STALKING THE ELUSIVE UNMET NEED FOR FAMILY-PLANNING

The discourse on unmet need in family planning (FP) emphasizes the need to obtain better conceptualizations based on the experiences of southern hemisphere countries. Unmet need has become a concept important for policy decisions, program strategies, budgeting, and resource allocations. The concept varies with the survey questions, with the definitions, and through the exclusion of factors. Conventional means exclude the needs of those not in consensual or marital unions and those who report use of a contraceptive. The exclusion of these women can have a sizeable impact. Unmarried people of reproductive age range from 8% in Mali to 46% in the Dominican Republic. In a study of unmarried women in Paraguay, 6% of single women had an unmet need by their own definition. Contraceptive users may be grouped three ways: 1) those wanting to avoid or postpone a pregnancy and who are using an ineffective method; 2) those who are using a theoretically effective method incorrectly or sporadically; and 3) those who are using an unsafe or unsuitable method. Included in the concept of unmet need are women who has mistimed or unwanted conception. The problems are that the survey questions regarding wantedness are biased and under-reported. Reported unplanned pregnancies and live births do not take into account abortions. The KAP surveys rarely ask for information on abortion; World Fertility Surveys tend to under-report voluntary abortion. There is a need to assess the need for safe, accessible, and affordable methods of pregnancy termination. Projections are that FP demand will rise sharply in most southern countries. national program strategies must be devoted to reducing the level of unmet need for the following women: 1) nonusers who are at risk of an unplanned pregnancy and need contraception; 2) users who need better contraceptive methods; 3) nonusers and users who need a safe, accessible method of pregnancy termination; and 4) nonusers and users who need more comprehensive sexual and reproductive health services. The current conventional method are useful only when limitations are noted clearly. Better measures, which expand the net of unmet need, will show the true extent of women and men's need for family planning formation and services.