Dr. Henry Mosley of the Bloomberg School of Public Health at Johns Hopkins University discusses the global unmet need for contraception, the reasons behind the unmet need, and ways the problem can be addressed.
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CCIH 2012 Conference, Family Planning Pre-Conference, Dr. Henry Mosley, Unmet Need for Family Planning
1. Family Planning Policies and
Programs
Unmet Need for Contraception
W. Henry Mosley
Johns Hopkins Bloomberg School of Public Health
2. What do we mean by the
“demand” for contraception in a
population?
3. Definitions of Measurements of
“Demand” for Contraception
1. Contraceptive prevalence is a measure of “met” demand for
fertility control.
2. Unmet need for contraception is measured as the proportion
of women in a sexual union desiring to space or limit
childbearing and not using contraception
3. Total potential demand for fertility control is measured by
contraceptive use + unmet need.
4. Demand for Contraception
As measured by contraceptive use and
unmet need
Unmet need
Total Potential
Contraceptive Demand for
Prevalence
Contraception
5.
6. What is unmet need?
• Women have an unmet need if they
– are sexually active
– do not want to have a child soon or at all
– are not using any contraceptive method
– are able to conceive
7. Unmet Need for Contraception
Calculation
Women are defined as having an
unmet need if they are:
• fecund
• married or living in union
• not using any contraception
• do not want any more children, or
• want to postpone for at least
two years
8. Unmet Need for Contraception
Calculation (continued)
Unmet need also includes currently
pregnant or amenorrheic women
• with unwanted or mistimed
pregnancies/births, and
• were not using contraception at time
of last conception
10. Defining Unmet Need - Kenya, 1993
Not using contraception 67%
Pregnant or amenorrheic 30% Not pregnant or amenorrheic 37%
Pregnancy Pregnancy Pregnancy Fecund Infecund
intended mistimed unwanted 24.6% 12.6%
12.7% 12.7% 4.6%
Want later Want no Want soon
9.4% more 8.7% 6.4%
Need for spacing Need for limiting Need for spacing Need for limiting
12.7& 4.6% 9.4% 8.7%
Total unmet need 35.5%
11. “Demand for Contraception”
by Women’s Age, Kenya, 1993
90
80
70
Contraceptive
% MWRA
60 use
50 Unmet need for
40 limiting
30 Unmet need for
spacing
20
10
0 Note: Totals of each
15- 20- 25- 30- 35- 40- 45- column = “demand for
19 24 29 34 39 44 49 contraception”
12. More than 100 million married women
have an unmet need for contraception
South & Southeast Asia
29 (27%)
Central Asia
Latin America & Caribbean
North Africa & West Asia
7 (7%) 60 (56%)
Sub-Saharan Africa
9 (8%)
3 (3%)
Number (in millions) and % distribution of married women with unmet need
13. Who has unmet need?
• Fifteen percent of married women in
developing countries:
– 24% in Sub-Saharan Africa
– 11% in South and Southeast Asia
– 10% in North Africa and West Asia
– 12% in Latin America and the Caribbean
14. Who has unmet need?
• Nine percent of never-married women in
Sub-Saharan Africa
• Five percent of never-married women in
Latin America
15. The big picture
• Levels of unmet need are higher in some
regions, countries and population groups
than in others
• The proportion of women with unmet need
is greatest, and has declined least, in Sub-
Saharan Africa
• In absolute numbers, unmet need is
concentrated in South and Southeast
Asia, the most populous regions
16. Expanded Definitions of Unmet Need
May include women who:
• are using an ineffective method
• are using a method incorrectly
• are using an unsafe method
• are using an unsuitable method
18. How does unmet need relate to
the levels of fertility and
contraceptive prevalence in a
population?
19.
20. What is the trend in contraceptive
demand and unmet need?
