As family planning services have become widely available in many countries, however, recent studies using DHS data report that the distance to a source of contraception—measured by how far the average person lives from the nearest service site—now has little relationship to the level of unmet need in a country (25, 237, 242).

Even if distance to any service site may not be important to unmet need, lack of access to people's preferred methods and services can be a formidable obstacle (25, 213). For example, in a 1987 study of unmet need in South Korea, Kye-Choon Ahn and colleagues noted that, since family planning services had been available virtually throughout the country for more than 20 years, lack of services no longer explained unmet need. Dissatisfaction with the available contraceptive methods was more important (2). In Uttar Pradesh, India, a study found that little of the considerable interest in contraception for spacing births was being met because the family welfare program gave little attention to temporary methods such as oral contraceptives (53). Also, injectables are not available.

Satisfying people's various contraceptive needs requires a range of contraceptive methods. Thus the more contraceptive methods available in a country, the lower the level of unmet need (see Figure 3). A study of DHS data from 44 countries found that, for each additional contraceptive method that is widely available in a country, contraceptive prevalence increases by an average 3.3 percentage points. More than half of this increase, or over 1.7 percentage points, comes from meeting unmet need. This study controlled for the effects of economic development by using each country's score on the UN Human Development Index as a factor in the analysis (19).

An earlier study of DHS data, which also controlled for the effects of development, found that wide distribution of each new contraceptive method raised contraceptive prevalence by six percentage points. This study did not examine how much of the increase came from meeting unmet need (97).

In addition to lack of preferred methods, various other "costs" limit access to family planning. Many potential clients do not use contraception because of "monetary, psychological, physical, and time-related costs," Martha Ainsworth reported in 1985 on the basis of CPS data (3). Analyzing DHS data, John Bongaarts and Judith Bruce observed in 1995 that difficulties obtaining "adequate services that can be used without undue personal costs—psychological costs, travel time, monetary outlay, and so forth"—are reasons for much unmet need (25).

Poor-quality services—or the expectation of poor services—keep some women from using family planning. Some have been poorly treated at family planning clinics or have had problems with services (10, 54, 165, 190, 204). Sometimes, lack of supplies in clinics causes women to discontinue contraceptive use (138). Other women do not go to clinics because they fear modern medicine and are suspicious of service providers (188).