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BACKGROUND Continued rapid population growth in sub-Saharan Africa is driven predominantly by high fertility. Contraceptive use was a key determinant of past fertility transitions. An analysis of this relationship in sub-Saharan Africa can yield a better understanding of the region's prospects for fertility decline. METHODS Using global estimates and projections, we describe trends in contraceptive use and fertility and analyse the relationship between the two. Timing, pace, and level parameters derived from Bayesian hierarchical models of historic contraceptive and fertility transitions are used to investigate how the experience of sub-Saharan Africa may be distinctive. RESULTS Fertility in sub-Saharan Africa fell from 6.4 births per woman in 1990 to 4.6 in 2020, the highest among regions today. Contraceptive use among married/in-union women in sub- Saharan Africa increased from 13% to 33% over the same period, and remains the region with lowest use. At all levels of contraceptive use, countries of sub-Saharan Africa tend towards higher fertility compared to other regions. Transitions in contraceptive use and fertility have occurred later in sub-Saharan Africa, and have been slower in Middle and Western Africa (but not Eastern and Southern Africa), compared to the experience of Asia, Latin America, and the Caribbean. CONTRIBUTION Based on an analysis using Bayesian models, we demonstrate large differences across countries in the pace and timing of fertility and contraceptive use transitions, and we confirm that Middle and Western Africa are distinct. The findings from these separate and independent models are similar, lending additional support to the validity of these conclusions. [ABSTRACT FROM AUTHOR]

Expanding access to contraception and ensuring that need for family planning is satisfied are essential for achieving universal access to reproductive healthcare services, as called for in the 2030 Agenda for Sustainable Development. To quantify the gaps that remain in meeting needs among adolescents, this study provides a harmonised data set and global estimates and projections of family planning indicators for adolescents aged 15–19 years. We compiled a comprehensive dataset of family-planning indicators among women aged 15–19 from 754 nationally representative surveys. We used a Bayesian hierarchical model with country-specific annual trends to estimate contraceptive prevalence and unmet need for family planning, with 95% uncertainty intervals (UIs), for 185 countries, taking into account changes in proportions married or in a union and differences in sexual activity among unmarried women across countries. Among 300 million women aged 15–19 years in 2019, 29.8 million (95% UI 24.6–41.7) use any contraception, and 15.0 million (95% UI 12.1–29.2) have unmet need for family planning. Population growth and the postponement of marriage influence trends in the absolute number of adolescents using contraception or experiencing unmet need. Large gaps remain in meeting family-planning needs among adolescents. The proportion of the need satisfied by modern methods, Sustainable Development Goals (SDG) indicator 3.7.1, was 59.2% (95% UI 44.8–67.2) globally among adolescents, lower compared to 75.7% (95% UI 73.2%–78.0%) among all women age 15–49 years. It was less than one half of adolescents in need in Western Asia and Northern Africa (38.7%, 95%UI = 20.9–56.5), Central and Southern Asia (43.5%, 95%UI = 36.6–52.3), and sub-Saharan Africa (45.6%, 95%UI = 42.2–49.0). The main limitations of the study are: (i) the uncertainty surrounding estimates for countries with limited or biased data is large; and (ii) underreporting of contraceptive use and needs is likely, especially among unmarried adolescents. [ABSTRACT FROM AUTHOR]