21. The overall demand for
contraception is increasing
% of married women aged 15–49
Latin America & North Africa & South & Southeast Sub-Saharan
Caribbean West Asia Asia Africa
22. Unmet need among married women has declined in all
regions, but remains highest in Sub-Saharan Africa
% of married women aged 15–49 with unmet need
100
80
60
40
26
17 18 24
14
20 12 10 11
0
Latin America & North Africa & West South & Southeast Sub-Saharan Africa
Caribbean Asia Asia
1990-1995 2000-2005
23. Countries with high fertility and
low contraceptive prevalence
have high unmet needs for
contraception.
24. Percent of Women in Union Using a Contraceptive
Method and with Unmet Needs for Family Planning
26. Most women with unmet need intend
to use a method in the future
% of women who intend to use a method
100 96
82
80 77 76
67
60
40
20
0
Married Never-married
Latin America & Caribbean Sub-Saharan Africa South & Southeast Asia
28. Reasons for Unmet Need
1. Lack of access
• to preferred method
• to preferred provider
Physical distance may not be of major
importance, but other “costs” are,
such as monetary, psychological,
physical, and time.
29. Reasons for Unmet Need
2. Poor quality of services provided.
This includes:
• choice of methods
• provider competence
• information given to clients
• provider-client relationships
• related health care services
• follow-up care
Reference: Judith Bruce Framework
30. Reasons for Unmet Need - cont.
3. Health concerns
• actual side effects
• fear of side effects
4. Lack of information and
misinformation about:
• available methods
• mode of action/how used
• side effects
• source/cost of methods
31. Reasons for Unmet Need - cont.
5. Family/community opposition
(power relationships in the household)
• pronatalist
• concerns about unfaithfulness
• fear of side effects
• objections to male providers
• religious objections
32. Reasons for Unmet Need - cont.
6. Little perceived risk of pregnancy
7. Ambivalence
34. Meeting Unmet Need
1. Improve access to good quality
services
• offer choice of methods
• eliminate medical barriers
• expand service delivery points
- home delivery
- social marketing
• provide confidentiality
35. Meeting Unmet Need
2. Link FP to other services
• prenatal care
• post-partum care/breastfeeding
• immunization
• post-abortion care
• child health services
• HIV and STD services
36. Where are the greatest global
challenges in terms of unmet need?
42. There are many benefits to
preventing unintended pregnancies
• Fewer unsafe abortions
• Healthier mothers and children
• Greater investments in each child
• Social and economic opportunities for women
• Economic growth
• Reduction of population pressures on
environment
A woman has an unmet need for contraception if she is married, in a consensual union, or unmarried and sexually active; is able to become pregnant; does not want to have a child in the next two years or wants to stop childbearing; and is not using any method of contraception, either modern or traditional. Women who use modern or traditional methods of contraception are considered to have their contraceptive needs met.
Fifteen percent of married women aged 15-49 in developing countries have an unmet need for contraception. These data are based on Demographic and Health Surveys conducted between 2000 and 2005. Note: These data exclude East Asia, which is made up primarily of China. For 10-year averages that include data from developing countries that have not conducted surveys since 2000, see Guttmacher Institute, Facts About the Unmet Need for Contraception in Developing Countries, New York: Guttmacher Institute, 2007, at http://www.guttmacher.org/pubs/2007/07/09/FB_unmetNeed.pdf.
Among never-married women, nine percent in Sub-Saharan Africa and five percent in Latin America have unmet need for contraceptives. No data are available for never-married women in Asia or North Africa
The demand for contraception worldwide is increasing, while unmet need is decreasing in most regions. As demand increases family planning programs have to satisfy not just unmet need, but also the growing number of users of family planning methods.
Unmet need in Sub-Saharan Africa declined by less than 10% between 1990 – 1995 and 2000 – 2005. By contrast, unmet need declined by a third or more in the other three regions studied.
In most countries, the majority of women—both married and never-married—with an unmet need for contraception intend to use a method in the future.
Source: Singh et al., Adding It Up: The Benefits of Investing in Sexual and Reproductive Health Care, New York: The Alan Guttmacher Institute and United Nations Population Fund, 2003.