Family Planning in Asia and the Pacific - International Council on ...

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The concept of “unmet need” has undergone fur<strong>the</strong>rref<strong>in</strong>ement <strong>in</strong> recent years with <strong>in</strong>creas<strong>in</strong>gly encompass<strong>in</strong>gdef<strong>in</strong>itions of <strong>the</strong> categories of women who can beconsidered as hav<strong>in</strong>g an unmet need. The current def<strong>in</strong>itionof unmet need accord<strong>in</strong>g to <strong>the</strong> United Nations PopulationDivision is:Unmet need for family plann<strong>in</strong>g is <strong>the</strong>number of women with unmet need forfamily plann<strong>in</strong>g expressed as a percentageof women of reproductive age who aremarried or <strong>in</strong> union. Women with anunmet need are those who are fecund<strong>and</strong> sexually active but are not us<strong>in</strong>g anymethod of contraception, <strong>and</strong> report notwant<strong>in</strong>g any more children or want<strong>in</strong>g todelay <strong>the</strong> birth of <strong>the</strong>ir next child (UnitedNations Department of Economic <strong>and</strong>Social Affairs, 2009).This def<strong>in</strong>ition is identical to that used <strong>in</strong> Demographic<strong>and</strong> Health Surveys. The method of computation requiresthat surveys identify women who are married or <strong>in</strong> a sexualunion <strong>in</strong> various statuses requir<strong>in</strong>g a complex branch<strong>in</strong>gprocess based upon answers to questions appear<strong>in</strong>g atvarious po<strong>in</strong>ts <strong>in</strong> <strong>the</strong> DHS questionnaire.Women who are excluded from <strong>the</strong> numerator <strong>in</strong>cludethose who are:(a) Us<strong>in</strong>g contraception to delay <strong>the</strong>ir next birth;(b) Us<strong>in</strong>g contraception to stop childbear<strong>in</strong>g;(c) Currently pregnant or amenorrheic <strong>and</strong> <strong>the</strong> pregnancywas:(i) Intended;(ii) Due to method failure;(d) Infecund (accord<strong>in</strong>g to an objective set of criteria);(e) Want a child with<strong>in</strong> <strong>the</strong> next two years.By a process of elim<strong>in</strong>ation, a residual is obta<strong>in</strong>ed that<strong>in</strong>cludes women who:(a) Are not us<strong>in</strong>g contraception;(b) Are not pregnant or amenorrheic;(c) Do not want ano<strong>the</strong>r child or do not want it with<strong>in</strong> <strong>the</strong>next two years;(d) Are pregnant or amenorrheic <strong>and</strong>(i) Did not want <strong>the</strong> child;(ii) Wanted <strong>the</strong> child but at a later date;(e) Are unsure about want<strong>in</strong>g <strong>the</strong> child at a later date.The denom<strong>in</strong>ator is all women who are married or <strong>in</strong> asexual union 20 .The concept of unmet need def<strong>in</strong>ed by <strong>the</strong>se criteriais considered to be consistent with a rights-based,voluntaristic approach to family plann<strong>in</strong>g because it is <strong>the</strong>respondent herself who states whe<strong>the</strong>r she wishes to haveano<strong>the</strong>r child, or have a child later, or did not want to have<strong>the</strong> child with whom she is currently pregnant, <strong>and</strong> not<strong>the</strong> state or a family plann<strong>in</strong>g worker. However, <strong>the</strong> processof measurement is complex <strong>and</strong> presupposes that womenhave a high level of awareness about <strong>the</strong>ir own state ofm<strong>in</strong>d with regard to childbear<strong>in</strong>g, someth<strong>in</strong>g that may notnecessarily be <strong>the</strong> case.The concept of unmet need also produces anomalies thatare difficult to <strong>in</strong>terpret. One anomaly arises from <strong>the</strong> factthat women who want more children, or wanted <strong>the</strong> childwith whom <strong>the</strong>y are currently pregnant, or who becamepregnant while us<strong>in</strong>g a contraceptive method, or are<strong>in</strong>fecund are <strong>in</strong>cluded <strong>in</strong> <strong>the</strong> denom<strong>in</strong>ator when calculat<strong>in</strong>g<strong>the</strong> percentage of women hav<strong>in</strong>g an unmet need. Oneresult of this is that where a high proportion of womenwant ano<strong>the</strong>r child or more children than <strong>the</strong>y currentlyhave, unmet need for family plann<strong>in</strong>g may be low. Thisdoes not necessarily mean that family plann<strong>in</strong>g servicesare unavailable or not used by those women who do wantto space or limit childbear<strong>in</strong>g, but some proportion of <strong>the</strong>women with an unmet need may not be us<strong>in</strong>g contraceptionbecause of <strong>the</strong>ir <strong>in</strong>ability to obta<strong>in</strong> contraception forwhatever reason. Thus, <strong>the</strong> measure confounds threequite different circumstances: one <strong>in</strong> which women havedifficulty obta<strong>in</strong><strong>in</strong>g contraception (result<strong>in</strong>g <strong>in</strong> high unmetneed); ano<strong>the</strong>r <strong>in</strong> which only a small proportion of womenactually want to control <strong>the</strong>ir childbear<strong>in</strong>g (result<strong>in</strong>g <strong>in</strong>low unmet need); <strong>and</strong> one <strong>in</strong> which a high proportion ofwomen who want to limit childbear<strong>in</strong>g are able to obta<strong>in</strong><strong>and</strong> use <strong>the</strong> means to do so.As Bhushan (1997) has po<strong>in</strong>ted out, “unmet need can below <strong>in</strong> two entirely different sett<strong>in</strong>gs: (1) <strong>in</strong> places wheremotivation for fertility regulation is low; <strong>and</strong> (2) <strong>in</strong> placeswhere motivation for fertility regulation is high but it iseasy to implement one’s preferences”. This proposition canbe verified by compar<strong>in</strong>g unmet need <strong>in</strong> Solomon Isl<strong>and</strong>s(7.7% accord<strong>in</strong>g to recent DHS estimates shown <strong>in</strong> Table7), with that <strong>in</strong> <strong>the</strong> United States, which has a reportedunmet need of 7 per cent (Guttmacher Institute) 21 .86
