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5.6 Unmet need for family planning

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Modified on 2012/03/05 16:09 by MDG Wiki Handbook Categorized as Goal 5
Contents

GOAL AND TARGET ADDRESSED

Goal 5. Improve maternal health
Target 5.B: Achieve, by 2015, universal access to reproductive health

DEFINITION AND METHOD OF COMPUTATION

Definition
This indicator is defined as the percentage of women of reproductive age, either married or in a consensual union, who have an unmet need for family planning.

Concepts
Women of reproductive age include all women aged 15 to 49.

Women with an unmet need for family planning are women who are fecund and sexually active but are not using any method of contraception, and report not wanting any more children or wanting to delay the birth of their next child for at least two years. Included are:
  • all pregnant women (married or in a consensual union) whose pregnancies were unwanted or mistimed at the time of conception;
  • all postpartum amenorrheic women (married or in consensual union) who are not using family planning and whose last birth was unwanted or mistimed;
  • and all fecund women (married or in consensual union) who are neither pregnant nor postpartum amenorrheic, and who either do not want any more children (want to limit family size), or who wish to postpone the birth of a child for at least two years or do not know when or if they want another child (want to space births), but are not using any contraceptive method.

Infecund women are not included in the numerator.

Infecund women are women who were first married five or more years ago, have not had a birth in the past five years, are not currently pregnant, and have never used any kind of contraceptive method. Also included are women who self-report that they are infecund, menopausal or have had a hysterectomy, never menstruated, have been postpartum amenorrheic for 5 years or longer, or (for women who are not pregnant or in postpartum amenorrhea) if the last menstrual period occurred more than six months prior to the survey.

Postpartum amenorrheic women are women who have not had a menstrual period since the birth of their last child and their last child was born in the period 0-23 months prior of the survey interview. If their period has not returned and their last child was born 24 months or more prior to the interview, women are considered fecund, unless they fall into one of the infecund categories above. Note that in previous definitions of unmet need for family planning, women were classified as being postpartum amenorrheic if their period had not returned for up to 5 years after the birth of their last child.

The methods of contraception considered for the calculation of this indicator include both modern and traditional methods of contraception. Modern methods of contraception include female and male sterilization, oral hormonal pills, intra-uterine devices (IUD), male and female condoms, injectables, implants (including Norplant), vaginal barrier methods and spermicides. Traditional methods of contraception include the rhythm method (periodic abstinence), withdrawal, lactational amenorrhea method (LAM) and folk methods. Note that LAM is classified in some surveys as a modern method. For computation of this indicator for MDG reporting, current contraceptive use is use of any method (whether modern or traditional).

Method of computation
Unmet need for family planning is calculated using the following formula:

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The diagram below indicates the procedure for the computation of the number of women of reproductive age, either married or in a consensual union, who have an unmet need for family planning.

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RATIONALE AND INTERPRETATION

Unmet need for family planning shows the gap between women's reproductive intentions and their contraceptive behaviour. The indicator is useful for tracking progress towards the target of achieving universal access to reproductive health. Information on contraceptive prevalence complements the indicator of unmet need for family planning. The sum of contraceptive prevalence and unmet need identifies total demand for family planning.

In principle, this indicator may range from 0 (no unmet need) to 100 (no needs met). However, values approaching 100 per cent do not occur in the general population of women, since, at any one time, some women wish to become pregnant and others are not at risk of pregnancy. Unmet needs of 25 per cent or more are considered very high, and values of 5 per cent or less are regarded as very low.

When unmet need for family planning is measured in a comparable way at different dates, the trend indicates whether there has been progress towards meeting women’s needs for family planning. It should be noted that, even when contraceptive prevalence is rising, unmet need for family planning may sometimes fail to decline, or may even increase. This can happen because in many populations the demand for family planning increases because of declines in the number of children desired. Changes in the desired spacing of births or changes in the percentage of women who are at risk of pregnancy can also influence the trend in demand for family planning, independently of trends in contraceptive prevalence.

Note that there is not a direct relationship between the unmet need for family planning, desired family sizes, and the actual fertility level. For instance, it is possible for unmet need to be high even though the actual fertility level matches the desired family size. This can happen either because of individual variation in the population’s desired family size, differences between the desired family size of men and women such that desired family size does not reflect the ideals of women, or because there are many mistimed births such that the number of births is desired, but the timing of births is not.

SOURCES AND DATA COLLECTION

Information on unmet need for family planning is collected through household surveys such as the Demographic and Health Surveys (DHS), Reproductive Health Surveys (RHS) and national surveys based on similar methodologies. Recently, a shorter, alternative approach to measuring unmet need has been developed and incorporated into the core Multiple Indicator Cluster Survey (MICS) programme. These surveys tend to be undertaken every three to five years. Other survey programmes, like the Pan-Arab Project for Family Health (PAPFAM) and the European Fertility and Family Surveys (FFS) can also be used.

Differences in the questions included in particular surveys may sometimes affect the estimates of unmet need for family planning and make comparability difficult over time or across countries. For example, some surveys do not gather all the information required to estimate infecundity in the same way. Differences in questions about contraceptive use, fertility desires and assessment of postpartum amenorrhea may also indirectly affect the measured level of unmet need for family planning.

Only women who are married or in a consensual union are assumed to be sexually active for the calculation of this indicator. If unmarried women are to be included in the calculation, it is necessary to determine the timing of the most recent sexual activity. Unmarried women should only be included in the numerator if they have had intercourse in the month prior to the survey interview.

