INDICATORS 3-4 : UNMET NEED AND DEMAND SATISFIED
UNMET NEED AND DEMAND SATISFIEDUNMET NEED AND DEMAND SATISFIED | FP2020 THE WAY AHEAD 2016-2017 /en/measurement-section/unmet-need-and-demand-satisfied-indicators-3-4
Percentage of women with an unmet need for modern contraception
The percentage of fecund women of reproductive age who want no more children or to postpone having the next child, but are not using a contraceptive method, plus women who are currently using a traditional method of family planning. Women using a traditional method are assumed to have an unmet need for modern contraception
Percentage of women whose demand is satisfied with a modern method of contraception
The percentage of women (or their partners) who desire either to have no additional children or to postpone the next child and who are currently using a modern contraceptive method. Women using a traditional method are assumed to have an unmet need for modern contraception
Across the FP2020 countries, we estimate that just over one in five married or in-union women of reproductive age have an unmet need for modern methods of contraception in 2017.f
While the first two Core Indicators look at modern family planning use, Core Indicator 3, unmet need for modern contraception, and Core Indicator 4, demand satisfied for modern contraception, take a wider view to also include women who want to avoid pregnancy but are not using modern contraception. These measures help to assess the degree to which governments and the broader family planning community are meeting the commitment to make family planning services available to all who want them. Core Indicator 4 is also an indicator for the Sustainable Development Goals (SDG) target 3.7, which includes ensuring universal access to family planning by 2030.g
Core Indicator 3, unmet need for modern contraception, captures women who are not using modern contraception, are at risk of becoming pregnant, and say that they do not want to have a child soon or that they do not want to have any more children.h It includes women currently not using a method as well as those using traditional methods, who are considered to have an unmet need for a more effective modern method. There are many potential reasons why a woman who does not want to become pregnant would not use modern contraception. These include limited geographic access to contraception as well as a wide range of other issues, such as perceived health side effects or social disapproval. This is why unmet need should not be interpreted as a direct measure of lack of access. Understanding the barriers to use within each country’s context is important to ensure that programs are able to address the needs of women across different settings and situations.
In 2017, 21.7% of married or in-union women of reproductive age across the FP2020 focus countries had an unmet need for modern methods of contraception. At the aggregate level, little change has been seen on this indicator since 2012 (a decline of less than half a percentage point); nevertheless, the overall picture hides many different changes that are happening across countries and regions. Similar to the S-Curve for changes in MCPR, we know that unmet need also changes in predictable ways as countries transition from low to high contraceptive use. The pattern generally follows an upside-down U shape, in which unmet need tends to rise first in countries with low levels of contraceptive use and unmet need: this is a sign of the changing desires of women to space and limit pregnancies. Eventually unmet need declines—the other side of the upside-down U—with improvements in contraceptive service delivery. Understanding this pattern can help countries interpret their level of unmet need and the changes that appear in the data.
In places with low contraceptive use and high fertility desires, unmet need tends to be low. As these dynamics change and contraceptive use begins to rise, unmet need also increases, since the demand for contraception initially outpaces a country’s ability to expand contraceptive services to meet this increased demand. This can be seen in Western Africa, where unmet need has increased slightly from 2012 (25.9% to 26.9%).
For countries in the middle of the S-Curve, where more rapid increases in MCPR can be seen, we start to see declines in unmet need. This can be seen in Eastern and Southern Africa, where unmet need for modern methods has dropped by more than 3 percentage points since 2012—by far the largest change in any region of FP2020 countries. Many countries in this region have also been experiencing rapid increases in MCPR, suggesting that this growth contributed at least in part to reductions in unmet need.
Finally, just as increases in MCPR begin to slow and eventually plateau, declines in unmet need slow. This can be seen in South Asia, which is home to a large percentage of the women of reproductive age living in the 69 FP2020 focus countries. Unmet need in South Asia has remained largely unchanged, moving from 20.8% in 2012 to 20.4% in 2017. For many countries in this region, unmet need is already low and further declines may be limited. We would never expect unmet need to reach 0; for comparison, in Europe unmet need for modern methods was 17.7% in 2017.7
Core Indicator 4, demand satisfied with a modern contraceptive method, is constructed based on MCPR and unmet need for modern methods, with total demand assumed to encompass current modern users and those with unmet need for modern methods. The proportion of these women using a modern method is termed “demand satisfied,” and is also affected by the dynamics of unmet need.8 In a country where unmet need is low because fertility desires remain high, overall demand for contraception will be lower meaning a smaller number of users (i.e., a lower MCPR) can result in a relatively high proportion of demand satisfied.
Levels of demand satisfied are shown in Figure 11, with regions ordered from the highest to lowest levels of demand satisfied shown in the circle above each bar. This measure is shown together with the MCPR and unmet need in each region to illustrate how the three indicators are related (data shown here for married and in-union women). It can be seen that overall demand (the height of the bar) is comprised of the combination of MCPR and unmet need, and is low in both Western and Central Africa as compared to the other regions. Demand satisfied with a modern method is the portion of the bar filled by MCPR, and is lowest in Central Africa, where there is slightly higher demand than West Africa but less contraceptive use. Several countries in West Africa have expanded access to a range of contraceptive choices and are beginning to see accelerated growth in the use of modern contraceptives. In Niger, the modern contraceptive prevalence rate has grown from 12% to 15% since 2012 among all women of reproductive age. At the same time unmet need has increased from 18% to 20%. In countries like Niger, where contraceptive use has historically been very low and fertility is high, an increase in unmet need is actually a sign of progress as it may indicate an increase in the percentage of women who desire to space or limit pregnancies. Niger’s growth in both MCPR and unmet need is a signal of opportunity for further investment in family planning information and services, and Niger would benefit from increased investment in SBC programs.
The country’s efforts over the last few years have dramatically increased access points for family planning services, so a comparative effort to increase demand is the next step in building on their success.
FP2020 is currently modeling unmet need for married women for the 69 FP2020 focus countries, and aims in future years to move to modeling unmet need for all women. This estimate differs from Adding It Up, which measures unmet need for all developing countries for married women and unmarried sexually active women.
“By 2030, ensure universal access to sexual and reproductive healthcare services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs.”
Women who are currently pregnant or postpartum amenorrheic whose pregnancy/last births were wanted at the time they occurred are not considered to be in need. However, pregnant or postpartum amenorrheic women whose pregnancy/last births were wanted later or not at all are considered to have an unmet need.
UNPD Model-Based Estimates and Projections of Family Planning Indicators 2017
Fabic MS, Choi Y, Bongaarts J, Darroch JE, Ross JA, Stover J, et al. Meeting demand for family planning within a generation: the post-2015 agenda. Lancet. 2014; 385: 1928–31. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393371/