Although <strong>the</strong> unmet need for family plann<strong>in</strong>g is similar <strong>in</strong>both countries, <strong>the</strong>ir fertility circumstances are completelydifferent. In Solomon Isl<strong>and</strong>s <strong>the</strong> contraceptive prevalencerate is 27 per cent (Table 4), whereas <strong>in</strong> <strong>the</strong> United States itis 69 per cent. Similarly, <strong>the</strong> total fertility rate <strong>in</strong> SolomonIsl<strong>and</strong>s is 4.6, whereas <strong>in</strong> <strong>the</strong> United States it is 2.1.In ano<strong>the</strong>r respect <strong>the</strong> two countries are similar, whichis to be expected, given <strong>the</strong> similar level of unmet need:<strong>in</strong> <strong>the</strong> United States, 89 per cent of <strong>the</strong> dem<strong>and</strong> forfamily plann<strong>in</strong>g is met; <strong>in</strong> Solomon Isl<strong>and</strong>s, 76 per centof <strong>the</strong> dem<strong>and</strong> for family plann<strong>in</strong>g is met (Table 8). Theproportion of dem<strong>and</strong> met <strong>in</strong> <strong>the</strong> two countries is roughlysimilar because, although <strong>the</strong> proportion of womenof childbear<strong>in</strong>g age who wish to limit births is muchhigher <strong>in</strong> <strong>the</strong> United States than <strong>in</strong> Solomon Isl<strong>and</strong>s, ahigh proportion of those women are able to meet <strong>the</strong>ircontraceptive needs. In Solomon Isl<strong>and</strong>s, a much smallerproportion of women of childbear<strong>in</strong>g age wish to regulate<strong>the</strong>ir childbear<strong>in</strong>g, but a similar proportion of <strong>the</strong>se womenis also able to meet <strong>the</strong>ir contraceptive needs.The implication of <strong>the</strong>se considerations is that statisticson unmet need must be <strong>in</strong>terpreted with caution <strong>and</strong> used<strong>in</strong> comb<strong>in</strong>ation with o<strong>the</strong>r measures of dem<strong>and</strong> for familyplann<strong>in</strong>g services.TableTable7VariablePercentage of currently married women (15-49 years of age) with an unmet need for familyplann<strong>in</strong>g <strong>in</strong> selected <strong>Pacific</strong> isl<strong>and</strong> countries, by socio-economic characteristics*Tuvalu2007Nauru2007Marshall Isl<strong>and</strong>s2007Solomon Isl<strong>and</strong>s2007Samoa 2009Kiribati2008Papua NewGu<strong>in</strong>ea2006‡Age group15-19 -- -- 33.2 15.0 -- 36.5 29.520-24 23.8 36.6 12.5 14.8 41.5 30.5 29.825-29 22.2 31.1 9.3 15.3 41.9 26.3 37.730-34 30.9 23.7 7.6 15.1 41.5 32.2 42.235-39 23.7 17.5 2.8 8.5 46.4 26.6 48.040-44 24.3 -- 1.4 2.3 46.2 29.7 61.445-49 20.2 -- 0.0 0.7 53.8 19.5 76.815-49 24.2 23.5 8.1 7.7 45.6 28.2 44.1ResidenceUrban 25.5 na 7.3 8.2 45.4 31.3 42.1Rural 23.1 na 9.6 11.6 45.6 25.3 44.3EducationNo education na na na 12.1 na 0.0 51.4Primary or less 20.5 na 9.0 11.6 54.8 25.5 43.5Secondary 27.6 23.5 7.6 10.1 45.4 30.3 30.0More than secondary+ 22.9 -- 8.9 3.0 43.2 26.2 naWealthQu<strong>in</strong>tile 1 (highest) 22.6 27.6 6.2 6.0 41.4 31.0 naQu<strong>in</strong>tile 2 25.8 19.3 4.6 9.8 43.6 31.5 naQu<strong>in</strong>tile 3 26.2 31.1 9.1 15.4 48.1 26.6 naQu<strong>in</strong>tile 4 22.7 20.8 11.1 10.4 47.7 26.9 naQu<strong>in</strong>tile 5 (lowest) 23.3 17.2 14.1 14.5 46.8 24.4 naSource: DHS reports for specified countries.*Note that <strong>the</strong> method of estimat<strong>in</strong>g unmet need <strong>in</strong> Papua New Gu<strong>in</strong>ea is not identical to <strong>the</strong> method used <strong>in</strong> <strong>the</strong> o<strong>the</strong>r countries.In Papua New Gu<strong>in</strong>ea <strong>the</strong> figures refer to <strong>the</strong> unmet need for stopp<strong>in</strong>g <strong>and</strong> not spac<strong>in</strong>g. Also, some o<strong>the</strong>r categories of unmet needare excluded. The Papua New Gu<strong>in</strong>ea figures are <strong>the</strong>refore underestimates when compared with <strong>the</strong> o<strong>the</strong>r countries. In all o<strong>the</strong>rcountries, <strong>the</strong> figures given are <strong>the</strong> sum of <strong>the</strong> unmet need for spac<strong>in</strong>g <strong>and</strong> <strong>the</strong> unmet need for stopp<strong>in</strong>g.‡Women who are undecided as to whe<strong>the</strong>r <strong>the</strong>y want ano<strong>the</strong>r child or responded “don’t know” are considered to have an unmet needfor contraception <strong>in</strong> Papua New Gu<strong>in</strong>ea. If <strong>the</strong>se women are excluded, <strong>the</strong> proportion of women with an unmet need is much lower(29.8%)87
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Family Pla
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ForewordThe Asia <
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Part 1Part 1Asia <
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Ensuring that <str