DISAGGREGATION

This indicator may be disaggregated by geographical area, age, education, rural or urban residence, poverty status and other characteristics that are relevant in the national context. Such analysis can identify population sub-groups where levels of unmet need are highest to help guide programmes aimed at improving access to family planning and other reproductive health services.

The total level of unmet need for family planning can also be separated into two additive components: unmet need for family planning to limit family size and unmet need for purposes of birth spacing. The family planning and other reproductive health needs of women who want to limit births are likely to differ from the needs of women who want to space births to some extent. For instance, some family planning methods are more suitable for long-term than short-term use.

COMMENTS AND LIMITATIONS

Although the majority of estimates of unmet need for family planning follow the standard method of calculation, there can be differences in the precise definition or method of calculation of this indicator. For instance, some surveys do not include pregnant women with a mistimed or unwanted pregnancy in the number of women with unmet need for family planning.

Trends in unmet need for family planning in a particular population should be based on successive data points that were calculated in a comparable way. In designing and monitoring programmes aimed at reducing unmet need for family planning, this indicator should be interpreted in connection with other relevant national data, including qualitative and quantitative information regarding the reasons that women who are at risk of an undesired or mistimed pregnancy are not using family planning, and assessments of the availability and quality of family planning and other reproductive health services.

According to the standard definition of unmet need for family planning, women who are using a traditional method of contraception are not considered to have an unmet need for family planning. Because traditional methods can be considerably less effective than modern methods, additional analyses may be conducted to distinguish between women relying on traditional and modern methods in order to determine the unmet need for modern contraception.

GENDER EQUALITY ISSUES



This indicator highlights the degree of congruence between women’s own stated preferences for number and timing of births and their family planning practice. Disaggregation of this indicator according to women’s social and demographic characteristics can provide additional insight regarding the degree to which unmet need for family planning particularly affects vulnerable groups such as adolescents and poor women. In addition, the sample surveys that provide the information needed to assess unmet need usually provide additional information that is useful in understanding the reasons, including gender-based reasons, why women have an unmet need for family planning. For example, some women may not know about contraceptive methods, while others may be dissuaded from using a method because of opposition from their partner or others.

DATA FOR GLOBAL AND REGIONAL MONITORING

The unmet need for family planning is produced at the global level by the United Nations Population Division (UNPD) in collaboration with the United Nations Population Fund (UNFPA).

The figures are generally obtained from national household surveys that are internationally coordinated—such as DHS, MICS and RHS. When DHS, MICS or RHS data are not available, data from national surveys that have incorporated the DHS methodology, but were conducted by national authorities without international technical assistance are used as inputs. Other national surveys conducted as part of the European Fertility and Family Surveys (FFS) and the Pan-Arab Project for Family Health (PAPFAM) may be considered as well.

The data are taken from published survey reports or, in exceptional cases, other published analytical reports. If clarification is needed, contact is made with the survey sponsors or authoring organization, which occasionally may supply corrected or adjusted estimates in response. The received data are not adjusted by the responsible international agencies, UNPD and UNFPA.

Regional estimates are weighted averages of the country data, using as weights the number of women aged 15–49 who are married or in a union for the reference year in each country. Global estimates are weighted averages of the regional estimates, using as weight the number of women aged 15–49 who are married or in a union in each region. No figures are reported if less than 50 per cent of the reference population in the region are covered.

SUPPLEMENTARY INFORMATION



EXAMPLES



REFERENCES

Bradley, Sarah E.K., Trevor N. Croft, Joy D. Fishel, and Charles F. Westoff. 2012. Revising Unmet Need for Family Planning. DHS Analytical Studies No. 25. Calverton, Maryland, USA: ICF International. Available from http://www.measuredhs.com/publications/publication-AS25-Analytical-Studies.cfm

Rutstein, S. O. and G. Rojas (2006). Online Guide to DHS Statistics. Calverton, Maryland: Measure DHS. Available from http://www.measuredhs.com/help/Datasets/index.htm.

UNITED NATIONS (2011). World Contraceptive Use 2010. New York. Available from http://www.un.org/esa/population/publications/wcu2010/Main.html

UNITED NATIONS CHILDREN’S FUND (2011). Multiple Indicator Cluster Survey -- Round 4. Available from http://www.childinfo.org/mics4.html

WESTOFF, C. F. (2006). New Estimates of Unmet Need and the Demand for Family Planning. DHS Comparative Reports, No. 14. Calverton, Maryland: Macro International Inc. Available from http://www.measuredhs.com/pubs/pdf/CR14/CR14.pdf.

WESTOFF, C. F. (2001). Unmet Need at the End of the Century. DHS Comparative Reports, No. 1. Calverton, Maryland: ORC Macro. Available from http://www.measuredhs.com/pubs/pdf/CR1/C1.pdf.

WESTOFF, C.F. and BANKOLE A. (1995). Unmet need: 1990-1994. DHS Comparative Studies, No. 16. Calverton, Maryland: Macro International Inc. Available from http://www.measuredhs.com/pubs/pub_details.cfm?ID=24.

WESTOFF, C.F. and L. H. OCHOA (1991). Unmet Need and the Demand for Family Planning. DHS Comparative Studies, No. 5. Columbia, Maryland: Institute for Resource Development/Macro International. Available from http://www.measuredhs.com/pubs/pub_details.cfm?ID=39&srchTp=advanced.

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