ABSTRACT
Objective To review progress towards adoption of contraception among married or cohabiting women in western and eastern Africa between 1991 and 2004 by examining subjective need; approval; access and use. Methods Indicators of attitudes towards and use of contraception were derived from Demographic and Health Surveys; which are nationally representative and yield internationally comparable data. Trends were examined for 24 countries that had conducted at least two surveys between 1986 and 2007. Findings In western Africa; the subjective need for contraception remained unchanged; about 46of married or cohabiting women reported a desire to stop and/or postpone childbearing for at least two years. The percentage of women who approved of contraception rose from 32 to 39 and the percentage with access to contraceptive methods rose from 8 to 29. The proportion of women who were using a modern method when interviewed increased from 7 to 15(equivalent to an average annual increase of 0.6 percentage points). In eastern African countries; trends were much more favourable; with contraceptive use showing an average annual increase of 1.4 percentage points (from 16in 1986 to 33in 2007). Conclusion In western Africa; progress towards adoption of contraception has been dismally slow. Attitudinal resistance remains a barrier and access to contraceptives; though improving; is still shockingly limited. If this situation does not change radically in the short run; the United Nations population projections for this subregion are likely to be exceeded. In eastern Africa; the prospects for a future decline in fertility are much more positive