In most countries today, people want—and are having—fewer children than they did in the past. In the industrialized countries, the trend toward smaller families has emerged gradually over the last century, in response to the spread of education, improvements in health conditions and the enhanced status of women. In the developing world, by contrast, the swiftness of the change has been dramatic. In less than 30 years, the size of the average family in many Asian and Latin American countries has fallen from roughly six children to about three children. Sub-Saharan Africa is the only developing region where most women still want and have large families.

These changes are not occurring because men and women value children and families less now than they did in the past. Indeed, for most adults, the birth of a child is a wondrous occasion, and nurturing children is their most precious and rewarding activity. But caught in the throes of massive economic and social changes, couples have concluded that it is in the best interest of their children, as well as in their own best interest, to plan and limit births. By doing so, they can give more to the children they do have and still experience the pleasures and rewards of parenthood.

The historic changes taking place affect both men and women. Clearly, however, women have a larger stake in being able to control their childbearing. It is they, after all, who experience the discomforts and risks attendant on pregnancy and childbirth, and in virtually all countries, women bear the primary responsibility for childbearing. Thus, their ability to have the number of children they want, when they want them, is central to the quality of women’s lives and the well-being of their families.

Further, women’s success in achieving their reproductive goals has important implications for the social and economic well-being of the communities and nations in which they live and, ultimately, for the future of the world. Rapid rates of population growth limit social and economic development, severely reducing the likelihood that developing societies can move out of poverty or that women can contribute to development as the equals of men. A woman’s ability to control her fertility, therefore, is fundamental to human progress

Couples in most countries want smaller families than they did in the past. Over the last 30 years, the size of the average family in many developing countries has fallen from roughly six children to about three. The ability of women to have the number of children they want, when they want them, is central to the quality of women's lives and has important consequences for the future of the world. Improvements in women's education, the spread of mass media and other changes have caused women to examine the desirability of large families and how to fulfil the role of mother. Extreme poverty, profound inequalities between men and women and early marriage severely limit women's ability to achieve their childbearing goals.

Women’s procreative desires and their struggles to achieve them have a commonality the world over. Most women today want two, three or four children, but in many countries, poverty and profound inequalities between men and women limit women’s ability to achieve this goal. So does lack of access to effective contraceptive protection. Contraceptive use has increased significantly as couples have come to want smaller families, and as governments have encouraged and facilitated the practice of contraception.Yet, nearly 230 million women worldwide—roughly one in six women of reproductive age—are still in need of effective birth control methods to postpone or avoid future childbearing.

The level of unintended pregnancy is lowest in countries where contraceptive use and access to effective methods are most extensive and where women play a major role in family decision-making. In too many countries, however, high rates of unwanted and mistimed childbearing and high abortion rates prevail instead. More than 50% of women in some countries report that they would have preferred to postpone their most recent birth or say that they had not wanted to have it, ever. And more than 50 million of the 190 million women who become pregnant each year have abortions; many of these procedures are clandestine and performed under unsafe conditions.

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