Unmet need for family planning

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.

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 andcoined the term "discrepant behaviour" to describe the status of such women. 1977 - Term "unmet need“ used by Bruce Stokes, citing both the evidence from KAP studies in developing countries and from fertility survey in the US. 1972 to 1984 - The World Fertility survey (WFS) conducted and first time to report extensively about unmet need .

9. Cont.. • 1970 to 1984 - 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. • 1982- 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?

15. 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. More than one-third of pregnancies in developing countries are unintended Induced abortions Wanted births Unwanted or mistimed births Spontaneous abortions (miscarriages) Outcomes of all pregnancies in developing countries

17. Most unintended pregnancies occur among women who were not using any contraceptive Modern method No method Traditional method Unintended pregnancies in developing countries, by women’s contraceptive use

18. 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

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

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

22. 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

23. Cont. • Health concerns • 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

24. Cont. • Family/community opposition • Concerns about unfaithfulness • Fear of side effects • Objections to male providers • Religious objections • Little perceived risk of pregnancy • 7. Ambivalence

25. 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

26. Cont…. 2. Improve communication about: • Source of FP information and supplies • Misinformation and rumors regarding effects/side-effects • Risks of contraception • Risks of pregnancy

27. 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.

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

29. 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.