In the past 50-60 years, desired and actual family size have decreased and contraceptive use has increased, especially in developing countries. Unmet need for modern contraceptives and unintended pregnancy levels remain significant. Data compiled by the United Nations and information from national surveys of women of reproductive age are used to examine trends. Oral contraceptives and condoms have been predominant methods in developed countries; sterilization has been the most common in Latin America and the Caribbean and Asia; hormonal methods, in Africa. Some 222 million women in developing countries have unmet need for modern contraceptives, resulting in 2012 in an estimated 54 million unintended pregnancies and 79,000 maternal deaths more than if they used modern methods. Improvements are needed in contraceptive information and services as well as in contraceptive methods themselves to increase couples' success in achieving their desired timing and number of children. Copyright © 2013 Elsevier Inc. All rights reserved.