
-1.6
-2.2
-3.2
0.0
0.8
0.0
12.0
12.7
24.4
16.7
18.4
26.8
16.7
19.1
26.8
-4.7
-5.7
-2.4
0.0
0.7
0.0
16.9
14.8
14.3
18.3
19.6
17.0
16.8
18.7
19.6
17.0
16.8
18.7
-2.7
-2.1
-2.5
-0.4
0.0
0.0
0.0
0.0
28.5
20.7
20.0
24.2
33.3
22.9
22.6
25.9
33.3
22.9
22.6
25.9
-4.8
-2.2
-2.6
-1.7
0.0
0.0
0.0
0.0
32.6
24.4
23.3
27.0
37.4
26.0
25.9
29.5
37.8
27.1
25.9
29.5
-4.8
-1.6
-2.7
-2.6
0.4
1.1
0.0
0.0
16.1
14.0
18.5
16.3
18.5
16.3
-2.5
-2.3
0.0
0.0
26.5
20.2
30.6
22.8
30.6
22.8
-4.2
-2.6
0.0
0.0
29.5
23.8
32.6
26.4
33.1
26.5
-3.1
-2.6
0.5
0.1
-1.3
-2.7
0.1
0.7
-2.5
-8.3
0.1
1.0
-2.9
-7.7
0.5
2.4
Min
36-month failure rates*
Absolute
difference
Standard
Max
Min
Max
Guttmacher Institute
Guttmacher Institute
APPENDIX TABLE 3. Sensitivity analysis showing how failure rates are affected under different assumptions of the length of left-truncated episodes, 43 countries,
1990–2013 (Continued)
Method, subregion, country and
survey year
Withdrawal
Eastern Africa
Burundi 2010
Comoros 2012
Ethiopia 2005
Kenya 2003
Malawi 2004
Mozambique 2011
Rwanda 2010
Tanzania 2004–05
Uganda 2011
Zimbabwe 2010–11
Western Africa
Benin 2011–12
Burkina Faso 2010
Niger 2012
Nigeria 2013
Senegal 2010–11
Northern Africa and Western Asia
Armenia 2010
Azerbaijan 2006
Egypt 2008
Jordan 2012
Morocco 2003–04
Turkey 2003
Eastern Europe and the Caucasus
Kazakhstan 1999
Kyrgyz Republic 2012
Moldova 2005
Tajikistan 2012
Ukraine 2007
Southern Asia
Bangladesh 2011
India 2005–06
Maldives 2009
Nepal 2011
Pakistan 2012–13
Southeastern Asia
Cambodia 2010
Indonesia 2012
Philippines 2003
Viet Nam 2002
Latin America and the Caribbean
Bolivia 1994
Brazil 1996
Colombia 2010
Dominican Republic 2002
Guatemala 1998–99
Honduras 2011–12
Paraguay 1990
Peru 2012
Average difference
Max difference
12-month failure rates*
Absolute
difference
Min Standard
Max
Min
Max
24-month failure rates*
Absolute
difference
Standard
Max
Min
Max
Min
18.4
18.6
18.6
-0.3
0.0
28.1
28.5
30.4
-0.4
1.9
32.4
32.4
34.9
0.0
2.5
9.6
10.1
10.1
-0.5
0.0
21.6
23.8
23.8
-2.2
0.0
23.9
26.7
26.9
-2.9
0.1
13.0
14.0
14.0
-1.0
0.0
21.7
22.9
22.9
-1.2
0.0
24.7
26.7
27.5
-2.0
0.7
19.5
22.0
22.0
-2.5
0.0
29.0
31.2
31.5
-2.2
0.3
32.6
32.6
35.3
0.0
