Abstract
ObjectiveThe predictive utility of the unmet contraceptive need indicator is not well known, despite being recognized as a key family planning indicator for showing the extant demand for birth control. This study assesses the dynamic influence of unmet need on time to contraceptive adoption, as compared with that of contraceptive intentions and their concordance. Study designThis observational study analyzed survey data, including a contraceptive calendar, reported by a panel of 747 non-contracepting, fecund and sexually active Ugandan women, first interviewed in a 2014 national survey and re-interviewed in 2018. We conducted descriptive, survival and multivariate Cox regression analysis of the influence of women's baseline measures of unmet need, self-reported intention to contracept and their concordance with time to adoption of modern contraception over 36 months. ResultsThe study found women classified as having unmet need were slower to adopt contraception than those without unmet need, after adjustment for background covariates (aHR=0.79, 95% CI=0.57–1.10). Women intending future contraceptive use were significantly faster to adopt (aHR=1.45, 95% CI=1.22–1.73) than those not intending. Women with no unmet need but intending to use had the highest rate of adoption compared to those with no need and no intention to use (aHR=2.78, 95% CI=1.48–5.25). ConclusionsThe unmet need indicator underperforms in predicting future contraceptive adoption compared to contraceptive intentions, which merits further consideration as a complementary predictor of future use. Non-contracepting women with unmet need but no intention to use contraception in particular warrant programmatic attention. ImplicationsA non-contracepting woman wanting to limit or space her births is defined as having unmet need, but little is known if she subsequently adopts contraception. By contrasting a woman's unmet need with her expressed intention to use, we offer reasons to further consider self-reported contraceptive intentions as a better predictor of adoption and the underlying latent demand for volitional regulation of fertility.
Highlights
Unmet need for contraception was conceptualized by population scientists in late 1970s and since has been used as a key family planning indicator for showing the demand for birth control [1]
Unmet need for contraception is separately measured for women seeking to space (2 years or more) and to limit births, and satisfaction of unmet need has been identified as potential means for averting maternal deaths [5]
The unadjusted hazard ratio (HR) was 0.66 for unmet need and the ratio adjusted for background covariates was 0.79
Summary
Unmet need for contraception was conceptualized by population scientists in late 1970s and since has been used as a key family planning indicator for showing the demand for birth control [1]. The construct signals a gap between birth control that women want and what services provide [2]. It is defined as the percent of women of. Reproductive age (all or married) who want to delay or limit childbearing but are not using contraception. Unmet need levels are globally and annually estimated by the United Nations [3] to track progress toward the 2030 Sustainable Development Goals and used to monitor family planning demand satisfied of target populations [4]. Unmet need for contraception is separately measured for women seeking to space (2 years or more) and to limit births, and satisfaction of unmet need has been identified as potential means for averting maternal deaths [5]
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