INTRODUCTION
The concept of “unmet need for family planning methods” refers to the proportion of women who do not want to become pregnant but are not using contraception, has been used since 1960 onwards during family planning and fertility surveys conducted in developing countries. The triggering factor to coin this terminology came following the findings on disconnect between women’s knowledge, attitudes and practices (KAP) about various family planning methods during the survey. The gap between the women’s knowledge on their reproductive intentions/fertility preferences and their contraceptive behavior and also the available options, to achieve their stated preferences is known as “KAP gap”, on this family planning program need to focus. Unmet need for contraception is therefore one of the several frequently used indicators for monitoring Family Planning Programs and is included in the MDG goal for improving maternal health, which is expressed as a percentage based on women who are married or in a consensual union.
DEFINITION
The ‘Unmet Need’ for contraception is thus defined as the proportion of currently married women who are fecund and sexually active, do not want any more children but are not using any form of family planning (unmet need for contraception for limiting) or those currently married women who want to postpone their next birth for two years but are not using any form of family planning (unmet need for contraception for spacing).
IMPORTANCE OF UNMET NEED FOR CONTRACEPTION
Women who are using Contraceptives are said to have “met need for family planning”. The ‘unmet need for family planning’ gives an estimate of the proportion of women who might potentially use contraception. The ‘total demand for family planning’ is made up of the proportion of married women with unmet need and married women with met need for family planning. The unmet need for contraception can lead to unintended pregnancies, which pose risks for women, their families, and society at large. These unintended pregnancies contribute to rapid population growth as also poses health risks to the women and their offspring. Moreover, majority of women with unintended pregnancies often resort to abortions, which if unsafe add to maternal mortality 4and morbidity. Therefore, the unmet need for family planning helps the Program Managers to initiate and/or expand the FP Program based on the area specific need in order to reduce the unintended pregnancies and its consequences as also population growth. Moreover, combining the estimate of unmet need with data on current contraceptive use provides a picture of the total potential demand for family planning in the country. For the FP Program the estimate is useful because it helps to access the potential market for contraception. For policy purposes, data on unmet need allow analysts to project how much fertility could decline if the additional need for family planning were met.
MEASUREMENT OF UNMET NEED
Unmet need for contraception is generally measured with household surveys, in which married women of reproductive age respond to a number of precisely worded questions. A woman is first asked whether she is using any method of contraception, whether for the purpose of limiting or spacing births. If she is using contraception, including traditional methods, she is considered to be a contraceptive user, and therefore does not have unmet need. Women who are not using contraception are then asked whether they are pregnant or amenorrheic (not menstruating, often due to a recent pregnancy or lactation). In the calculation of unmet need, pregnant or amenorrheic women whose pregnancy was mistimed or unwanted are added to the proportion with unmet need, even though they do not at the time of the survey have an immediate need for contraception, given their pregnancy. Women who are not pregnant or amenorrheic and are infecund do not have unmet need, nor do women who want to become pregnant soon. Note that the measurement of unmet need does not include an assessment of whether women want or intend to use contraception.
There are some shortcomings in the data on ‘unmet need’. The survey excludes data of unmarried women, whose level of sexual activity (and therefore risk of pregnancy) varies greatly and is not measured. Similarly unmarried youths who are sexually active represent a large and growing segment of the population, but their needs for contraception are not measured. Moreover, the data exclude women who are using contraceptive methods that are ineffective or personally unsatisfactory, who may have an unmet need for a different contraceptive method.
IMPORTANCE AND REASONS FOR UNMET NEED FOR FAMILY PLANNING
Knowing the level of unmet need for family planning methods in a given area at a certain time does not necessarily by itself provide information on why unmet need exists, or what the potential future demand for contraception might be. Women may have one or more reasons for not intending to use contraceptives which may be related to desired fertility (wanting to have more children), to opposition to contraception for cultural or religious reasons (by women or their husbands, or others), to lack of knowledge of methods and where to obtain them, or to fear of side effects or health concerns. Knowing why women have unmet need is useful when planning information, education, and communication (IEC) campaigns and behavioral change communication (BCC) programs to generate 5demand for family planning services. For example, women with unmet need who are not planning on using contraception because of health concerns may be provided with information on several alternative contraceptive methods or counseling on side effects. In contrast, women with unmet need who want to use contraception in the future may need information on where to go and cost of a contraceptive method, etc.
