• Lack information about contraceptive methods, where to find them, and how to use them, and are reluctant to try something new that they know little about (see Chapter 2.3: Lack of Information);
• Have concerns about side effects of contraceptives, sometimes based on incorrect information (see Chapter 2.2: Health Concerns and Side Effects);
• Think, incorrectly, that using contraception is riskier than becoming pregnant and (see Comparing Risks in Chapter 2.2);
• Mistakenly believe they cannot become pregnant (see Chapter 2.5: Little Perceived Risk of Pregnancy).

In this view, as information spreads, more people are exposed to the small-family norm, to contraception, and to contraceptive users, and thus more people want to control their own fertility and to use contraceptives themselves. As Susan Watkins has suggested, based on a review of studies, social interaction through communication produces ideational change and spreads information—first creating unmet need, as reproductive attitudes change, and then helping to meet it, as contraceptive behavior changes (225).

In Matlab, Bangladesh, which has been the focus of intensive, well-researched family planning efforts for years, Rezina Mita and Ruth Simmons found that discussion of contraception, a belief in the value of fertility control, and widespread interest in using contraception are common in most communities. While village elders may think that young, unmarried women should not know about contraception, nevertheless, as one young woman told the interviewers, "the news somehow spreads" (131).

In contrast, in rural Nepal, where few program efforts have been made, many women remain hesitant to use contraception because their relatives and friends are not already using it. Women in the unmet need group "clearly struggled with the idea of being the first person in their family or neighborhood" to use family planning, Sharon Stash has reported (204).

Where contraception is not widely known, both mass-media and personal testimonials of satisfied users can introduce family planning and make it more acceptable (156). Where contraception already is widely known, mass-media discussions and individual or group counseling can offer clients accurate information, reassurance, and encouragement (25, 165, 190).

Mass-media communication has increased knowledge, favorable attitudes, and contraceptive use—each a step in the progression from nonuse to use. For instance, in Egypt exposure to family planning messages in the mass media was the most important determinant of women's knowledge of contraceptives, even more important than education level or residence, analysis of DHS data found (18). In Uttar Pradesh, India, among women who were not using contraception, those exposed to mass-media messages about family planning were considerably more likely to say that they intended to use contraception than women with no exposure, according to an analysis of the 1992-93 National Family Health Survey (53). In Ghana, Kenya, Nigeria, Zimbabwe, and elsewhere, studies have found that mass-media messages about family planning increase contraceptive use (104, 106, 145, 154, 155, 241).

Improving interpersonal communication also helps to address unmet need. Family planning clients who have a chance to learn about side effects and about other contraceptive methods during a counseling session are more likely to continue using the method that they choose (159). Women who have been counseled on what to expect are more satisfied with their methods and use them longer (62, 76). In a study in India the level of unmet need was much lower when service providers told clients about family planning methods (163). Direct communication by service providers is especially important where the mass media has limited reach and women and men do not mix outside the home, as in Bangladesh (131).

In Nepal the government's strategy to address unmet need makes improved communication the key. Interviews with service providers in 1994 found that more than half had difficulty informing and educating their clients about contraception. A baseline survey in the same year found that most clients had never received any family planning materials from health workers (207). In response, the government is using radio programs to reach both service providers and clients. A weekly radio soap opera dramatizes the way village families deal with family planning and reproductive health problems, while an entertaining and educational series designed especially for health workers highlights the importance of good counseling (85).