Health Transitions and the Rise of Modern Contraceptive Prevalence: Demand, Access, and Choice.

Improvements in health and mortality, known as the health transition, played important roles in the rise of modern contraceptive prevalence across countries. We describe key mechanisms and selected research evidence that show how health transitions helped shape contraceptive transitions around the world. Mechanisms include how decreases in child mortality rates affect the motivation to use contraception and how the organization and expansion of health care affect key barriers to contraceptive use. Substantial increases in child survival resulting from health transitions increase demand for deliberate fertility regulation and contraceptive use. Improved access to primary health care, particularly maternal and child health services and expansion into rural communities, was associated with increases in modern method use. Country-specific policies that affected the organization and delivery of health care led to the dominance of particular modern methods in some countries. Empirical evidence is limited on how the quality of health care has affected aggregate level increases in modern method use. Using modern contraceptive prevalence to define the contraceptive transition reflects current data limitations but future research on the relationship of health transitions with macrolevel contraceptive prevalence trends may be able to incorporate more comprehensive aspects of how health transitions impact contraceptive choice and agency.