In 1992 Population Reports estimated the total unmet need at 120 million women, based on DHS and comparable surveys conducted between 1985 and 1991 (174). The new estimate is somewhat lower than the earlier one primarily because the 1992-93 National Family Health Survey of India, released in 1995 (93), revealed less unmet need in the world's second most populous country than estimated earlier based on data from other countries in the region.

Still, more married women with unmet need live in India than in any other country—about 31 million. Other countries with more than one million married women with unmet need, as reported in the DHS, are Pakistan at 5.7 million, Indonesia and Bangladesh at 4.4 million each, Nigeria at 3.9 million, Mexico at 3.1 million, Brazil at 3.0 million, the Philippines at 2.5 million, Egypt at 1.8 million, and Kenya, Tanzania, and Turkey at 1.1 million each. Also, Vietnam has an estimated 5.2 million women with unmet need (179). In China, the world's most populous country, there probably is little unmet need, given the high level of contraceptive use, at an estimated 83% of married women of reproductive age in 1992 (218).

Regional and national differences. In the developing world as a whole, excluding China, about 20% of married women of reproductive age have unmet need. There is wide variation in this percentage among regions and countries (see Tables 1 and 2). The level of unmet need is highest in sub-Saharan Africa, where in some countries one married woman in every three has unmet need. In most of these countries more married women have unmet need than are using contraception. Among other developing regions, levels of unmet need are similar. Because of the large population of Asia, however, by far the greatest number of women with unmet need live in this region (see Table 1).

Among countries surveyed by the DHS in sub-Saharan Africa, unmet need ranges from 15% in Zimbabwe to 37% in Rwanda. Among Asian countries surveyed, unmet need varies from 11% in Thailand to 32% in Pakistan. In North Africa and the Near East, unmet need is close to the 20% average for the developing world in every country except Turkey, where it is 11%—with Thailand's, the lowest level recorded. In 6 of the 11 countries in Latin America and the Caribbean surveyed by the DHS, unmet need is below 20%. In Bolivia, Ecuador, El Salvador, Guatemala, and Mexico, however, the level is between 24% and 29% (see Table 2).

According to the FP/RHS, in Latin America estimates of unmet need are (132, 174):

Belize 1991	26%	Jamaica 1993	13%
Costa Rica 1992	23%	Nicaragua 1992	24%
Ecuador 1994	14%	Panama 1985	13%
El Salvador 1993	16%	Paraguay 1995	12%

Unlike the DHS, FP/RHS estimates include unmarried women as well as those who are married or in union. In the FP/RHS unmet need is estimated as the percentage of fecund, sexually active women, regardless of marital status, who are not using contraception even though they do not currently want to become pregnant. Also, unlike the DHS, the FP/RHS definition of unmet need does not include women who are already pregnant unintentionally, nor can unmet need be divided into limiting and spacing components (174).

Expanded estimates. Estimates of the expanded unmet need for family planning range widely depending on the criteria used. The International Planned Parenthood Federation (IPPF) has estimated that in developing countries, among the 172 million women estimated to be using modern temporary contraceptive methods, 97 million—over one-half of all such users—probably will stop using the method for a reason other than becoming pregnant and thus could be said to have an unmet need (94). Including women using withdrawal or periodic abstinence who probably will be unsuccessful or dissatisfied increases the number by 14 million. Thus the IPPF estimates that 111 million of the 200 million current users of temporary methods could have unmet need by this expanded definition.

Women using withdrawal or periodic abstinence as their contraceptive method often face substantial risk of an unintended pregnancy (180). For example, in the Philippines 33% of couples relying on periodic abstinence and 44% using withdrawal become pregnant within 12 months (56).

Where many couples rely on traditional methods, their inclusion raises the unmet need figure substantially. In Romania 43% of married women use withdrawal or periodic abstinence. Just 10% of women have unmet need in the sense that they are not using any contraceptive method, but 39% have unmet need if the criterion is not using a modern method (132, 192).

Similarly, an analysis of the 1987 Sri Lanka DHS found that, if the 21% of currently married women using traditional methods are all assumed to have unmet need, the level of unmet need among married women ages 15 to 49 would increase from 15% for any method to 31% for a modern method (50).

Estimates for unmarried women and for men. As the ICPD Programme of Action recognized, unmet need probably is substantial among the "growing numbers of sexually active unmarried individuals" (217). To estimate unmet need among never-married women, Westoff and Akinrinola Bankole examined data from 19 sub-Saharan African countries, where the DHS asked never-married women about their reproductive attitudes, sexual activity, and contraceptive use (237). Unmarried women cannot be presumed to be sexually active. Thus Westoff and Bankole consider fecund never-married women to have unmet need only if (1) they report that they were sexually active within the month before the survey and (2) they do not desire pregnancy but (3) they are not using contraception or else are pregnant unintentionally or amenorrheic after an unintended pregnancy.

By this definition, in the 19 countries studied unmet need among never-married women ages 15 to 49 ranges from 2% in Burundi and Mali to 16% in Namibia. The researchers also estimated levels of unmet need for never-married women by an expanded definition that includes those who have ever had sexual experience, whether or not in the past month. By this definition unmet need among never-married women is over 20% in 10 of the 19 countries, reaching 29% in Ghana and Zambia (237).

To estimate unmet need among young adults, Westoff and Bankole also reported on all women ages 15 to 19, whether married or not. Under the criterion of sexual activity during the month before the survey, in this group more women have unmet need than use contraceptives in 15 of the 19 countries studied (237).

Surveys are beginning to collect information on reproductive attitudes and contraceptive use among men. For example, in the 1993 Jamaica Contraceptive Prevalence Survey (CPS) unmet need among men is estimated at 20%, according to the formulation used in the FP/RHS (127) (see Others with unmet need in Chapter 1.1).

While DHS data do not yield estimates of unmet need among men, in a DHS Comparative Study, in 8 of 13 countries studied, the percentage of married men who do not want any more children exceeds the percentage using contraception (including use by their wives) (61). The Population Reference Bureau, using DHS data from six countries, estimates that one-quarter to two-thirds of husbands do not want to have more children but are not using contraception (157).

While evidence is limited, some level of unmet need is likely to exist in every country, developing and developed alike, even where family planning is widely used (2, 39, 148). For example, in the United States it was estimated that in 1988 about four million women, or about 7% of all women of reproductive age including unmarried as well as married, were not using contraception even though they did not want to become pregnant (29).