OCs are the top modern method among married women in 78 of 150 countries with available data and, if China and India are omitted from the world estimate, the most widely used contraceptive method overall. Outside China and India about 12% of married women use the pill. By comparison, 9.5% rely on female sterilization, and almost as many use traditional or folk methods. About 9% use IUDs. (Table 2 presents OC use data with and without China and India.)

Considering developing countries alone, 6% of married women use the pill—far fewer than use female sterilization, at 21%, and the IUD, at 13%. When China and India are removed from the use estimate, however, OCs become the most popular method in developing countries, used by 10% of married women compared with 9% relying on female sterilization and 8% on traditional methods. IUD use falls to 7%.

In developed countries OCs are the most widely used method. Some 16% of married women use the pill. Condoms and the IUD tie for second place at 14%, while slightly less than 14% of married women use traditional or folk methods.

Worldwide, among sexually active unmarried women, OCs are even more widely used than among married women. In countries with available data 26% of sexually active unmarried women use the pill. Data on current contraceptive use among unmarried women are available in Africa, Eastern Europe, Latin America, the Caribbean, and most developed nations. OCs are the most popular method among unmarried women in Latin America, North America, and Northern and Western Europe.

Patterns in use of family planning methods vary considerably within and among countries and regions. Differences in availability, access, cost, promotion, program policy, as well as people's preferences, help to explain these differences. Indeed, exceptionally high rates of use for any one method can suggest that access to other methods may be limited.

Near East and North Africa. In this region nearly 10 million women use OCs—13% of the region's 74 million married women. Three of every 10 family planning users are pill users. In Algeria, Iran, Kuwait, Morocco, Oman, Qatar, and the United Arab Emirates, OCs are the most widely used method.

In Algeria 44% of married women relied on the pill in 1995—the highest level of pill use in the developing world, accounting for 84% of all contraceptive use. Iran and Kuwait also report high levels of pill use, at 23% and 24% of married women. In contrast, levels of OC use are low—4%—in Turkey, where overall contraceptive use is 64%, and in Yemen, where overall use is about 21%.

In Morocco pill use has risen substantially, from 14% of married women in 1980 to 32% in 1995. In Egypt, however, OC use fell from 17% of married women in 1980 to 10% in 1995. In the 1990s many Egyptian women shifted to IUDs (188), which have been more promoted. (See Figure 1.)

Latin America and the Caribbean. In Latin America and the Caribbean, OCs are the second most widely used method among married women, following female sterilization. About 14% of married women use the pill—nearly one in every seven married women, or one in every five family planning users.

Some of the world's highest levels of current OC use, as well as ever use, are found in Latin American countries. For example, in Brazil 6 million women use the pill—in numbers fourth in the world after China, Germany, and Indonesia. Some 21% of married women used OCs in 1996, over one-fourth of all Brazilian women using family planning. Brazilian women overwhelmingly use either the pill or female sterilization. Access to the IUD is limited, and a 1994 rating of access to family planning methods found that the condom was readily accessible to less than 80% of couples in Brazil (73).

In some Latin American countries contraceptive use shifted from the 1980s through the mid-1990s. Smaller percentages used OCs as the use of female sterilization and IUDs grew. Overall, OC use rates dropped from one in every six married women in 1987 to one in every seven in 2000. In Colombia, for example, prevalence of OC use fell from 17% of married women in 1978 to 13% in 1995 (see Figure 1). In Mexico OC use declined from 14% in 1982 to 8% in 1995. At the same time, overall contraceptive use increased from 46% to 72% in Colombia and from 48% to 67% in Mexico. Researchers studying Mexican data conclude that the shift from OCs to other methods is occurring because more family planning users are older women choosing IUDs and sterilization once they have had all the children they want (519).

In Latin America the pill is the most popular way for sexually active unmarried women to avoid pregnancy. One-fourth of sexually active unmarried women use the pill. Use is highest in Brazil, at 36%

Sub-Saharan Africa. Pill use accounts for about one-quarter of all contraceptive use among both married and unmarried women in sub-Saharan Africa. Overall, about 15% of married women use family planning, and slightly less than 4% use the pill. Among sexually active unmarried women, about 43% use some contraceptive method, and 10% use the pill.

In some African countries levels of OC use are among the world's highest. For example, in Zimbabwe 33% of married women and 32% of sexually active unmarried women were using OCs in 1994. In Zimbabwe access to the pill is generally good, while access to the IUD and to female and male sterilization is considerably more difficult (73). Also, in Reunion 40% of married women use OCs, in Mauritius 21%, and in Botswana and Cape Verde about 18%. Among sexually active unmarried women, about 17% in both Mali and Niger are using the pill, and about 20% in Botswana and South Africa. Nevertheless, high levels of pill use are more the exception than the rule in sub-Saharan Africa. In five countries of the region, 1% or less of married women use the pill. In another eight countries use is between 1% and 2%.

JHU/CCP

In Bangladesh a village health worker discusses family planning with a client. In this country oral contraceptives have become the most widely used contraceptive, used by about 21% of married women.

Prevalence of OC use is highest in southeast Asia, led by Thailand, where an estimated 27% of married women of reproductive age used OCs in 1993. Despite the low percentage who use the pill, China has more pill users than any other country—about 7.6 million. Indonesia, the world's fourth largest country, has 6.1 million pill users. Few data are available about contraceptive use among unmarried women in Asia.

In a few Asian countries OC use among married women has increased considerably in recent years. In Bangladesh, for example, OCs have become the most widely used contraceptive method, taken by nearly 21% of married women of reproductive age in 1996–97 compared with 3% in 1983 (see Figure 1). Pill use also has grown recently in Sri Lanka and Vietnam.

Eastern Europe and Central Asia. In Eastern Europe and Central Asia 65% of married women use family planning, but only about 6% use the pill. IUDs, traditional methods, and condoms are more widely used. In 8 of 14 countries surveyed in the 1990s, levels of OC use were 5% or lower. Hungary is an exception; some 33% of married women use the pill. OC use is lowest in the Central Asian Republics. Among sexually active unmarried women in the region, just 6.5% use the pill, while larger percentages rely on condoms or traditional methods.

Other regions. In most developed countries the majority of married women rely on either the pill or female sterilization. In developed regions outside Eastern Europe and Central Asia, the pill ranks first, used by 21% of married women. In Western Europe half of all married women are pill users. In North America female sterilization is the choice of 24% of married women. The pill ranks second at 16%.

Japan reports the world's lowest rate of OC use. In 1994, when the most recent survey was taken, less than 0.5% of married women relied on the pill. Low-dose OCs were approved for contraceptive use in Japan only in September 1999. Before this date medium- and high-dose pills were available but only to treat menstrual disorders (276).

Some of the highest levels of pill use in the world are among sexually active unmarried women in developed countries. Outside Eastern Europe and Central Asia, 36% of sexually active unmarried women in developed countries use the pill. Some 45% in Europe use the pill; in North America, 36%.

For country-by-country statistics on OC use, see the internet website of the Johns Hopkins Center for Communication Programs at http://www.populationreports.org/a9/a9suptab.stm.