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of methods for all, in</str
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and undertake <str
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Report on the Regi
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SESSION 1: Changin
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that improving <st
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at a hospital would be offered post
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Bounkoung Phichit, Deputy M
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medicines
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Thus, while knowledge of modern met
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Hon. Mr. Malakai Tabar, Chairman, P
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curricula. If the
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Page 51: BackgroundGlobal development effort
Page 54 and 55: TableTable1EventNational policyYear
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Page 58 and 59: TableTable2Current Contraceptive Pr
Page 60 and 61: Figure(-1.2), Cook Island</
Page 62: FigureTableTable3Trends in<
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Page 67: 2008 2009% Bilateral % Multilateral
Page 70 and 71: family planning wi
Page 73 and 74: IntroductionFamily
Page 75 and 76: The advent of the
Page 77 and 78: FigureFigure1Oceania and</s
Page 79 and 80: next 25 years, however, TFR fluctua
Page 81 and 82: FigureFigureFigure2Total fertility
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Page 131 and 132: ConclusionThe Bangladesh Fa
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Page 137 and 138: IndiaIndiaFamily <
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TableTable5Indicators of contracept
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TableTable6Adjusted odds ratios for
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FigureFigure3Contraceptive prevalen
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TableTable7Adjusted and</st
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the north
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TableTable10Differences between nor
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TableTable11 Total fertility rate <
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End Note1The first camp was success
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152
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154
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Figure1980s and ex
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health care and ed
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assistance from UNFPA and</
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in CPR. Likewise,
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International supp
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in development has
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__________ (2007). Population <stro
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170
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TableTable2What has the</st
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per cent of women reported us<stron
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is provider bias that such methods
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TableTable7skewed distribution of h
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TableTable8TableTable9182
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that of the nation
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TableTable12 7some policies that ex
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The system guides the</stro
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FigureFigure4Total donor expenditur
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FigureFigureagain
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Impact of family plannin</s
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marketing of contr
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United States Agency for In
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200
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acceptable. From an NGO perspective
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FigureThis trend of limited donor f
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Figureto have the
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FigureFigure5Percentage change <str
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FigureFigure6Desire to limit childb
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coordination betwe
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the 1980s
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Policy Management.__________ (n.d.,
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218
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Population Activities (UNFPA) for a
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where family plannin</stron
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Thus an objective assessment of <st
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226
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Figureeconomic growth durin
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TableTable1TableTable2For spac<stro
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eflect a provider bias (e.g., <stro
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The Indonesian delegation was very
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than in ensur<stro
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in-country <strong
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(Ministry of Healt
