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

women with only primary education <strong>in</strong> Samoa (54.8%)<strong>and</strong> women with no education <strong>in</strong> Papua New Gu<strong>in</strong>ea(51.4%). In Solomon Isl<strong>and</strong>s, <strong>the</strong> highest level of unmetneed is also among women with no education or onlyprimary education.There is no clear relationship between unmet need <strong>and</strong>household wealth. Only <strong>in</strong> Marshall Isl<strong>and</strong>s is unmet needhighest <strong>in</strong> <strong>the</strong> poorest fifth of <strong>the</strong> population. Elsewhereunmet need is highest <strong>in</strong> <strong>the</strong> middle wealth qu<strong>in</strong>tile, exceptfor Kiribati where <strong>the</strong> second highest qu<strong>in</strong>tile has <strong>the</strong>highest unmet need.In summary, as was <strong>the</strong> case with CPR, unmet need isnot strongly associated with socio-economic factors at <strong>the</strong>microlevel on a cross-country basis. While unmet need isgenerally higher <strong>in</strong> rural areas, this is not true <strong>in</strong> all countries.Similarly, <strong>in</strong> some countries unmet need is higher amongwomen with secondary education but <strong>in</strong> o<strong>the</strong>r countriesuneducated women have higher unmet need. Fur<strong>the</strong>rmore,nei<strong>the</strong>r high nor low wealth is associated with unmetneed. The strongest relationship <strong>in</strong> most countries is age,although it is not l<strong>in</strong>ear. In Marshall Isl<strong>and</strong>s <strong>and</strong> SolomonIsl<strong>and</strong>s, countries with <strong>the</strong> lowest level of unmet need,<strong>the</strong> highest levels were found <strong>in</strong> younger age groups. Thiswas also <strong>the</strong> case <strong>in</strong> Kiribati <strong>and</strong> Nauru with much higheroverall unmet need.Ano<strong>the</strong>r measure of <strong>the</strong> extent to which <strong>the</strong> family plann<strong>in</strong>gneeds of a country or subgroups with<strong>in</strong> a country are be<strong>in</strong>gmet is <strong>the</strong> “total dem<strong>and</strong>” for family plann<strong>in</strong>g. This is <strong>the</strong>sum of women currently us<strong>in</strong>g contraception <strong>and</strong> thosewho have an unmet need. The proportion of <strong>the</strong> totaldem<strong>and</strong> that is met is current users divided by <strong>the</strong> totalof users <strong>and</strong> non-users. Where unmet need is low, it canbe expected that <strong>the</strong> proportion of <strong>the</strong> total dem<strong>and</strong> thatis met will be high. This can be confirmed with referenceto <strong>the</strong> <strong>Pacific</strong> isl<strong>and</strong> countries with <strong>the</strong> recent DHS (Table8). The two countries with <strong>the</strong> lowest level of unmet need(Marshall Isl<strong>and</strong>s <strong>and</strong> Solomon Isl<strong>and</strong>s) have <strong>the</strong> highestproportion of total dem<strong>and</strong> satisfied – 84.6 per cent <strong>and</strong>75.6 per cent, respectively – as might be expected.As was found with o<strong>the</strong>r fertility <strong>and</strong> contraceptive<strong>in</strong>dicators, <strong>the</strong> percentage of total dem<strong>and</strong> for contraceptionthat is satisfied is not clearly associated with <strong>the</strong> socioeconomiccharacteristics of women at <strong>the</strong> microscale. Tosome extent, <strong>the</strong> proportion of dem<strong>and</strong> satisfied is higher<strong>in</strong> urban than rural areas, but not <strong>in</strong> all countries. Womenwith a primary or lower level of education are more likelyto have lower proportions of <strong>the</strong>ir total dem<strong>and</strong> satisfied,but aga<strong>in</strong> this is not true <strong>in</strong> all countries. In general, as with<strong>the</strong> o<strong>the</strong>r <strong>in</strong>dicators, women younger than 30 years of agehave a smaller proportion of <strong>the</strong>ir total dem<strong>and</strong> satisfied,thus