Insights into unmet need in Senegal

Abstract

Background Over the past 20 years the DHS data show that current use of modern contraceptives among all married or cohabiting women increased very slowly from 5% to 12% and unmet need remained unchanged at about 30%. The total demand for contraception (unmet need plus use) slightly increased from 36% to 43% over the same period. Any advances in our understanding of the causes of unmet need could have profound implications for programmes. Objectives This study aims to establish the relative importance of lack of access and attitudinal resistance towards use of contraception in different population and geographical strata of Senegal. It is intended to inform policy makers on the priority that should be given to behaviour change communication or improved access/information, and also helpful in the design of interventions to reduce health concerns and fear of side effects, such as provision of broader method mix and better counseling. Methods The data from the Senegal DHS 20010-11 were used for the analysis. All analyses were based on married or cohabiting fecund women who were exposed to risk of pregnancy at the time of the survey. We identified whether women with unmet need have access (defined by knowledge of pills and injectables, and a supply source) and attitudinal acceptance (defined by intention to use in the future). We assessed variations in unmet need across different strata by bivariate and multivariate analyses. Self-reported reasons for unmet need were assessed. Results Among exposed women, 41% had unmet need, 22% were using any modern contraceptive and 36% wanted a child within 2 years. Those with unmet need fell equally into three main groups: had access and positive attitude; had access but lacked positive attitude; and lacked access. Most of those lacking access had no intention to use family planning. The main self-reported reasons for non-use were respondent’s opposition (18.6%) and infrequent sex (17.7%) followed by breastfeeding and health concerns. The evidence suggests that infrequent sex results in part from the fact that many women were not living in the same households as their husbands. It may also be regarded by couples as an alternative to contraception. Regional and educational variations were substantial. The least educated, the poorest those living in rural areas, Northern, Central and Southeastern areas were more likely to have unmet need without access or positive attitude than their counterparts. Breastfeeding women had high unmet need. Discussion and implications Over half of women having unmet need for family planning in Senegal did not intend to use family planning in the future and this was consistent across all population strata. Reasons for non-use confirm the existence of widespread opposition to use of modern contraception. Unfamiliarity and lack of information is likely to be a reason for such opposition. In societies with low levels of adult education, as in Senegal, initial suspicion of contraception has also been documented. Positive endorsement of family planning by political, religious and traditional leaders may help alleviate these suspicions. The fact that one-third of those with unmet need lacked even basic access testifies to the historic weak implementation of family planning programmes in Senegal. Mass media messages, together with community-based informational efforts, may reduce lack of knowledge of methods and sources of supply. The high level of unmet need among breastfeeding women calls for a sharper focus on postpartum contraception.