Access to safe and adequate sexual and reproductive healthcare constitutes part of the Universal Declaration of Human Rights, as upheld by the United Nations.
Most countries in Africa have some of the lowest rates of contraceptive use; highest maternal, infant, and child mortality rates; and highest fertility rates in the world. 45% of pregnancies that occur among adolescents in Africa are unplanned. It is estimated that 1 in 3 pregnancies that are unintended in Africa occur among girls between the ages of 15 and 19.
Public policies and cultural attitudes play a role in birth control prevalence. Approximately 30% of all women use birth control, although over half of all African women would use birth control if it were available. The main problems that prevent the use of birth control are limited availability (especially among young people, unmarried people, and the poor), high cost, limited choice of birth control methods, lack of knowledge on side-effects, spousal disapproval or other gender-based barriers, religious concerns, and bias from healthcare providers. There is evidence that increased use of family planning methods decreases maternal and infant mortality rates, improves quality of life for mothers, and stimulates economic development. However, according to CHASE AFRICA, a charitable organisation that promotes healthcare and education for women in Kenya and Uganda, approximately 1 in 5 women who want family planning cannot access it.
Prevalence
In Africa, 24% of women of reproductive age have an unmet need for modern contraception. Low rates of contraceptive use are most prevalent in sub-Saharan African countries.
Research undertaken in 2007 led by Akinrinola Bankole found that correct and consistent condom use by those aged 14–19 was found to be 38% in Burkina Faso, 47% in Ghana, 20% in Malawi and 36% in Uganda. According to a 2008 study done by Ike Nwachukwu and Obasi in Nigeria, modern birth control methods were used by 30% of respondents.
In Uganda, NGOs are trying to make contraceptives more available in rural areas.
The Demographic Health Survey (DHS) of 2013 revealed that a mere 2% of sexually-active girls between the ages of 15 and 19 use contraceptives. 23% of the girls in this age group have children. In 2022, BMC Public Health conducted a study that examined contraceptive-use among school-going adolescents across nine sub-Saharan African countries. Not using condoms during sex was most notably associated with being younger, having limited to no parental support, being sexually inexperienced, or having multiple sexual partners at once. Although, across the nine countries, more than 50% of sexually-active participants had used a condom at their last sexual encounter. Over a third used other methods of contraceptive for their last sexual intercourse. The highest rate of contraceptive-use was found in those from Namibia, and the lowest prevalence was found to be in Tanzania. The study concluded that there remains a great need for substantial intervention into contraceptive-use.
Use of contraception is also reported to decline each year a young woman ages.
Namibia, with a contraception-use rate of 46% in 2006–07, has one of the highest rates of contraceptive-use in Africa. Senegal, with an overall rate of 8.7% in 2005, has one of the lowest.
In Sub-Saharan Africa, extreme poverty, lack of access to birth control, and restrictive abortion laws result in approximately 3% of women to have unsafe abortions.
Limited contraceptive-use contributes to an exponential rise in population across the continent. The United Nations has predicted that by 2050 the population will more than double.
Factors contributing to prevalence
A growing population, limited access to contraception, limited availability in different contraceptive methods, perceived or actual cultural stigma and religious judgement, poor quality of sexual and reproductive healthcare, and gender-based barriers, each contribute to the high "unmet need" for contraception in Africa. There needs to be consistent and effective provisions of modern contraceptives for the improvement of family planning.
There is a correlation between parental support and guidance, and the sexual health and use of contraception in young women.
In Eastern Africa, the unmet need is attributed to socioeconomic variables, including the family planning program environment and reproductive behaviour models. Data collected in the late twentieth century, suggests that high fertility rates in Sub-Saharan African countries, compared to other developing countries, is due to "the inter-related factors of early childbearing, high-infant mortality, low education and contraceptive use, and persistence of high fertility-sustaining social customs."
Referring to family projects that are underway in the Democratic Republic of Congo, an advisor to the United Nations Population Fund, Frederick Okwayo, stated that "the logistics of providing care is difficult because of the bad infrastructure." A lack of infrastructure, resulting from minimal governmental funding and a limited number of health clinics in some areas, create prominent barriers to accessing birth control.
An analysis of birth rates and fertility in Ghana found that without effective contraception, "the total number of children a woman bears is principally a function of the age at which childbearing begins." The study finds that pregnancies which occur in childhood and adolescence can be prevented by contraceptive-use.
