Dr. Henry Mosley of the Bloomberg School of Public Health at Johns Hopkins University discusses the global unmet need for contraception, the reasons behind the unmet need, and ways the problem can be addressed.
A woman has an unmet need for contraception if she is married, in a consensual union, or unmarried and sexually active; is able to become pregnant; does not want to have a child in the next two years or wants to stop childbearing; and is not using any method of contraception, either modern or traditional. Women who use modern or traditional methods of contraception are considered to have their contraceptive needs met.
Fifteen percent of married women aged 15-49 in developing countries have an unmet need for contraception. These data are based on Demographic and Health Surveys conducted between 2000 and 2005. Note: These data exclude East Asia, which is made up primarily of China. For 10-year averages that include data from developing countries that have not conducted surveys since 2000, see Guttmacher Institute, Facts About the Unmet Need for Contraception in Developing Countries, New York: Guttmacher Institute, 2007, at http://www.guttmacher.org/pubs/2007/07/09/FB_unmetNeed.pdf.
Among never-married women, nine percent in Sub-Saharan Africa and five percent in Latin America have unmet need for contraceptives. No data are available for never-married women in Asia or North Africa
The demand for contraception worldwide is increasing, while unmet need is decreasing in most regions. As demand increases family planning programs have to satisfy not just unmet need, but also the growing number of users of family planning methods.
Unmet need in Sub-Saharan Africa declined by less than 10% between 1990 – 1995 and 2000 – 2005. By contrast, unmet need declined by a third or more in the other three regions studied.
In most countries, the majority of women—both married and never-married—with an unmet need for contraception intend to use a method in the future.
Source: Singh et al., Adding It Up: The Benefits of Investing in Sexual and Reproductive Health Care, New York: The Alan Guttmacher Institute and United Nations Population Fund, 2003.
CCIH 2012 Conference, Family Planning Pre-Conference, Dr. Henry Mosley, Unmet Need for Family Planning
Family Planning Policies and Programs Unmet Need for Contraception W. Henry MosleyJohns Hopkins Bloomberg School of Public Health
What do we mean by the“demand” for contraception in a population?
Definitions of Measurements of “Demand” for Contraception1. Contraceptive prevalence is a measure of “met” demand forfertility control.2. Unmet need for contraception is measured as the proportionof women in a sexual union desiring to space or limitchildbearing and not using contraception3. Total potential demand for fertility control is measured bycontraceptive use + unmet need.
Demand for ContraceptionAs measured by contraceptive use and unmet need Unmet need Total Potential Contraceptive Demand for Prevalence Contraception
What is unmet need?• Women have an unmet need if they – are sexually active – do not want to have a child soon or at all – are not using any contraceptive method – are able to conceive
Unmet Need for Contraception CalculationWomen are defined as having anunmet need if they are: • fecund • married or living in union • not using any contraception • do not want any more children, or • want to postpone for at least two years
Unmet Need for Contraception Calculation (continued)Unmet need also includes currentlypregnant or amenorrheic women • with unwanted or mistimed pregnancies/births, and • were not using contraception at time of last conception
Defining Unmet Need - Kenya, 1993 Not using contraception 67% Pregnant or amenorrheic 30% Not pregnant or amenorrheic 37%Pregnancy Pregnancy Pregnancy Fecund Infecund intended mistimed unwanted 24.6% 12.6% 12.7% 12.7% 4.6% Want later Want no Want soon 9.4% more 8.7% 6.4%Need for spacing Need for limiting Need for spacing Need for limiting 12.7& 4.6% 9.4% 8.7% Total unmet need 35.5%
“Demand for Contraception” by Women’s Age, Kenya, 1993 90 80 70 Contraceptive% MWRA 60 use 50 Unmet need for 40 limiting 30 Unmet need for spacing 20 10 0 Note: Totals of each 15- 20- 25- 30- 35- 40- 45- column = “demand for 19 24 29 34 39 44 49 contraception”
More than 100 million married women have an unmet need for contraception South & Southeast Asia 29 (27%) Central Asia Latin America & Caribbean North Africa & West Asia7 (7%) 60 (56%) Sub-Saharan Africa 9 (8%) 3 (3%) Number (in millions) and % distribution of married women with unmet need
Who has unmet need?• Fifteen percent of married women in developing countries: – 24% in Sub-Saharan Africa – 11% in South and Southeast Asia – 10% in North Africa and West Asia – 12% in Latin America and the Caribbean
Who has unmet need?• Nine percent of never-married women in Sub-Saharan Africa• Five percent of never-married women in Latin America
The big picture• Levels of unmet need are higher in some regions, countries and population groups than in others• The proportion of women with unmet need is greatest, and has declined least, in Sub- Saharan Africa• In absolute numbers, unmet need is concentrated in South and Southeast Asia, the most populous regions
Expanded Definitions of Unmet Need May include women who: • are using an ineffective method • are using a method incorrectly • are using an unsafe method • are using an unsuitable method
How does unmet need relate to the levels of fertility and contraceptive prevalence in a population?
What is the trend in contraceptive demand and unmet need?
The overall demand for contraception is increasing% of married women aged 15–49 Latin America & North Africa & South & Southeast Sub-Saharan Caribbean West Asia Asia Africa
Unmet need among married women has declined in all regions, but remains highest in Sub-Saharan Africa% of married women aged 15–49 with unmet need 100 80 60 40 26 17 18 24 14 20 12 10 11 0 Latin America & North Africa & West South & Southeast Sub-Saharan Africa Caribbean Asia Asia 1990-1995 2000-2005
Countries with high fertility and low contraceptive prevalence have high unmet needs for contraception.
Percent of Women in Union Using a ContraceptiveMethod and with Unmet Needs for Family Planning
Unmet Need versus Intention to Use Contraception
Most women with unmet need intend to use a method in the future% of women who intend to use a method 100 96 82 80 77 76 67 60 40 20 0 Married Never-married Latin America & Caribbean Sub-Saharan Africa South & Southeast Asia
Reasons for Unmet Need1. Lack of access • to preferred method • to preferred providerPhysical distance may not be of majorimportance, but other “costs” are,such as monetary, psychological,physical, and time.
Reasons for Unmet Need2. Poor quality of services provided. This includes: • choice of methods • provider competence • information given to clients • provider-client relationships • related health care services • follow-up care Reference: Judith Bruce Framework
Reasons for Unmet Need - cont.3. Health concerns • actual side effects • fear of side effects4. Lack of information and misinformation about: • available methods • mode of action/how used • side effects • source/cost of methods
Reasons for Unmet Need - cont.5. Family/community opposition(power relationships in the household) • pronatalist • concerns about unfaithfulness • fear of side effects • objections to male providers • religious objections
Reasons for Unmet Need - cont.6. Little perceived risk of pregnancy7. Ambivalence
Meeting Unmet Need1. Improve access to good qualityservices • offer choice of methods • eliminate medical barriers • expand service delivery points - home delivery - social marketing • provide confidentiality
Meeting Unmet Need2. Link FP to other services • prenatal care • post-partum care/breastfeeding • immunization • post-abortion care • child health services • HIV and STD services
Where are the greatest globalchallenges in terms of unmet need?
There are many benefits topreventing unintended pregnancies• Fewer unsafe abortions• Healthier mothers and children• Greater investments in each child• Social and economic opportunities for women• Economic growth• Reduction of population pressures on environment