unmet need for family planning

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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. - PowerPoint PPT Presentation

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Unmet need for family planning

Unmet need for family planningDr. Pramod BackgroundFamily 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) useor 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.The percent with an unmet need for family planning is the number of women with unmet need for family planning expressed as a percentage of women of reproductive age who are married or in a union. Women with unmet need are those who are fecund and sexually active but are not using any method of contraception, and report not wanting any more children or wanting to delay the birth of their next child.

3Cont..Women are defined as having an unmet need if they are:FecundMarried or living in unionNot using any contraceptionDo not want any more children, orWant to postpone for at least two years4Cont..Unmet need also includes: pregnant or amenorrheic women

With unwanted or mistimed pregnancies/births, and

Not using contraception at time of last conception5Expanded Definitions of Unmet NeedMay include women who:

are using an ineffective methodare using a method incorrectlyare using an unsafe methodare using an unsuitable method6How 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 groupssuch as:AdolescentsMigrantsUrban slum dwellersRefugeesWomen in the postpartum period

Why Are Policymakers Concerned About Unmet Need?

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

Number (in millions) and % distribution of married women with unmet need60 (56%)29 (27%)7 (7%)9 (8%)3 (3%)1616More than one-third of pregnancies in developing countries are unintended

Induced abortionsSpontaneousabortions (miscarriages)Wanted birthsUnwanted or mistimed birthsOutcomes of all pregnancies in developing countries1717More than one-third of pregnancies in developing countriesabout 76 million each yearare unintended. About half of these end in induced abortions, most of which are either illegal or unsafe. The remaining half (16% of all pregnancies) result in unwanted or mistimed births.

Source: AGI, Sharing Responsibility: Women, Society and Abortion Worldwide, New York: AGI, 1999; and Sedgh et al, Induced abortion: the global reality and avoidable risks, Lancet, submitted 2007.Most unintended pregnancies occur among women who were not using any contraceptive

Modern methodNo methodTraditionalmethodUnintended pregnancies in developing countries, by womens contraceptive use1818Two-thirds of unintended pregnancies in developing countries occur among women who were not using any method of contraception.

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.

Benefits to preventing unintended pregnancies Fewer unsafe abortions Healthier mothers and childrenGreater investments in each childSocial and economic opportunities for womenEconomic growth Reduction of population pressures on environment

1919Source: 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.

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

% of married women aged 1549 with unmet need2020Unmet need in Sub-Saharan Africa declined by less than 10% between 19901995 and 20002005. By contrast, unmet need declined by a third or more in the other three regions studied.The overall demand for contraception is increasing

% of married women aged 1549Latin America & CaribbeanNorth Africa & West AsiaSouth & Southeast AsiaSub-Saharan Africa2121The 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.

uncertain or unable to decide about what course to follow = ambivalent

22What are the Reasons for Unmet Need?Lack of access

to preferred methodto preferred provider

23ContPoor quality of services provided. This includes:

Choice of methodsProvider competenceInformation given to clientsProvider-client relationshipsRelated health care servicesFollow-up care24Cont.Health concernsActual side effectsFear of side effects

Lack of information and misinformation about:Available methodsMode of action/how usedSide effectsSource/cost of methods25Cont.Family/community opposition

Concerns about unfaithfulnessFear of side effectsObjections to male providersReligious objectionsLittle perceived risk of pregnancy

7. Ambivalence26uncertain or unable to decide about what course to follow = ambivalent

How to meet Unmet Need?1.Improve access to good quality servicesOffer choice of methodsEliminate medical barriersExpand service delivery pointsHome deliverySocial marketingProvide confidentiality27Cont.2. Improve communication about:

Source of FP information and supplies

Misinformation and rumors regarding effects/side-effects

Risks of contraception

Risks of pregnancy28: legitimacy :lawfulness by virtue of being authorized or in accordance with law

Cont3. Overcomes husbands 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.

29Cont..Link Family Planning to other services

Prenatal carePost-partum care/breastfeedingImmunizationPost-abortion careChild health services30conclusion 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.

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