Some of the factors identified that prevented use of modern birth control methods in a 2008 study in Nigeria were "perceived negative health reaction, fear of unknown effects, cost, spouse's disapproval, religious belief and inadequate information." According to a study titled 'Equity Analysis: Identifying Who Benefits from Family Planning Programs', the main factors that contribute to the unavailability of family planning information and modern birth control methods are low education level, young age, and living in a rural area. A 1996 study that included couples in both urban and rural Kenya who did not want have a child, yet were not using birth control, found additional factors that limited birth control use to traditional practices, such as "naming relatives" and a preference for sons who can provide more financial security to parents as they age.
Until the 1990s, contraception and family planning were associated with fears of eugenic ideology and population control, which narrowed the scope of behavior-change communication and distribution of contraceptive devices.
Patriarchal ideologies that are fostered by traditional cultural and religious beliefs, and primarily undermine the worth of female autonomy and the validity of female agency, greatly contribute to a reduction of contraceptive-use.
Fatimata Sy, who directed the Ouagadougou Partnership that launched in 2011 to increase the use of modern contraception across Africa, explained that the biggest hindrances to the movement were religion, social and gender norms and cultural taboos.
Men are frequently cited as a major factor preventing adequate birth control access in Africa. They reinforce many societal and cultural ideologies that block women from choosing and accessing sexual and reproductive healthcare. Male adolescents were also among the highest of those who used no contraception during sexual intercourse.
John Magufuli, president of Tanzania from 2015 to 2021, strongly advised women to not use birth control or any other family planning method. He stated that those who do are "lazy" and "do not want to work hard to feed a large family". He also declared that women were not allowed to return to education after they had become pregnant, reinforcing a 1960s law that banned young mothers from attending state school education.
In the cities of Nairobi and Bungoma in Kenya, major barriers to contraceptive use revolve around sexual partners unable to agree on the contraceptive method and their reproductive intentions. Approximately 33% of wives in Nairobi and 50% of wives in Bungoma desired no more children, compared to 70% of husbands wanting around four or more children than their wives wanted.
A 2013 study in Kenya and Zambia shows a correlation between ante-natal care use and post-partum contraceptive use which suggests that contraceptive use could be increased by promoting ante-natal care services. A 1996 study in Zambia again cites the importance of educating both men and women and states that single mothers and teenagers should be the primary focus of birth control education. Of the 376 women recruited after giving birth at a hospital, 34% had previously used family planning, and 64% had used family planning a year after giving birth. Of the women who did not use family planning, 39% cited spousal disapproval as the reason. 84% of single mothers had never used family planning before and 56% of teenagers did not know anything about family planning. A 1996 Kenyan study suggests the need for modern contraception education that promotes quality of life over "traditional reproductive practices."
Birth control methods In most African countries, only a few types of birth control are offered, which makes finding a method that fits the reproductive needs of a couple or an individual difficult. Many African countries had low access scores on almost every method. In the 1999 ratings for 88 countries, 73% of countries offered condoms to at least half their population, 65% of countries offered the pill, 54% offered IUDs, 42% offered female sterilization, and 26% offered male sterilization. Low levels of condom use are cause for concern, particularly in the context of generalized epidemics in Sub-Saharan Africa. The use rate for injectable contraceptives increased from 2% to 8%, and from 8% to 26% in Sub-Saharan Africa, while the rate for condoms was 5%–7%. The least used method of contraception is male sterilization, with a rate of less than 3%. 6%–20% of women in Sub-Saharan Africa used injectable contraceptives covertly, a practice more common in areas where contraceptive prevalence was low, particularly rural areas.
Cultural attitudes toward family planning In Northern Ghana, payment of bridewealth in cows and sheep signifies the wife's obligation to bear children, which results in an ingrained expectation toward a woman's duty to reproduce. As a result, men often perceive contraceptive-use as an indicator of their wife's infidelity or promiscuity.
Child and forced marriages, a human rights breach that remains particularly high in sub-Saharan African countries, limit female autonomy and often result in a culture that prevents women and young girls from being in control of their reproductive health. The possibility that women may act independently, either toward healthcare or socially, is also regarded as a threat to the strong patriarchal tradition. Recently, however, attitudes toward child marriages have improved, particularly in Nigeria, with many discussing the social and emotional disadvantages this can cause.
According to a 1987 study by John Caldwell, large families are seen as socially favourable and infertility is viewed negatively. This can cause a paradoxical use in birth control, where it is used to increase birth intervals, rather than to limit family size.
Physical abuse and reprisals from the extended family pose substantial threats to women. A 1999 survey conducted in northern Ghana found that 51% of female and 43% of male respondents considered domestic violence to be justified if a wife used a contraceptive method without her husband's knowledge. Women feared that their husband's disapproval of family planning could lead to the withholding of affection or sex, and even lead to divorce.