CONTENTS
HIGHLIGHTS
September, 1996 |
The level of unmet need in a country is not static but always in flux, depending on the interplay of two factors—fertility desires and contraceptive use. "Unmet need is a moving target," as Westoff and Bankole have observed. It rises as more women want to control their fertility, and it falls as more use contraception (237, 239). Thus a high level of unmet need does not necessarily indicate program failure, nor does a low level necessarily indicate success. Moreover, even where the proportion of women with unmet need is declining, the absolute number with unmet need may be growing because the population is growing (238). Most countries follow a similar pattern as they move through the demographic transition from high to low fertility. In general, a population passes through four stages, during which the level of unmet need first rises and then falls (238): (1) High fertility. At first there is neither much contraceptive use nor much unmet need because most couples do not want to, or are unaware that they can, limit or space births. Fertility is high. (2) Change in attitudes. As more couples want to control their fertility, unmet need rises because attitudes change faster than contraceptive use rises. Contraceptive use begins to rise as well, however, and the fertility rate starts to decline. (3) Change in behavior. Reproductive attitudes continue to change and, as information and services respond to people's changing attitudes, contraceptive use rises rapidly, while unmet need declines. Fertility often declines rapidly. (4) Lower fertility. Finally, most women do not want more children, and use of family planning is widespread. There is little unmet need remaining. Fertility stabilizes at a lower level than before. Recent survey data illustrate this pattern among countries at different levels of contraceptive use (see Figure 2). In countries with high contraceptive prevalence, the level of unmet need is low. At lower levels of contraceptive use, the level of unmet need is high, with slightly lower levels of unmet need in countries with the very lowest levels of contraceptive use. Even in these countries, however, the levels of unmet need suggest that a transition is starting. Recent change. How have levels of unmet need changed in recent years? Only 10 countries have conducted two DHS since 1985 with which to measure unmet need comparably. In each of these countries the percentage of women with unmet need declined between surveys. In seven—Colombia, the Dominican Republic, Egypt, Ghana, Indonesia, Kenya, and Morocco—the decline has been slight. In the other three the decline has been substantial, at 12 percentage points in Bolivia and Peru and 7 in Zimbabwe (see Table 3). Meanwhile, the level of contraceptive use stayed about the same in Indonesia and Colombia and grew appreciably in the other countries. Among five countries in Latin America and the Caribbean that conducted two FP/RHS since 1986, the level of unmet need dropped substantially in four (132, 174):
Westoff and Luis Ochoa studied changes in the percentage of women with unmet need, although only for limiting births, over a longer period by comparing 13 countries surveyed by the World Fertility Survey (WFS) in the late 1970s and again by DHS in the late 1980s (238). In the two sub-Saharan countries studied, Ghana and Kenya, unmet need for limiting had increased; it had more than doubled in Kenya. Unmet need for limiting had declined in all other countries—Egypt, Morocco, and Tunisia; Indonesia, Sri Lanka, and Thailand; and Colombia, the Dominican Republic, Ecuador, Mexico, and Peru. |