PRB

(June 2014) Despite the benefits of contraceptive use, more than 220 million women in developing countries say they want to postpone their next birth, or not have any more children, but they are not using any type of family planning method.¹ These women have an “unmet need” for family planning.

A recent analysis by the Population Reference Bureau suggests that over the course of their reproductive lives, many more women likely experience unmet need than previously recognized, and a substantial number also experience multiple episodes. Contraceptive needs can fluctuate owing to changes in fertility desires that occur in response to changing life circumstances such as having a child, entering a serious relationship, and experiencing changes in household finances.² Accordingly, women may pass in and out of unmet need, like a revolving door, rather than experiencing it as a one-time event. Current measures typically provide only a snapshot view of unmet need.

This analysis reveals how a longer-term perspective could provide important additional information that would help shed light on improving family planning services.

Unpacking Unmet Need: What the Evidence Tells Us

To better understand the patterns of women’s unmet need and their implications, PRB analyzed the Demographic and Health Survey (DHS) five-year contraceptive calendar data for married women of reproductive age in 13 countries (Bangladesh, Burkina Faso, Ethiopia, India, Indonesia, Kenya, Malawi, Nepal, Nigeria, Rwanda, Senegal, Tanzania, and Uganda). These countries were selected for analysis because they had recent contraceptive calendar data available, and they are among the priority countries included in the Family Planning 2020 initiative.

The analysis examined two aspects of unmet need: the extent to which point-in-time measures of unmet need miss the magnitude of the problem, compared to measures over the five-year period prior to the survey; and the extent to which women had more than one episode of unmet need in the same five-year timeframe. Specifically, the calendar data provided an opportunity to identify any mistimed or unwanted births experienced by each woman over the five-year period. Assuming that women with mistimed or unwanted births had unmet need for family planning preceding those pregnancies, the authors identified women who had at least one episode of unmet need during the study period. Multiple episodes of unmet need were assessed using data on mistimed or unwanted births over the five years as well as women’s reports of unmet need at the time of the DHS. For all analyses, the research team used data from the most recent waves of DHS available per country at the time of the study, and restricted the analysis to women who were married throughout the five-year period for comparability across countries.

Toshiko Kaneda is a senior policy analyst at the Population Reference Bureau. Rhonda Smith is associate vice president in International Programs at PRB. The brief is based on the research conducted by these authors, and by Jill Hagey, a former policy analyst at PRB. Funding for this research was provided by the William and Flora Hewlett Foundation.

References

1. Sarah E.K. Bradley et al., “Revising Unmet Need for Family Planning,” DHS Analytical Studies No. 25 (Calverton, MD: ICF International, 2012).
2. Christian Sennott and Sara Yeatman, “Stability and Changes in Fertility Preference Among Young Women in Malawi,” International Perspectives on Sexual and Reproductive Health 38, no. 1 (2012).