Population Reports is published by the Population Information Program, Center for Communication Programs, The Johns Hopkins School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202-4012, USA

Millions of women would prefer to avoid becoming pregnant either right away or ever, but they are not using contraception. These women have an "unmet need" for family planning. Programs can serve many of these women by developing strategies that respond directly to their concerns.

Unmet need can be a powerful concept for family planning programs. First, it is based on women's own statements in answer to survey questions. Second, it identifies the group most likely to be interested in contraception, but not already using contraception. Third, it poses a clear challenge—to reach and serve these women. The concept is usually applied to married women but also can apply to the unmarried and even to people whose current family planning method is inappropriate or inadequate.

Why is unmet need widespread? For some people unmet need is a stage that they pass through, when they have recognized a need to control their fertility but have not yet taken action. Others, however, may face serious impediments to using contraception, such as inadequate access to good-quality services, worry about health and side effects, lack of information, or opposition from husbands or others.

In developing countries over 100 million women who are married or in union have unmet need for spacing or limiting births. India has the most, at about 31 million women. Other surveyed countries where large numbers of women have an unmet need are Pakistan at 5.7 million, Indonesia and Bangladesh at 4.4 million each, Nigeria at 3.9 million, Mexico at 3.1 million, Brazil at 3.0 million, and the Philippines at 2.5 million.

Among surveyed countries, levels of unmet need, as a percentage of all married women of reproductive age, range from 11% in Thailand and Turkey to 36% in Kenya and 37% in Rwanda. The developing-country average is about 20%.

In an unmet need strategy, programs first identify the reasons for unmet need and then use this information to develop specific responses that address these various reasons. An unmet need strategy complements continued service to current clients and outreach to those who currently want more children. It does not substitute for these other strategies. Rather, an unmet need strategy adds a focus on serving women whose reproductive attitudes resemble those of contraceptive users but whose practices do not.

Surveys and in-depth studies around the world suggests several approaches as part of most unmet need strategies:

• Maximize access to good-quality health. Improving the quality of family planning services and making contraceptives easier to obtain and use will help meet the needs of many women. In particular, adding new contraceptive methods, such as injectables, can attract new users and enable current clients to continue use rather than discontinuing when their needs change.
• Emphasize communication. Many women have never tried contraception because they do not know enough about it, while others have discontinued use because they did not receive proper counseling about side effects. In either case, programs can help overcome these obstacles through counseling, other interpersonal channels, and mass-media communication.
• Focus on men as well as women. Encouraging communication between spouses and involving men more in family planning are key. While most couples agree on reproductive matters, husbands who oppose contraception or worry about its side effects often prevent their wives from using it.
• Collaborate with other services for new mothers and young children. Unmet need is concentrated among women who have recently given birth or who are currently pregnant unintentionally. Many soon will become pregnant again unless they start using contraception.