A survey of 55 developing countries shows that while the use of modern contraceptives has increased over the last several decades, their use by the world's poorest people remains low.
Emmanuela Gakidou, with Harvard University's Initiative for Global Health and lead author of the new study, says the work demonstrates what she calls "a contraceptive gap" separating the poor from the rest of the world. "What we have found is that even in countries with an average per capita income of $4,000, the poorest women don't have access to contraceptive services."
Gakidou says a combination of poverty and health care infrastructure is driving the contraceptive gap, but that poor women with reproductive health services fair better. "Where there are services, women are using contraceptive methods," she says.
The study finds strong regional differences with the lowest rates of contraceptive use found in sub-Saharan Africa. Use among the poor was highest in South and Southeast Asia, and the largest inequalities in use were found in Latin America.
Based on the survey's overall findings, Gakidou calls for greater access to reproductive health care services for women in remote areas. "By supplying these services, they will be affecting a large part of maternal and child health including increased access to contraception."
Gakidou recommends that ministries in developing countries change their focus to address the interests of the poor. "Because the focus globally right now is on the averages of contraceptive use, and that average is going up for each country. If we focus on the disadvantaged, the benefits will be huge."
The study is published in PloS Medicine and available for free online.