Measuring unmet need for family planning

Chart for calculating unmet need

Preamble

“Millions of women would prefer to avoid becoming pregnant either right away or ever, but are not using contraception. These women have an unmet need for family planning. Programs can serve many of these women by developing strategies that respond directly to their concern.” Ref: Population Reports, Sept 1996. Unmet need is defined on the basis of women’s responses to survey questions and following are some of the definitions that have been used since 1970’s. The KAP-Gap Definition one: Women who wanted to have no more children but were not using contraception. (Ignored spacers, exposure to risk of pregnancy) The world fertility survey (WFS 1972-1984) Definition two: Same as above but excluded pregnant and amenorrheic women, because they did not currently need contraception. (Ignored spacers) In 1981, John Anderson and Leo Morris measured the percentage of women of reproductive age who are “exposed to the risk of unintended pregnancy and are not using contraceptive”. (Included spacers). Next year Nortman and Gary developed a model by including pregnant, breast feeding, or amenorrheic in the definition of unmet need. After ICPD 1994, Sinding and Fathalla have suggested to measure unmet need more broadly including unmet need among people who are using contraception but may be dissatisfied with their method. By using both qualitative and quantitative data, they suggest experience with sideeffects, discontinuation and other problems of contraception could help extend the focus of unmet need from use of any method to the quality of care. Arguments over who is at risk, should we include inappropriate method use and method failure. DHS started asking questions on intentions about current pregnancy, therefore, including pregnant women. Recently included category is unmarried women. In short, include all women who are “at risk” of an unintended or mistimed pregnancy. Considering the importance of measurement of unmet need, now all DHS and FP/RH Survey questionnaire ask about extended definition of unmet need.

Casterline (1997) pointed out that there can be inaccuracies in the reporting of contraceptive use and in the reporting of fertility preferences, and both pieces of information are required for estimating unmet need. Furthermore, his work shows that unmet need is subject to different definitions, and its measurement is not straightforward. Therefore, any survey undertaken for the measurement of unmet need must consider issues of definition in advance.
Following chart shows the standard formulation of unmet need.