By this definition, in the developing world as a whole, about 120 million married women—about one in every five—have an unmet need for family planning, either for limiting or spacing births (164 ). In most countries surveyed by the Demographic and Health Surveys (DHS), between 20% and 30% of all married women of reproductive age have an unmet need for family planning. Outside sub-Saharan Africa, most women with an unmet need do not want to have any more children. In sub-Saharan countries surveyed, most unmet need is for spacing births (204).

Another telling indicator of the challenge facing family planning programs, described as "the ultimate unmet need for family planning" (26), is that more than 50 million women each year terminate their pregnancies with abortions, most of them illegal and dangerous (26, 240).

Serving the hard-to-reach. In the 1990s family planning programs must do more to serve the less educated, the poor, and the ethnic minorities, as well as the educated, the employed, and the majority (218, 223, 225, 241, 246, 249, 266, 267). In most surveyed countries, even where contraception is widely practiced, unmet need is greater in rural areas than in the cities, a fact suggesting that access to family planning services is unequal (164 , 204).

"The time of just promoting the concept of family planning to the general public is over," observes Alfonso López Juárez, Director General of Fundación Mexicana para la Planeación Familiar (MEXFAM), Mexico's International Planned Parenthood affiliate (241). Particularly where contraceptive use has already risen substantially, it is unlikely to continue rising unless family planning programs make progress toward reaching all groups and areas (234).

The impact of meeting unmet need. If programs could meet all unmet need for family planning, millions more women would be able to achieve the reproductive control that they want, effectively and safely. The use of modern methods of contraception would rise substantially. Fertility would fall as a result, and population growth rates would slow.

Many family planning specialists believe that the existing demand for family planning and reproductive health services is already so strong that, if every individual's needs could be met with services, fertility rates would decline as much as, or even more than, most governments call for in their development plans (191). For example, Steven Sinding, John Ross, and Alan Rosenfield have calculated that, in 13 of 17 countries studied, meeting the unmet need for family planning would exceed the government's demographic objectives for levels of contraceptive use (184). Moreover, demographic objectives do not take account of the specific needs of different groups. A focus on meeting unmet need implies satisfying individuals' needs (171).

Sinding has calculated that, if all the unmet need for family planning in developing countries were met, contraceptive prevalence would rise from the current level of about 50% to at least 60%. As a result, fertility would fall from an average of about four children per woman to just over three (183). A fertility decline of this magnitude would reduce the annual rate of population growth in the developing world from 2.3% to 1.6% (163). These statistics exclude China, where there is presumed to be little unmet need for family planning because the level of contraceptive use is as high as in developed countries.

Projections are not predictions, however. Future fertility declines cannot be assumed simply on the basis of past declines. Unintended childbearing cannot be wished away. Meeting the unmet need will be difficult, requiring continued commitment and more financial support for family planning programs.

Keeping pace. Even as programs work to meet the existing demand for family planning, the number of potential contraceptive users is rising rapidly. One reason is that the number of people reaching reproductive age is soaring—a consequence of rapid population growth in the past. Just to maintain current levels of contraceptive use, an estimated 100 million more married couples will need to be served by the year 2000 than were being served in 1990 (108, 109).

Another reason is that reproductive norms are changing. Almost everywhere, couples want fewer children than in previous generations. For example, the percentage of married women of reproductive age who report that they want to have no more children rose during the 1980s in each of 15 countries surveyed by both the World Fertility Survey (WFS) and DHS. The largest increase occurred in Kenya, where the percentage of women wanting no more children rose from 10% in the WFS to 33% in the DHS (203). Also, in the past decade the percentage of unwanted or mistimed births has risen, a statistic suggesting that the demand for family planning is growing faster than the supply (164 ).

The need for contraception is likely to increase further, particularly if women's educational opportunities improve and women's status rises, leading women to want to delay having their first child, to space their births more widely, and to have fewer children (21 , 56, 218). "The need for an assured supply of contraceptives to meet the growing demand for family planning in developing countries will pose a major obstacle to the continued success of family planning programs," according to the United Kingdom Overseas Development Administration (226).