The causes of unmet need for contraception and the social content of services

Stud Fam Plann. Mar-Apr 1995;26(2):57-75.

Abstract

Since the 1960s, survey data have indicated that substantial proportions of women who have wanted to stop or delay childbearing have not practiced contraception. This discrepancy is referred to as the "unmet need" for contraception. The traditional interpretation, that these women lack access to contraceptive supplies and services, has led in turn to an emphasis on expanding family planning programs. This study analyzes survey data and related anthropological studies on the causes of unmet need and concludes that the conventional explanation is inadequate. Although for many environments geographic access to services remains a problem, the principal reasons for nonuse are lack of knowledge, fear of side effects, and social and familial disapproval. This finding underscores the need for expanded investment in services that not only provide contraceptives, but also attend to closely related health and social needs of prospective clients. Programs are likely to be most successful when they reach beyond the conventional boundaries of service provision to influence and alter the cultural and familial factors that limit voluntary contraceptive use.

PIP: Since the 1960s, survey data have indicated that substantial proportions of women who have wanted to stop or delay childbearing have not practiced contraception. This discrepancy is referred to as the unmet need for contraception. The traditional interpretation, that these women lack access to contraceptive supplies and services, has led to an emphasis on expanding family planning programs. Recent estimates put the total number of women with an unmet need in the developing world at about 120 million. This study analyzes national Demographic and Health Survey data and related anthropological studies on the causes of unmet need and concludes that the conventional explanation is inadequate. Sub-Saharan Africa stands out as the region with the lowest potential demand and contraceptive prevalence and having the highest unmet need. The unmet need in Asian countries is only 14%. The proportion of women not currently seeking to become pregnant and those who do not want children rises from 29% to 73% between the lowest and the highest levels of development. The prevalence of contraceptive use also increases sharply between the lowest and highest development group: from 4% to 16% for spacing, from 3% to 43% for limiting, and from 7% to 59% for total use. Although for many environments geographic access to services remains a problem, the principal reasons for nonuse are lack of knowledge (25%), especially in Sub-Saharan countries, fear of side effects both life-threatening and non-life-threatening (20%), and social and familial/husband disapproval (9%), even when the women have never discussed family planning with their husbands or families. This finding underscores the need for expanded investment in services that not only provide contraceptives, but also attend to closely related health and social needs of prospective clients. Programs are likely to be most successful when they reach beyond the conventional boundaries of service provision to influence and alter the cultural and familial factors that limit voluntary contraceptive use.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Contraception Behavior / psychology*
  • Developing Countries*
  • Family Planning Services / organization & administration*
  • Female
  • Health Knowledge, Attitudes, Practice
  • Health Services Needs and Demand*
  • Humans
  • Pregnancy
  • Spouses / psychology