An estimated 100 million married women have unmet need for family planning (208). There is probably much unmet need among unmarried women as well, although estimates based on surveys exist only for married women. Women are considered to have unmet need if they are sexually active, fecund, and do not want to become pregnant, but they are not using either modern or traditional contraception (279).

While most husbands and wives agree about using contraception, couples who disagree (or in which the wife thinks that her husband disapproves) make up a substantial share of couples with unmet need. Many married women who want to avoid pregnancy are not using contraception because their husbands object, according to the Demographic and Health Surveys (DHS) (37, 208, 261, 278). On average, in the DHS 9% of married women with unmet need cite husband's disapproval as the principal reason that they do not use contraception (37). When interviewed in-depth, women with unmet need are even more likely to cite their husbands' opposition as a reason for not using contraception than is apparent from survey responses (208).

Qualitative studies among married women with unmet need for family planning demonstrate the powerful role that their husbands play in determining whether they use contraception. In Uttar Pradesh, India, 87% of women with unmet need said that the decision to use contraception ultimately rests with the husband. More than one-quarter agreed with the statement: "My husband would get very angry if I talked to him about family planning methods" (296).

In urban Guatemala women with unmet need told interviewers that they often deferred to their husbands' wishes despite their own preferences. For example, a woman who had been pregnant 11 times and had six living children said that, while both she and her husband wanted to space future pregnancies, she was waiting for her husband to take the initiative and decide which method they would use. If her husband decided not to use any method, she would be too embarrassed to do or say anything (296).

Husbands' objections reflect a variety of reasons, including not only desire for more children or opposition to family planning but also worries about their wives' health, side effects of contraception, lack of information, and little discussion of family planning—reasons that women with unmet need also cite. As well as husbands' opposition, other factors that explain women's unmet need for family planning include family and social opposition, lack of access to appropriate contraceptives, health concerns, worries about side effects, lack of information, and little spousal communication about family planning.

Most women with unmet need probably have a number of reasons for not using contraception, and these reasons may not be well formed and may change over time (49, 208). In Manila and several rural areas of the Philippines, for example, women's fears of side effects, together with their husbands' fears, explained much of the unmet need (49). In a rural area of Kenya many women used contraception tentatively, ready to discontinue should they change their minds, experience side effects, or face opposition from their husbands (215). In Nepal many women with unmet need expressed concerns about their health and also said that their husbands opposed family planning (237).

Sometimes, women do not use contraception because they think that their husbands object, when in fact their husbands approve (see Communication Is Key to Accurate Perceptions). For example, among couples surveyed in the 1991-92 Tanzania DHS, 63% of wives reported that their husbands disapproved of family planning when this was not so. In fact, in 59% of the cases both husband and wife approved (208). Often, a wife does not know her husband's views about reproductive matters because the couple rarely or never discusses family planning.