1. Unmet need for family planning
Dr. Pramod

2. Background
Family planning being a viable solution to control such fast growing populations, not only helps in spacing and limiting the number of children, but also improves maternal and child health, empowers women and boosts economic development.
More than 100 million sexually active women in developing countries would like to adopt family planning but they are not able to.
Today in India , around 50% of currently married women (ages 15-49) use or whose sexual partners use any form of modern contraception.
India has about 31 million of women with unmet need for family planning, despite the existence of the National Policy on Family Planning since the year 1983.

3. What is unmet need for family planning?
Definition: Many women who are sexually active would prefer to avoid becoming pregnant but nevertheless are not using any method of contraception. These women are considered to have an Unmet need for family planning . or
Currently married women who are not using any method of contraception but who do not want any more children or want to wait two or more years before having another child are defined as having an unmet need for family planning.
The percent with an unmet need for family planning is the number of women with unmet need for family planning expressed as a percentage of women of reproductive age who are married or in a union. Women with unmet need are those 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.

4. Cont….. 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

5. Cont….. Unmet need also includes: pregnant or amenorrheic women
With unwanted or mistimed pregnancies/births, and
Not using contraception at time of last conception

6. 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

7. How the Unmet Need Concept Evolved?
1960- Surveys of contraceptive knowledge, attitudes, and practices ( KAP ) showed a gap between some women's reproductive intentions and their contraceptive behaviour and called as “KAP gap”.
1972- Analysis of women's responses to three KAP surveys in Taiwan, Ronald Freedman and colleagues first identified a specific group of women who might be expected to adopt contraception--even without changing their desired family size because they said that they wanted to have no more children but were not using contraception.

8. Cont..
1974 -Freedman and Lolagene Combs for the first time used survey data to identify the size of this group in several countries, and they found it to be substantial and coined the term "discrepant behaviour" to describe the status of such women Term "unmet need“ used by Bruce Stokes, citing both the evidence from KAP studies in developing countries and from fertility survey in the US to The World Fertility survey (WFS) conducted and first time to report extensively about unmet need .

9. Cont..
1970 to Contraceptive Prevalence Surveys (CPS) conducted and made possible further refinement and measurement. The CPS added questions about women's interest in postponing, or spacing, next births.
Dorothy Nortman said that women who were pregnant, breastfeeding, or amenorrheic should be included in the definition of unmet need because they would soon need contraception again.
1984 -The Demographic and Health Surveys (DHS) conducted and further improved measurement of unmet need. The DHS asks pregnant women whether their current pregnancies were intentional, mistimed, or unwanted and also whether they were using contraception at the time of conception.
1985- Family Planning /Reproductive Health Surveys (FP/RHS) and provide estimates of unmet need, including among unmarried women.

10. How to calculate unmet need ?
The majority of estimates of unmet need for family planning follow the procedure adopted in the Demographic and Health Surveys (DHS), which is regarded as the standard method of computation.
Unmet need for family planning =
Women (married or in a union) who are not using contraception, are fecund, and desire to either stop childbearing or postpone their next birth for at least two years + pregnant women whose current pregnancy was unwanted or mistimed + women in post-partum amenorrhea who are not using contraception and, at the time they became pregnant, had wanted to delay or prevent the pregnancy x 100 / Total number of women of reproductive age (15-49) who are married or in a union

13. Unmet need is especially high among groups
such as:
Adolescents
Migrants
Urban slum dwellers
Refugees
Women in the postpartum period

14. Why Are Policymakers Concerned About Unmet Need?

16. More than 100 million married women have an unmet need for contraception
29 (27%)
60 (56%)
7 (7%)
9 (8%)
3 (3%)
Number (in millions) and % distribution of married women with unmet need 16

17. More than one-third of pregnancies in developing countries are unintended
Induced abortions
Wanted births
Unwanted or
mistimed births
More than one-third of pregnancies in developing countries—about 76 million each year—are unintended. About half of these end in induced abortions, most of which are either illegal or unsafe. The remaining half (16% of all pregnancies) result in unwanted or mistimed births.
Source: AGI, Sharing Responsibility: Women, Society and Abortion Worldwide, New York: AGI, 1999; and Sedgh et al, Induced abortion: the global reality and avoidable risks, Lancet, submitted 2007.
Spontaneous
abortions (miscarriages)
Outcomes of all pregnancies in developing countries 17

18. Most unintended pregnancies occur among women who were not using any contraceptive
Modern method
No method
Traditional
method
Two-thirds of unintended pregnancies in developing countries occur among women who were not using any method of contraception.
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.
Unintended pregnancies in developing countries, by women’s contraceptive use 18

19. 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
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. 19

20. 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
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. 20

21. The overall demand for contraception is increasing
% of married women aged 15–49
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.
Latin America & Caribbean
North Africa & West Asia
South & Southeast Asia
Sub-Saharan Africa 21

22. uncertain or unable to decide about what course to follow = ambivalent

23. What are the Reasons for Unmet Need?
Lack of access
to preferred method
to preferred provider

24. Cont… 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

25. Cont. Health concerns Lack of information and misinformation about:
Actual side effects
Fear of side effects
Lack of information and misinformation about:
Available methods
Mode of action/how used
Side effects
Source/cost of methods

26. Family/community opposition
Cont.
Family/community opposition
Concerns about unfaithfulness
Fear of side effects
Objections to male providers
Religious objections
Little perceived risk of pregnancy
7. Ambivalence
uncertain or unable to decide about what course to follow = ambivalent

27. How to meet 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

28. Cont…. 2. Improve communication about:
Source of FP information and supplies
Misinformation and rumors regarding effects/side-effects
Risks of contraception
Risks of pregnancy
: legitimacy :lawfulness by virtue of being authorized or in accordance with law

29. Cont… 3. Overcomes husband’s opposition:
Address men directly with Information about the benefits and safety of family planning. Recognizing men's often-dominant role in decision-making but promoting the equal participation of a women, too.
Encourage better communication between spouses about family planning and reproductive health.
Help women lean how they can talk with their partners about family planning, including how to start the discussion.

30. Cont.. Prenatal care Post-partum care/breastfeeding Immunization
Link Family Planning to other services
Prenatal care
Post-partum care/breastfeeding
Immunization
Post-abortion care
Child health services

31. conclusion
Needs to be built the capacity of ASHAs, ANMs, nurses, doctors and family planning counselors both in the public and private sector, for counseling and effective delivery of these methods.