Abstract
<h3>Key Messages</h3> “Need”-based measures, such as unmet need and demand satisfied, are indicators used at the global level to assess progress in the family planning (FP) field and provide strong justification for FP programs. These measures are commonly misused or misinterpreted and might not actually represent what girls and women want or need in terms of contraceptive methods and services. To strengthen understanding and use, we recommend that inaccurate and confusing language be removed from the names and labels of these measures and that the FP field work to identify more accurate language. Using a human rights and reproductive justice lens, the field needs to do 2 things: (1) consider refinements to current measures that better capture self-identified needs and preferences; and (2) develop new measures that capture the perspectives of users, potential users, and non-users; this likely requires formative research with women, men, and couples on motivations, aspirations, and preferences around fertility desires and contraceptive use.
Highlights
N These measures are commonly misused or misinterpreted and might not represent what girls and women want or need in terms of contraceptive methods and services
N Using a human rights and reproductive justice lens, the field needs to do 2 things: (1) consider refinements to current measures that better capture self-identified needs and preferences; and (2) develop new measures that capture the perspectives of users, potential users, and nonusers; this likely requires formative research with women, men, and couples on motivations, aspirations, and preferences around fertility desires and contraceptive use
FP2030 recognizes the importance of women and girls’ autonomy in seeking and using family planning (FP)
Summary
Unmet need was originally referred to as the knowledge, attitudes, and practices (KAP) gap, or “KAP-gap,” taking its name from a suite of surveys fielded in the 1960s developed to capture KAPs of women to permit direct examination of birth rates, fertility desires, and contraceptive use behaviors. Measures of unmet need have been used to illustrate funding requirements and potential impacts if all women (and their partners) who want to avoid pregnancy use a contraceptive method.[1,36] The estimates that result from this type of projection may overestimate service need since, as discussed previously, many women who are classified as having an unmet need may not want to use a method even if it is made freely accessible and available They overestimate service needs by assuming all women who are married or who had sex in the past 30 days are at risk of pregnancy if they do not report current contraceptive use.[17] These estimates may underestimate service need since some women and couples may be dissatisfied with their current method and if alternatives were offered, they might visit a facility to switch methods.[25] Given the possibility for over- or underestimation of unmet need and that demand satisfied fails to capture individuals’ actual preferences, these measures need to be reconsidered as the sole global indicators to measure progress toward universal access to FP and sexual and reproductive health services
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