2BackgroundFamily 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.
3What 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 .orCurrently 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.
4Cont….. Women are defined as having an unmet need if they are: Fecund Married or living in unionNot using any contraceptionDo not want any more children, orWant to postpone for at least two years
5Cont….. Unmet need also includes: pregnant or amenorrheic women With unwanted or mistimed pregnancies/births, andNot using contraception at time of last conception
6Expanded Definitions of Unmet Need May include women who:are using an ineffective methodare using a method incorrectlyare using an unsafe methodare using an unsuitable method
7How 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.
8Cont..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 .
9Cont..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.
10How 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
16More 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 need16
17More than one-third of pregnancies in developing countries are unintended Induced abortionsWanted birthsUnwanted ormistimed birthsMore 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.Spontaneousabortions (miscarriages)Outcomes of all pregnancies in developing countries17
18Most unintended pregnancies occur among women who were not using any contraceptive Modern methodNo methodTraditionalmethodTwo-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 use18
19Benefits to preventing unintended pregnancies Fewer unsafe abortionsHealthier mothers and childrenGreater investments in each childSocial and economic opportunities for womenEconomic growthReduction of population pressures on environmentSource: 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
20Unmet need among married women has declined in all regions, but remains highest in Sub-Saharan Africa% of married women aged 15–49 with unmet needUnmet 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
21The overall demand for contraception is increasing % of married women aged 15–49The 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 & CaribbeanNorth Africa & West AsiaSouth & Southeast AsiaSub-Saharan Africa21
22uncertain or unable to decide about what course to follow = ambivalent
23What are the Reasons for Unmet Need? Lack of accessto preferred methodto preferred provider
24Cont… Poor quality of services provided. This includes: Choice of methodsProvider competenceInformation given to clientsProvider-client relationshipsRelated health care servicesFollow-up care
25Cont. Health concerns Lack of information and misinformation about: Actual side effectsFear of side effectsLack of information and misinformation about:Available methodsMode of action/how usedSide effectsSource/cost of methods
26Family/community opposition Cont.Family/community oppositionConcerns about unfaithfulnessFear of side effectsObjections to male providersReligious objectionsLittle perceived risk of pregnancy7. Ambivalenceuncertain or unable to decide about what course to follow = ambivalent
27How to meet Unmet Need? 1.Improve access to good quality services Offer choice of methodsEliminate medical barriersExpand service delivery pointsHome deliverySocial marketingProvide confidentiality
28Cont…. 2. Improve communication about: Source of FP information and suppliesMisinformation and rumors regarding effects/side-effectsRisks of contraceptionRisks of pregnancy: legitimacy :lawfulness by virtue of being authorized or in accordance with law
29Cont… 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.
30Cont.. Prenatal care Post-partum care/breastfeeding Immunization Link Family Planning to other servicesPrenatal carePost-partum care/breastfeedingImmunizationPost-abortion careChild health services
31conclusionNeeds 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.