Mind the Gap: Realigning Unmet Need’s Measurement with its Interpretation Open Access

Abstract

Unmet need for family planning has been a central indicator in international family planning for decades, informing programs and policies on reproductive health care and contraception. Despite its prominence in the global reproductive health field, both critics and proponents of the measurements have cautioned about limitations to the metric’s conceptualization, validity, and measurement approach since its inception. One particularly important point of debate surrounds the intuitive interpretation of the term “unmet need,” leading many to interpret the indicator as lack of access to contraceptives or “unmet demand”. The purpose of this research is to investigate how the fundamental assumptions that currently underpin the unmet need indicator can be realigned to better measure the number of women who want to use contraception but cannot, as unmet need is commonly interpreted as representing “unmet demand”. This analysis conceptualized three different interpretations of “demand for contraception” based on women’s reasons for contraceptive nonuse. The three conceptualizations were used to create three estimates of supply-side unmet need by removing women without a demand for contraception based on women’s reasons for contraceptive nonuse. These three formulations of supply-side unmet need were applied to the datasets for seven select African countries and compared to the traditional measure of unmet need. Approach A for supply-side unmet need, the most liberal of the estimates, included reasons related to access and decreased estimates by an average of 9.3 percentage points. Approach B for supply-side unmet need decreased estimates by an average of 7 points and included the criteria from Approach A and reasons related to social pressure. The most conservative approach, Approach C, included all reasons from the previous two approaches and added reasons related to health concerns. This approach reduced unmet need estimates by 5 points, on average. Supply-side unmet need functions to close the gap between the measurement and interpretation of unmet need. The indicator contributes to a growing body of literature calling for the centering of individual users and their preferences within family planning program delivery. 

Table of Contents

Table of Contents

Chapter One: Introduction. 1

Chapter Two: Literature Review.. 4

Definition and Measurement 4

Critiques of Assumptions, Measurement, Interpretation, and Application. 5

Reasons for Contraceptive Nonuse Among Women with Unmet Need. 13

Chapter Three: Manuscript 18

Introduction. 19

Background. 20

Methods. 26

Results. 35

Discussion. 39

Chapter Four: Conclusions and Recommendations. 48

References. 56

Tables and Figures

Table 1................................................................................................ 13

Figure 1............................................................................................... 14

Figure 2............................................................................................... 25

Table 2................................................................................................ 26

Figure 3............................................................................................... 30

Table 3................................................................................................ 30

Table 4................................................................................................ 34

Table 5................................................................................................ 35

Figure 4............................................................................................... 36

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Family Planning
Committee Chair / Thesis Advisor	Roger Rochat, Emory University
Committee Members	Leigh Senderowicz, Harvard University

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