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

Source: Westoff, 2006

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

Source: Ross and Winfrey, 2002

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 Need

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 Need

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?

Total Fertility Around 2005

Contraceptive Prevalence

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

The End

CCIH 2012 Conference, Family Planning Pre-Conference, Dr. Henry Mosley, Unmet Need for Family Planning

by Christian Connections for International Health on Jul 04, 2012

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CCIH 2012 Conference, Family Planning Pre-Conference, Dr. Henry Mosley, Unmet Need for Family Planning Presentation Transcript