World Development Report 1984

FIGURE 8.6 childbearing age have unmet need for contracep-
Contraceptive use by method: Bangladesh, India, and tion to limit or space births. Pilot projects there
Sri Lanka, 1975-83 have achieved rates of contraceptive use of 35 to 40
Percentage of married women aged 1549 percent with modern methods, three to four times
60 the prevalence of these methods nationwide. In Sri
Lanka 44 percent of women of childbearing age
who want no more children are nevertheless not
50 practicing contraception.
To satisfy unmet need, family planning programs
must resolve important issues of access and
40 quality.
* Access. Better family planning outreach could
30 go a long way to increase contraceptive use
throughout the region. Access is most restricted in
Nepal and Pakistan. In Nepal there is unmet need
20 . for contraception among 22 to 27 percent of eligible
women. About half of currently married women in
* w | | | Nepal are unaware of a modern contraceptive
10 1 method, and an additional 15 percent who are
aware do not know where a method can be
- 1 t [ j ~~~~~~~obtained. In Pakistan, three-quarters of married
_women of childbearing age knew of a modern
1975 1983-84 1975 1982-83 1975 1982 method in 1975, but only 5 percent were using
Bangladesh India Sri Lanka one. A quarter to a half of these women had unmet
need for contraception to limit births. Since then
Method contraceptive use has stagnated. The government
* Traditional (rhythm, abstinence, - TUD plans to meet the need for contraception by greatly
withdrawal, other)
- Injectable contraceptives and
_1 IUD
- Pill
expanding and upgrading services.
* Method mix. Family planning programs in
vaginalmethods
i: Condom _
Sterilization (male
and female)
South Asia have continued to emphasize steriliza-
tion to the neglect of reversible methods of contra-
ception, particularly in India and Sri Lanka (see
Figure 8.6). Sterilization accounts for more than
three-quarters of modern contraceptive use in
female education-all of which would have a pro- India and Nepal, two-thirds in Sri Lanka, and
found effect on fertility. In Bangladesh family plan- about half in Bangladesh. Sterilization is clearly in
ning and greater economic independence of demand among couples who want no more chilwomen
are jointly promoted through credit coop- dren. But other forms of contraception are used
eratives for women (see Box 8.8). A few countries less, largely because they are not widely available.
are moving beyond schemes that compensate Given the high rate of child mortality in South
those who adopt contraception to consider posi- Asia, reversible contraceptive methods may be
tive incentives for small families. Bangladesh has more desirable for couples who have had two or
contemplated offering bonds to sterilization clients three children but who do not wish to be sterilized
with two to three children and to couples who immediately. To maximize contraceptive use, both
postpone a first pregnancy or space children at reversible methods and sterilization need to be,
long intervals (see Box 6.4). India is considering a made available.
scheme to give "green cards" to couples sterilized The only widely available reversible method in
after two children; these cards would entitle them India is the condom, which is provided through
to preferential access to social services. 400,000 retail outlets in the social marketing pro-
Desired family size in Bangladesh is now about gram as well as in family planning program outfour;
actual size averages about 5.5. Sri Lankan lets. The pill, important in countries such as Indowomen
are having on average one child more than nesia, is not offered through social marketing
they want. According to a 1979 survey in Bangla- arrangements, and in 1981-82 was being distribdesh,
as many as 41 percent of married women of uted through only 4,500 rural and 2,500 urban out-
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