Unmet need for family planning

Dr. Pramod

Background• Family planning being a viable solution to control such fast growing

populations, not only helps in spacing and limiting the number of children, but also improves maternal and child health, empowers women and boosts economic development.

• More than 100 million sexually active women in developing countries would

like to adopt family planning but they are not able to.

• Today in India , around 50% of currently married women (ages 15-49) use or whose sexual partners use any form of modern contraception.

• India has about 31 million of women with unmet need for family planning, despite the existence of the National Policy on Family Planning since the year 1983.

What is unmet need for family planning?

• Definition: Many women who are sexually active would prefer to avoid becoming pregnant but nevertheless are not using any method of contraception. These women are considered to have an Unmet need for family planning .

or

• Currently married women who are not using any method of contraception but who do not want any more children or want to wait two or more years before having another child are defined as having an unmet need for family planning.

Cont…..

Women are defined as having an unmet 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

Cont…..

Unmet need also includes: pregnant or amenorrheic women

With unwanted or mistimed pregnancies/births, and

Not using contraception at time of last conception

Expanded Definitions of Unmet Need

May include women who:

are using an ineffective methodare using a method incorrectlyare using an unsafe methodare using an unsuitable method

How the Unmet Need Concept Evolved?

1960- Surveys of contraceptive knowledge, attitudes, and practices ( KAP ) showed a gap between some women's reproductive intentions and their contraceptive behaviour and called as “KAP gap”.

1972- Analysis of women's responses to three KAP surveys in Taiwan, Ronald Freedman and colleagues first identified a specific group of women who might be expected to adopt contraception--even without changing their desired family size because they said that they wanted to have no more children but were not using contraception.

Cont..1974 -Freedman and Lolagene Combs for the first time used

survey data to identify the size of this group in several countries, and they found it to be substantial and coined the term "discrepant behaviour" to describe the status of such women.

1977 - Term "unmet need“ used by Bruce Stokes, citing both the evidence from KAP studies in developing countries and from fertility survey in the US.

1972 to 1984 - The World Fertility survey (WFS) conducted and first time to report extensively about unmet need .

Cont..

• 1970 to 1984 - Contraceptive Prevalence Surveys (CPS) conducted and made possible further refinement and measurement. The CPS added questions about women's interest in postponing, or spacing, next births.

• 1982- Dorothy Nortman said that women who were pregnant, breastfeeding, or amenorrheic should be included in the definition of unmet need because they would soon need contraception again.

• 1984 -The Demographic and Health Surveys (DHS) conducted and further improved measurement of unmet need. The DHS asks pregnant women whether their current pregnancies were intentional, mistimed, or unwanted and also whether they were using contraception at the time of conception.

• 1985- Family Planning /Reproductive Health Surveys (FP/RHS) and provide estimates of unmet need, including among unmarried women.

How to calculate unmet need ?

• The majority of estimates of unmet need for family planning follow the procedure adopted in the Demographic and Health Surveys (DHS), which is regarded as the standard method of computation.

Unmet need for family planning = Women (married or in a union) who are not using contraception, are fecund, and

desire to either stop childbearing or postpone their next birth for at least two years + pregnant women whose current pregnancy was unwanted or mistimed + women in post-partum amenorrhea who are not using contraception and, at the time they became pregnant, had wanted to delay or prevent the pregnancy x

100 / Total number of women of reproductive age (15-49) who are married or in a union

Unmet need is especially high among groups

such as:• Adolescents• Migrants• Urban slum dwellers• Refugees• Women in the postpartum period

• Why Are Policymakers Concerned About Unmet Need?

More than 100 million married women have an unmet need for contraception

South & Southeast Asia

Central Asia

Latin America & Caribbean

North Africa & West Asia

Sub-Saharan Africa

Number (in millions) and % distribution of married women with unmet need

60 (56%)

29 (27%)

7 (7%)

9 (8%)3 (3%)

More than one-third of pregnancies in developing countries are unintended

19%

15%

50% 16%

Induced abortions

Spontaneousabortions (miscarriages)

Wanted births

Unwanted or mistimed births

Outcomes of all pregnancies in developing countries

Most unintended pregnancies occur among women who were not using any contraceptive

66%14%

20%

Modern method

No methodTraditionalmethod

Unintended pregnancies in developing countries, by women’s contraceptive use

Unmet need among married women has declined in all regions, but remains highest in Sub-Saharan Africa

17 1826

1411

24

12 10

0

20

40

60

80

100

Latin America &Caribbean

North Africa & WestAsia

South & SoutheastAsia

Sub-Saharan Africa

1990-1995 2000-2005

% of married women aged 15–49 with unmet need

The overall demand for contraception is increasing

17 12 14 1018 11

59 6954 60 41 59

14 20

26 24

0

20

40

60

80

100

1990-1995

2000-2005

1990-1995

2000-2005

1990-1995

2000-2005

1990-1995

2000-2005

Unmet need Met need

% of married women aged 15–49

Latin America & Caribbean

North Africa & West Asia

South & Southeast Asia

Sub-Saharan Africa

What are the Reasons for Unmet Need?

1. Lack of access

to preferred method to preferred provider

Cont…

2. 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

Cont.

3. Health concerns Actual side effects Fear of side effects

4. Lack of information and misinformation about:

Available methods Mode of action/how used Side effects Source/cost of methods

Cont.5. Family/community opposition

Concerns about unfaithfulness Fear of side effects Objections to male providers Religious objections

6. Little perceived risk of pregnancy

7. Ambivalence

How to meet Unmet Need?

1.Improve access to good quality services Offer choice of methods Eliminate medical barriers Expand service delivery points

Home delivery Social marketing

Provide confidentiality

Cont….2. Improve communication about:

Source of FP information and supplies

Misinformation and rumors regarding effects/side-effects

Risks of contraception

Risks of pregnancy

Cont…3. Overcomes husband’s opposition:

Address men directly with Information about the benefits and safety of family planning. Recognizing men's often-dominant role in decision-making but promoting the equal participation of a women, too.

Encourage better communication between spouses about family planning and reproductive health.

Help women lean how they can talk with their partners about family planning, including how to start the discussion.

Cont..

4. Link Family Planning to other services

Prenatal care Post-partum care/breastfeeding Immunization Post-abortion care Child health services

conclusion

• Needs to be built the capacity of ASHAs, ANMs, nurses, doctors and family planning counselors both in the public and private sector, for counseling and effective delivery of these methods.