demographic factors have a stronger impact thansocio-economic ones.Expla<strong>in</strong><strong>in</strong>g patterns of unmet needAs Bhushan (1997), Casterl<strong>in</strong>e <strong>and</strong> S<strong>in</strong>d<strong>in</strong>g (2000), <strong>and</strong>o<strong>the</strong>rs have po<strong>in</strong>ted out, from a programme perspective<strong>the</strong> key issue <strong>in</strong> respond<strong>in</strong>g to unmet need is to identify<strong>the</strong> country-specific causes of it. As Casterl<strong>in</strong>e <strong>and</strong> S<strong>in</strong>d<strong>in</strong>galso note, <strong>the</strong>re is a temptation for policymakers to addressunmet need by focus<strong>in</strong>g almost exclusively on improv<strong>in</strong>gaccess to services, but lack of access is not always <strong>the</strong>primary reason for unmet need. Detailed research maybe required to uncover <strong>the</strong> actual reasons among variousgroups of women.Although DHS are not generally f<strong>in</strong>ely adapted to <strong>the</strong>specific country <strong>in</strong> which <strong>the</strong>y are conducted, <strong>the</strong>ir resultsprovide a useful po<strong>in</strong>t of departure for more detailedresearch on <strong>the</strong> underly<strong>in</strong>g causes of unmet need. Ast<strong>and</strong>ard DHS question asked of currently married womenwho are not us<strong>in</strong>g contraception is whe<strong>the</strong>r <strong>the</strong>y <strong>in</strong>tendto use contraception <strong>in</strong> <strong>the</strong> future. The responses to thisquestion <strong>in</strong> seven <strong>Pacific</strong> countries are shown <strong>in</strong> Table 9.Ra<strong>the</strong>r than employ <strong>the</strong> st<strong>and</strong>ard DHS format, however,<strong>the</strong> data <strong>in</strong> Table 9 have been arranged accord<strong>in</strong>g to<strong>the</strong> previously mentioned “ready, will<strong>in</strong>g, <strong>and</strong> able”conceptualization of Lesthaeghe <strong>and</strong> V<strong>and</strong>erhoeft. Becausewomen who are already practis<strong>in</strong>g contraception can beconsidered as fulfill<strong>in</strong>g all three conditions, <strong>the</strong>y are excludedfrom <strong>the</strong> table. The two rema<strong>in</strong><strong>in</strong>g categories of womenare those who ei<strong>the</strong>r are unable to use contraception or areunwill<strong>in</strong>g to do so. The <strong>in</strong>ability to use contraception maybe caused by lack of knowledge, <strong>the</strong> difficulty of locat<strong>in</strong>g asource, or <strong>the</strong> lack of money to pay for transportation orfor <strong>the</strong> method itself.Unwill<strong>in</strong>gness to practise contraception arises from anumber of factors, rang<strong>in</strong>g from religious objections,spousal opposition to fear of side effects <strong>and</strong> general healthconcerns. A third category “not specified” is <strong>in</strong>cluded toshow <strong>the</strong> extent to which respondents give o<strong>the</strong>r reasonsor are unable to give a response.It is clear from Table 9 that lack of knowledge of, oraccess to, contraception is a significant impediment tocontraceptive use only <strong>in</strong> Papua New Gu<strong>in</strong>ea, where 50.9per cent of women who say that <strong>the</strong>y do not <strong>in</strong>tend to usecontraception <strong>in</strong> <strong>the</strong> future give this reason. Only <strong>in</strong> Nauru(12.7) <strong>and</strong> Solomon Isl<strong>and</strong>s (13.5) does <strong>the</strong> percentageof women cit<strong>in</strong>g this reason rise above a few percentagepo<strong>in</strong>ts.It appears that <strong>in</strong>ability to access contraception is not amajor cause of unmet need <strong>in</strong> most of <strong>the</strong> <strong>Pacific</strong> countriesrecently conduct<strong>in</strong>g a DHS. That a majority of women <strong>in</strong>Papua New Gu<strong>in</strong>ea would cite this reason is underst<strong>and</strong>ablegiven <strong>the</strong> low level of female literacy, low urbanization89