2.7
5.6
6.9
6.9
-1.3
0.0
13.0
15.0
15.0
-2.0
0.0
16.7
18.1
18.1
-1.4
0.0
11.8
14.6
14.0
18.6
14.0
18.6
-2.2
-4.0
0.0
0.0
19.2
24.0
25.8
31.3
25.8
31.4
-6.6
-7.3
0.0
0.1
23.0
28.6
30.4
37.6
30.6
37.6
-7.4
-9.0
0.2
0.0
12.1
12.8
12.8
-0.7
0.0
18.7
19.9
19.9
-1.2
0.0
22.9
24.4
24.4
-1.5
0.0
12.3
13.1
13.1
-0.8
0.0
18.7
21.2
21.2
-2.5
0.0
21.9
25.2
25.2
-3.3
0.0
17.5
5.4
10.6
4.7
7.6
17.6
6.3
12.9
6.1
8.1
18.2
6.3
12.9
6.1
8.1
-0.2
-0.8
-2.3
-1.4
-0.5
0.5
0.0
0.0
0.0
0.0
23.8
12.8
17.4
8.4
10.9
24.4
16.5
22.9
11.6
12.0
24.9
16.5
22.9
11.6
12.3
-0.6
-3.7
-5.6
-3.2
-1.1
0.5
0.0
0.0
0.0
0.3
24.2
15.5
21.4
12.8
13.5
24.4
22.0
28.5
16.9
15.6
26.8
22.0
28.5
16.9
15.8
-0.2
-6.5
-7.1
-4.1
-2.1
2.4
0.0
0.0
0.0
0.2
6.5
8.0
8.0
-1.5
0.0
12.1
15.9
15.9
-3.8
0.0
14.5
19.3
19.3
-4.9
0.0
6.4
5.8
6.4
6.7
6.8
6.7
0.0
-0.9
0.4
0.0
12.0
8.3
12.1
9.5
12.6
9.5
-0.1
-1.2
0.5
0.0
15.0
10.4
15.0
12.8
17.1
12.8
0.0
-2.4
2.1
0.0
6.9
4.9
15.7
7.8
5.5
17.2
7.8
5.5
17.2
-0.9
-0.6
-1.5
0.0
0.0
0.0
13.7
8.7
26.1
15.2
11.4
29.1
15.2
11.4
29.1
-1.5
-2.7
-3.0
0.0
0.0
0.0
17.5
11.4
30.1
19.5
16.0
33.9
19.5
16.0
33.9
-2.1
-4.6
-3.8
0.0
0.0
0.0
15.1
13.8
10.9
12.2
15.1
15.7
11.4
12.7
15.7
15.7
11.4
12.7
0.0
-1.9
-0.5
-0.5
0.6
0.0
0.0
0.0
22.8
21.0
17.4
17.1
24.5
23.4
19.1
18.0
24.7
23.4
19.1
18.0
-1.7
-2.4
-1.7
-0.9
0.2
0.0
0.0
0.0
25.9
23.7
19.8
19.1
28.6
26.7
21.6
20.1
29.3
26.7
21.9
20.2
-2.8
-3.1
-1.8
-1.0
0.6
0.0
0.2
0.1
9.8
13.5
10.6
14.1
10.6
14.1
-0.7
-0.6
0.0
0.0
15.0
19.1
15.6
19.4
16.4
19.6
-0.6
-0.4
0.8
0.2
18.7
21.3
20.3
21.6
20.7
22.6
-1.6
-0.3
0.4
1.1
-1.1
-4.0
0.1
0.6
-2.3
-7.3
0.2
1.9
-2.9
-9.0
0.5
2.7
Min
36-month failure rates*
Absolute
difference
Standard
Max
Min
Max
*Number of failures per 100 episodes of use. Notes : Minimum (Min) and maximum (Max) columns show the minimum and maximum failure rates found under a series of
simulations. Rates were simulated assuming that left-truncated episodes in fact began in the month the calendar began, and starting n months before the start of the
calendar, where n = 0, 3, 6, 9, …, 30, 33. The standard columns exclude all left-truncated episodes from the analysis.
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