Key takeaways:
- Researchers report that despite 6 decades of contraceptive innovation, global unmet need remains high, with approximately half of pregnancies worldwide still unintended.
- Significant regional disparities persist, with modern contraceptive use ranging from 40% to 83% in parts of Africa compared with up to 89% in high-income European countries.
- Male participation in contraception remains minimal, and no new male-focused methods have reached the market in over a century, though 2 reversible options are now in clinical trials.
- Adolescents, marginalized communities, transgender and non-binary individuals, and those facing stigma or financial barriers experience disproportionate challenges in accessing contraception.
- Experts emphasize improved education, expanded research funding, provider training, and seamless transitions to hormone therapy as critical strategies to reduce unplanned pregnancies and enhance reproductive autonomy.
In a recent article published in The Lancet, researchers have highlighted gaps in contraception access and associated barriers, indicating sources of unplanned pregnancies and abortions.1
These gaps have remained despite significant advances in contraception within the past 60 years, leading to a new era of contraception research. The researchers made a call to action for immediate attention to be provided to underserved populations such adolescent girls and young women, men, and transgender and non-binary populations.
“Despite major advances in contraceptive technologies over more than half a century, substantial unmet needs remain,” said Deborah Anderson PhD, professor at Boston University and lead researcher. “In recent years approximately 50% of pregnancies worldwide have been unintended, leading to a high rate of abortion.”
Variability in contraceptive use
In 2024, 57% of reproductive-aged women completing a survey in the United Kingdom expressed a present desire to avoid pregnancy. Use of a modern contraception method was reported by 77% of these women, while 15% did not use any method of contraception.
Significant disparities in modern contraception use based on region have also been reported, with a range of 40% to 83% reported in some regions of Africa vs 77% to 89% in high-income European countries. Additionally, men comprise less than 25% of the population using contraception, with only 2% of men worldwide undergoing vasectomy.
Male condom use as the primary contraception method is also reported in only 20% of couples. Hormonal contraceptives such as pills, implants, rings, injections, and hormonal intrauterine devices have been proven to have great efficacy, but significant side effects have been indicated.
Side effects and other barriers
These side effects have been reported as significant barriers to hormonal contraceptive use. Investigators have also highlighted additional barriers to contraceptive use such as religious beliefs, individual or social opposition, and infrequent sex.
According to Anderson, marginalized families and communities are more likely to experience adolescent pregnancies, though this type of pregnancy remains a challenge in all countries. Barriers providing additional challenges toward contraceptive access in adolescents include lack of education, restrictive policies, stigma, and financial hardship.
Investigators also noted a lack of male-focused contraception, with no new methodologies for this population entering the market in over 100 years. Transgender and non-binary patients, especially those who have not received gender-affirming surgeries, are also at risk of pregnancy when engaging in sexual activity.
Recommendations to address contraceptive gaps
Anderson concluded there has been stagnation in contraception use over the past 25 years. Therefore, she and her colleagues recommended steps be taken to address these gaps such as:
- Identifying modern and basic clinical research
- Intensifying financial support from government philanthropic and industrial entities
- Addressing the needs of underserved populations
- Increasing male contraception
Clinical trials for 2 new reversable male contraceptives were highlighted. These include the hormonal method NET/T and the testicular enzyme inhibitor YCT-529, both of which decrease the number of sperm in semen by reversibly inhibiting spermatogenesis.
Finally, understanding user preference and training providers to counsel users are vital for supporting patients. According to investigators, improved patient education is the best method to avoid unplanned pregnancy.
“Providing improved contraception choices will enhance the health, economic status and well-being of women and their families and is an important step towards social justice,” said Anderson.
Contraception options for perimenopausal women
Perimenopausal women also have access to effective contraceptive methods, as discussed by Andrew Kaunitz, MD, professor at the University of Florida College of Medicine, at The Menopause Society Annual Meeting 2025.2
According to Kaunitz, pregnancy risk remains well into reproductive years, highlighting the need for continued contraception use. Clinical guidelines have highlighted estrogen-progestin contraceptives as safe and effective in healthy women until menopause, though laboratory markers should be avoided to determine menopausal status in these patients.
Kaunitz also noted the simple transition directly to systemic hormone therapy. This can be used to address bone health concerns and menopausal symptoms in patients transitioning into menopause.
“Women using hormonal contraception can transition without any hormone-free days or weeks and without any specific laboratory testing to systemic hormone therapy, for instance, an estradiol patch and progestational agent or oral estrogen,” said Kaunitz.