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FigureTrends and p
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TableTable3Unmet need for contracep
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TableTable5TableTable6TableTable725
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TableTable8TableTable9Malaysia, abo
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previously mentioned is based on fo
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TableTable16births and</str
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FigureFigure3TRF54.5Scatter plots o
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ReferencesAng, Eng Suan (2007). Stu
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Demographic data sheet: population
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population size, with just 336,000
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NuptialityIn Myanmar nuptiality is
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FigureIn Myanmar, birth-spac<strong
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Scope of coverage and</stro
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FigureIn Myanmar, out of six select
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equirements. The Min</stron
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according to <stro
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Adolescent sexual and</stro
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FigureHIV/AIDS. An HIV-positive wom
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National Population PolicyMyanmar i
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Linkages with o<st
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TableTable4Achievements of Myanmar
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monitoring <strong
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Nay Pyi Taw, 26 October 2010.53 Sit
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TableTableA296
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dispense and adm<s
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(1) I am against a
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FigureFigureFigure3Use of modern co
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FigureFigure7Traditional method use
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Figureprojection, and</stro
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Figure 11 summarizes the</s
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correlating <stron
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Figurethe use of c
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FigureFigure15Sexual behaviour <str
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track the distribu
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Figureservices, which should <stron
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FigureFigureFigure18 Population <st
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National Statistics Office, <strong
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TableTable11326
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TableTable19Laws and</stron
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worker and hours w
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334
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336
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includin</
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TableTable1Contraceptive prevalence
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These results suggest that about 70
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2 The (period) TFR is the</
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346
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FigureThe existence of traditional
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Guinea case by <st
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The establishment of provin
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provide family plannin</str
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Figurelegal requirement nor a condi
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FigureTableTable5TableTable6Figure4
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modern method and
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married or in unio
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Figureolder. Both the</stro
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TableTable15The immediate past Nati
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out that the “ne
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Commodity securitySupply cha<strong
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is able to achieve. In Papua New Gu
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Qualitative assessments by a number
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increasin<
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service delivery poin</stro
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Population: Views from Men
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1545-1730Day 2: December 9Session 2
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Day 3, December 10Session 50830-100
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15Mr. Tong Sithen1
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54Ms. Shadiya IbrahimAssistant Repr
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93Mr. Melkie AntonProject OfficerUn
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131Dr. John P. SkibiakDirectorRepro
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International <str
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