CONTENTS
HIGHLIGHTS
September, 1996 |
Despite the word "need," statistics on unmet need do not measure demand for family planning services, some analysts have pointed out, because surveys do not directly ask women whether they want or need contraception (52, 161). Nor do survey responses indicate the intensity of women's interest in avoiding pregnancy (245). In particular, some have criticized assumptions that improving access to contraception would satisfy all unmet need (161). Such criticisms do not invalidate the concept of unmet need. Rather, they point to the importance of understanding the various reasons for unmet need and, as a result, recognizing how much unmet need family planning programs can meet and the various ways that they can do so. While the term "unmet need" may evoke the image of women seeking contraceptives, Rodolofo Bulatao has observed, "the reality is that many of those counted as having unmet need still need to be convinced that contracepting is acceptable and in their interests" (31). To avoid misinterpretation, Bulatao has suggested substituting the term "blocked fertility preferences" to describe the women who want to control their fertility but "for some reason--internal or external, psychological or social or physical--are not taking steps to do so" (31). (Because the term "unmet need" has become widely used and accepted, Population Reports uses it throughout.) Changing attitudes and behavior. While unmet need may not equal demand for contraception, it can be considered an "essential step" between preferring lower fertility and acting on this preference by using contraception (70). Adopting a new behavior such as family planning is not an instantaneous act but a process, as people become increasingly aware and interested and, eventually, decide to adopt and to maintain a new behavior (128, 162, 176). "Unless we assume that the gradual development of a new value--wanting fewer births--is immediately followed by the adoption of birth control, we can expect a group to exist with discrepant goals and means," Freedman and Lolagene Coombs observed in 1974. "This should be a group with a high potential for adoption of contraception" (73). That is, unmet need is a stage between changing attitudes and changing behavior (19). Based on a review of studies over the past two decades, Freedman in 1996 concluded that family planning programs have played an important role in helping women move from having an unmet need to being contraceptive users. Programs help convert "what are often somewhat uncertain and ambiguous desires not to have more children into a definite demand for contraception." In other words, they help women with unmet need overcome barriers to contraceptive use, "thereby converting latent to manifest demand for contraception" (70). |