Over the last decade, unmet need for FP increased from 13% in 2010, 15.2% in 2014 and to 20.4% (2021 - 2022) among currently married women. The unmet need for FP among young married women aged 20-24 is the highest at 30.3%, (MICS 2021-2022). Unmet need was reportedly high amongst rural women at 23% compared to 14.3% for urban women in 2021-2022. The Hhohho region has the highest unmet need at 22% compared to the other three regions which have 20% for both Manzini and Shiselweni whilst Lubombo is the lowest at 19% for the same period. The poorest (24.3%) and the second (25.8%) wealth quintiles also have the highest unmet need. Unmet need for women living with HIV is also high at 26%.
The unmet need for FP among unmarried women is much higher than the married women of reproductive age at 33.1%. Unmarried women in urban areas have a higher unmet need (35.4%) compared to the rural areas (31.7%). Manzini has the highest unmet need (37.9%), followed by the Lubombo region (31.1%), Hhohho (30.8%) and Shiselweni (28.7%). The contribution by unmarried young women aged 15 - 19 years is 46.2% and 20 - 24 years is 41%. Unmet need for unmarried women is highest in the 4th wealth quintile at 39% and 2nd quintile at 37.8%.
The increase in unmet need was largely due to a disruption in commodity supply chain coupled with fiscal challenges, misconceptions, fear of side effects and socio-cultural factors. Evidence shows that social norms, traditional beliefs and practices prevent women from taking up family planning services. There are beliefs that contraceptives are against religious principles and that they interfere with natural processes which can lead to infertility or other harmful side effects. Furthermore, prolonged postpartum abstinence influences the timing and use of contraceptives as well as reliance on traditional healers and remedies for fertility regulation. Side effects are also a common reason for discontinuing contraceptives among young women. Additionally, childbearing among teenagers is also associated with adverse social consequences especially regarding educational matters since teenage mothers are more likely to drop out of school.
The modern contraceptive prevalence rate (mCPR) for unmarried women slightly improved over the 12-year period from 38% in 2012 to 42%; in 2023. Similarly, the mCPR for all women including both married and unmarried women has slightly increased from 47% to 51%. However, the mCPR for married women reduced from 66.1% in 2014 to 58% in 2022.
The overall trend of demand satisfied declined from 83.3% in 2010 to 73% in 2022. Rural demand satisfied is 81.1% in 2010, with a slight increase to 85.6% in 2014 and a sharp decline to 70.3% in 2022. Urban demand satisfied was at 88.4% in 2010, dropping to 79.1% in 2014 and slightly increased to 79.9% between 2022.
Eswatini has a good method mix which includes oral contraceptives, injectables, barrier methods, implants and surgical methods. Analysis of the routine data through MoH Annual Reports shows that the most commonly used modern contraceptive method is male condoms at 46%, followed by injectables (32%) and the oral contraceptives (12%). Male condoms are the most preferred method because they provide triple protection and are widely distributed compared to all the other methods. Injectables are also preferred because they are easily concealed from partners and family members.
Even though the adolescent birth rate in Eswatini declined from 89 in 2010 to 78 in 2022, teenage pregnancy is still rife. Young women aged 20-24 years residing in the rural areas are twice more likely to give birth before the age of 18 years than those in urban areas (14% vs 6%) as stated in MICS 2021-2022. Early childbearing before the age of 18 years in young women is about 5 times higher for those in the poorest households compared to those in richest households. The adolescent birth rate is highest at 106/1000 among adolescents with primary school education compared with those with 75/1000 for those with secondary education. This was exacerbated by COVID-19, where 1,094 adolescent and teenage girls became pregnant in a period of three months.
