Alternative Measures of Unmet Need for Family Planning in Developing Countries

Abstract

Estimates of the unmet need for family planning among currently married women in developing countries who want no more children vary widely within countries and between countries depending upon the measure used to define that need. The authors examine the implications of 12 measures of unmet need in 18 3rd World countries that participated in the World Fertility Survey and address the differential demographic impact of the various measures. By the simplest measure--the percentage of currently married women who want no more children and are not using an effective contraceptive (pill IUD injection sterilization barrier methods)--unmet need averages 40% in these 18 countries ranging from 58% in Peru to 24% in Kenya. (While 2 countries may have the same levels of unmet need as Kenya and Costa Rica do the reasons may be quite different. Very few Kenyan women say they want no more children and so their contraceptive use is extremely low; a large proportion of Costa Rican women on the other hand say they want no more children and their level of contraceptive practice is very high.) When the measure is use of any method including ineffective ones unmet need declines to 35%. As the measures become more rigorous the proportion of unmet need declines. The authors suggest that there is no best estimate of unmet need. For a clinic-based family planning program in its early stages with a limited budget and little outreach or educational component the most stringent measure of unmet need is probably the most appropriate to define the programs target group. This group would include women who want no more children desire fewer children than they actually have are not pregnant or infecund are not breastfeeding and are not using any method of contraception but indicate that they intend future use. On the other hand a well financed program with extensive educational activities may want to use the measure that includes all women who want no more children are not pregnant or infecund and are not using an effective method. The investigators point out that in some countries there may be considerable unmet need for contraceptive services for childspacing; adding this measure could raise the total unmet need considerably. In most of the countries analyzed it was found that the fertility rate among women with unmet need was about twice that of women whose need has been met. If all need were met the fertility would decline on average about 11%--ranging from 5% in Kenya and Costa Rica to 25% in Korea. (authors) (summaries in ENG FRE)