Unintended pregnancy in sub-Saharan Africa: magnitude of the problem and potential role of contraceptive implants to alleviate it

Contraception. 2008 Jul;78(1):73-8. doi: 10.1016/j.contraception.2008.03.002. Epub 2008 May 14.


Background: Unintended pregnancies continue to burden many countries in sub-Saharan Africa. Our aim was to estimate the number of unintended pregnancies in the region and model the impact of expanding use of contraceptive implants at the expense of short-term hormonal birth control methods.

Study design: For the 42 countries in mainland sub-Saharan Africa, we estimated current levels of unintended pregnancy, prevalence of hormonal contraceptive use and number of unintended pregnancies stemming from early discontinuation and typical method failure rates. Using a decision-analytic model, we estimated the potential impact of more widespread use of the contraceptive implant.

Results: Every year in sub-Saharan Africa, approximately 14 million unintended pregnancies occur and a sizeable proportion is due to poor use of short-term hormonal methods. If 20% of the 17.6 million women using oral contraceptives or injectables wanted long-term protection and switched to the contraceptive implant, over 1.8 million unintended pregnancies could be averted over a 5-year period.

Conclusion: Poor patterns of short-term hormonal contraceptive use (high discontinuation rates and incorrect use) contribute significantly to the problem of unintended pregnancy in sub-Saharan Africa. More availability and widespread use of highly effective methods, such as the contraceptive implant, will improve reproductive health in the region.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Africa South of the Sahara
  • Contraception / methods
  • Contraception / standards
  • Contraception / statistics & numerical data*
  • Contraception Behavior*
  • Contraceptive Agents, Female / administration & dosage*
  • Contraceptives, Oral / administration & dosage
  • Decision Trees
  • Drug Implants
  • Family Planning Services
  • Female
  • Humans
  • Patient Compliance*
  • Pregnancy
  • Pregnancy, Unplanned*
  • Risk Factors


  • Contraceptive Agents, Female
  • Contraceptives, Oral
  • Drug Implants