Factors Underlying Unmet Need for Contraception: A Global Analysis

Unmet need is a widely used family planning indicator, and in 2008 it was added to the set of MDG indicators. Yet there is considerable confusion about what “unmet need” represents, reflecting lack of clarity about the underlying concept. Unmet need is commonly interpreted as tantamount to unsatisfied demand for contraception. But the conventional unmet need indicator does not use survey items asking women whether they want to use contraception, nor does it use any measures of access to contraception. Moreover, if reducing unmet need is an explicit policy goal, then program design should be informed by a good understanding of reasons for unmet need. The aims of this paper are: (i) to clarify what the widely used estimates of unmet need actually represent; (ii) to explore reasons for unmet need, with the aim of deepening our understanding of the policy and programmatic challenge. After discussing the concept (and clarifying what it does and does not represent), we conduct an extensive and thorough analysis of DHS data on reasons for non-use in surveys from 1990 to the present, looking for societal variation and variation according to stage of transition. Programmatic implications of the main reasons for unmet need are identified.