CONTENTS
HIGHLIGHTS
September, 1996 |
An unmet need strategy is best evaluated over the long term. Programs should not necessarily be judged—and certainly not exclusively judged—on whether the percentage of women with an unmet need decreases. A rising proportion of women with unmet need is not necessarily a sign of failure. Even as programs attract more people to contraceptive use, they also may stimulate others to want fewer children (3). Since attitudes usually change before behavior, a temporary increase in unmet need should be expected as a normal part of rising interest in family planning and the transition from high to low fertility in a country. Also, as noted (see Chapter 3, Trends in Unmet Need), the absolute number of women with unmet need may increase substantially, even as the percentage falls, because the number of women of childbearing age is growing (238). For example, in Egypt during the 1980s the percentage of women with an unmet need for limiting births declined slightly, from 18% to 15%, but the absolute number of women with an unmet need for limiting rose by nearly one-fifth (18). To measure progress in meeting unmet need, a program ideally would identify a group of women with unmet need and follow its members over time. This approach is being tested in a panel study in Gujarat, India, which is tracing changes in the unmet need status of women who were first interviewed in 1989 (see Prototype Studies on Addressing Unmet Need). In the absence of such longitudinal studies, programs can examine how the aggregate level of unmet need changes over time. This examination can be based on two or more national surveys or can come from smaller surveys conducted by programs themselves. Changes should be traced separately by age groups as well as for all women. This analysis can show how the balance of unmet need and contraceptive use changes, as women move through their reproductive years, in response to program efforts and other influences. Long-term changes are revealed chiefly in a series of cross-sectional national surveys, such as the DHS. Between such surveys, service statistics, commercial sales, and small-scale surveys can help programs monitor and evaluate their efforts. The most important criterion for judging an unmet need strategy should be whether it helps women with unmet need achieve their own reproductive goals. Under favorable conditions, as programs succeed in removing obstacles that prevent women from learning about and using contraception safely and effectively, contraceptive use should rise, the number of unintended pregnancies should fall, and unmet need should decline to low levels—probably to about half the current average for the developing world—that is, from 20% to about 10% or less. These statistics point both to the challenge ahead and to the potential of effective unmet need strategies. |