Current Status in India
In India Family Planning Program is one of the oldest program started since 1952, it has undergone transformation in terms of policy and actual program implementation. Over the years, the program has been expanded to reach every nook and corner of the country and has penetrated into primary health centers (PHCs) and sub-centres (SCs) in rural areas, Urban Family Welfare Centers and Postpartum Centres in the urban areas. Technological advances, improved quality and coverage for health care has resulted in a rapid fall in the crude birth rate (CBR) and growth rate.
However, in terms of actual contraception usage the pace has been rather slow. With increasing awareness there is increasing unmet need in most of the states in India.
As per the latest available data (DLHS III) the unmet need of contraception in india is 21.3%, with a higher share of limiting methods (13.4%) and lower share of spacing methods (7.9%). There has been a decline of 16% in the total unmet need from DLHS I to DLHS III, but from DLHS II to DLHS III the drop is only 0.2% which is the matter of concern Fig. 1.
The unmet need shows a huge interstate differential, Bihar with unmet need of >30 has the highest unmet need in the country whereas the lowest unmet need is of Andhra Pradesh.
Besides interstate differences there is also age differential among the age group contributing to the highest fertility (15–24 years) have higher unmet need (28.3%) (DLHS III) with almost 74% unmet need for spacing methods (Table 1).
Key factors influencing the unmet need of family planning methods:
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Availability of the Services
- Sometimes the unavailability of the particular type of service may result in generating the unmet need.
- Supply demand gap: Unavailability of commodity can result in unmet need.
Accessibility of the Services
- Sociocultural barriers—perceptions that their husbands, other family members, or their religion opposes family planning.
- Unavailability of FP services in the close vicinity.
Awareness/Literacy
- Increase in awareness and literacy results in generating demand in the community which sometimes reflect as unmet need.
- Lack of knowledge about the risk of becoming pregnant.
- Inadequate/no knowledge about various available family planning methods.
Fear of Side Effects of Contraceptives
Many of these barriers could be overcome through better information and counseling for both women and men.
OUTCOME OF UNMET NEED FOR FAMILY PLANNING
One of the outcomes of high unmet need is unintended pregnancies. Unintended pregnancy is a primary reason for abortion and further maternal death. Access to safe and voluntary family planning counseling and services thus significantly reduces unintended pregnancies and abortions and saves women’s lives.
Studies suggest that by fulfilling the unmet need for contraception the maternal mortality can be reduced up to 35%, with a significant fall in abortion related mortalities and morbidities.
Government of India’s initiative to address unmet need for family planning methods and increase contraception usage:
- Home delivery of contraceptives (oral pills, condoms and EC pills).
- Ensuring spacing at birth.
- Promoting IUD 380A intensively as a spacing method because of its longevity of 10 years and advantages over other IUDs.
- Expanding basket of choice by introduction of Cu IUCD 375 with effectivity of five years.
- Introducing PPIUCD as a new method of contraception—promoting PPIUCD as a method of contraception, within 48 hours of delivery as the mode of providing spacing in postpartum period. This will give a chance to capitalize the huge cases coming in for institutional delivery under JSY. Introduction of PPIUCD as a method of contraception has also improved the basket of choice further.
- Fixed day Fixed Place Family Planning Services at District Hospitals, CHCs and PHCs.
- Availability of RMNCH Counselors.
- The outreach activities through the institution of ASHAs and Monthly Health and Nutrition Days.
- Strengthening social marketing of contraceptives.
CONCLUSION
The unmet needs for family planning methods helps to understand the magnitude of the problem in the country as a whole and also the statewise variations including the characteristics of the women who are not using any contraceptive method. Family Planning Program has therefore a definitive role to play in helping the people to get proper information and services including easy availability of products that they need through informed choice. From policy perspective—reduction of unmet need for family planning is important both for achieving demographic goals and enhancing individual rights. From Demographic standpoint—reduction of unmet need can lower fertility, which in turn controls population growth. For the couple—the reduction of unmet need will help to achieve their reproductive goals and prevent unintended pregnancies and thereby help in reduction of maternal morbidity and mortality.