Measuring the Unmet Need for Contraception to Space and Limit Births

This paper describes how data from Contraceptive Prevalence Surveys (CPS) can be applied to a model for computing the potential total contraceptive demand and unmet demand during 1 year. By asking respondents in 6 countries (Bangladesh Colombia Costa Rica Korea Mexico and Thailand) to specify their preferences for the timing of their next pregnancy the CPS make it possible for the 1st time on a comparative basis to calculate the need for contraception to space births as well as to prevent them. The key feature of the model used is that it incorporates time as a factor and allows for changes in exposure to the risk of unintended pregnancy. Specifically the model recognizes analytically that pregnant and breastfeeding women who are frequently excluded from estimates of contraceptive need rejoin the group of exposed women and require contraceptive protection for at least part of the time period under review. Applying the model during a 1-year period an average of 34% of fecund married women in the 6 countries wish to postpone or prevent another pregnancy but are not using a contraceptive method. This proportion--the unmet need for contraception--ranges from a low of 22% in Costa Rica to a high of 67% in Bangladesh. Although most of the women with unmet need are likely to be those who wish to terminate childbearing birth spacers nevertheless constitute a sizable proportion of the unmet need group (43% on average ranging from 24% in Korea to 55% in Bangladesh and Costa Rica). Similar proportions of older and younger women 32% and 37% are likely to have an unsatisfied need for contraceptive services; but among younger women the unmet need for contraception to space births predominates whereas among older women the major portion of the unsatisfied need stems from the desire to prevent births. On average women who give birth during the 1-year period account for 36% of the unmet need among younger women and for 13% among older women. The range for younger women is from 26% in Bangladesh and Thailand to 46% in Colombia and for older women from 8% in Korea to 15% in Bangladesh and Colombia. The importance of these findings is that women with a live birth during the 1-year interval are women of proven fecundity whose failure to practice contraception to limit or space births is likely to result in an unintended pregnancy. (authors modified) (summaries in ENG SPA FRE)