1. Top of page
  2. Abstract

Unmet need for contraception has been a central indicator for monitoring the progress of family planning programs for 25 years. The purpose of this article is to provide a broad context for the more focused contributions that follow in this special issue. The validity and measurement of the concept of unmet need are discussed. We then present regional trends among married women since 1970. Major reductions in unmet need have been achieved, with the clear exception of sub-Saharan Africa. Less success can be claimed in addressing the needs of sexually active unmarried women, who contribute nearly 20 percent to overall unmet need in developing countries. Prominent reasons for unmet need in settings where contraceptive uptake is low include social resistance and insufficient information concerning methods. As contraceptive use increases, the importance of these reasons wanes, but concerns regarding side effects and health impact remain a barrier, and discontinued users now constitute a large proportion of those with unmet need. Drawing on these reasons, we outline measures to further reduce unmet need.



  1. Top of page
  2. Abstract
  • Adanu, Richard M., Joseph D. Seffah, John K. Anarfi, et al. 2012. “Sexual and reproductive health in Accra, Ghana,” Ghana Medical Journal 46(2): 5865.
  • Ali, Mohamed M., John Cleland, and Iqbal H. Shah. 2004. “Condom use within marriage: A neglected HIV intervention,” Bulletin of the World Health Organization 82(3): 180186.
  • Ali, Mohamed M., John Cleland, and Iqbal H. Shah. 2012. “Causes and consequences of contraceptive discontinuation: Evidence from 60 Demographic and Health Surveys.” Geneva: World Health Organization.
  • Bankole, Akinrinola. 1995. “Desired fertility and fertility behaviour among the Yoruba of Nigeria: A study of couple preferences and subsequent fertility,” Population Studies 49(3): 317328.
  • Bankole, Akinrinola and Suzette Audam. 2011. “Fertility preferences and contraceptive use among couples in sub-Saharan Africa,” African Population Studies Journal 25(2): 556586.
  • Bankole, Akinrinola and Susheela Singh. 1997. “Couples' fertility and contraceptive decision-making in developing countries: Hearing the man's voice,” International Family Planning Perspectives 24(1): 1524.
  • Basu, Alaka Malwade. 2005. “Ultramodern contraception: Social class and family planning in India,” Asian Population Studies 1(3): 303323.
  • Becker, Stan. 1999. “Measuring unmet need: Wives, husbands or couples?International Family Planning Perspectives 25(4): 172180.
  • Becker, Stan and Elizabeth Costenbader. 2001. “Husbands' and wives' reports of contraceptive use,” Studies in Family Planning 32(2): 111129.
  • Bongaarts, John. 2014. “The impact of family planning programs on unmet need for contraception,” Studies in Family Planning 45(2): 247262.
  • Bradley, Sarah E.K. and John B. Casterline. 2014. “Estimating unmet need: History, theory, and measurement,” Studies in Family Planning 45(2): 123150.
  • Bradley, Sarah E.K., Trevor N. Croft, Joy D. Fishel, and Charles F. Westoff. 2012. “Revising unmet need for family planning,” DHS Analytical Study No. 25. Calverton, MD: ICF International.
  • Bradley, Sarah E.K., Trevor N. Croft, Shea O. Rutstein. 2011. “The impact of contraceptive failure on unintended births and induced abortions: Estimates and strategies for reduction,” DHS Analytical Study No. 22. Calverton, MD: Macro International.
  • Casterline, John B. and Laila O. El-Zeini. 2014. “Unmet need and fertility decline: A comparative perspective on prospects in sub-Saharan Africa,” Studies in Family Planning 45(2): 227245.
  • Casterline, John B., Zeba A. Sathar, and Minhaj ul Haque. 2001. “Obstacles to contraceptive use in Pakistan: A study in Punjab,” Studies in Family Planning 32(2): 95110.
  • Chandra-Mouli, Venkatraman, Donna R. McCarraher, Sharon J. Phillips, Nancy E. Williamson, and Gwyn Hainsworth. 2014. “Contraception for adolescents in low and middle income countries: Needs, barriers, and access,” Reproductive Health 11(1): 18.
  • Cleland, John and Iqbal H. Shah. 2013. “The contraceptive revolution: Focused efforts are still needed,” The Lancet 381(9878): 16041606.
  • Dodoo, F. Nii-Amoo. 1993. “A couple analysis of micro-level supply/demand factors in fertility regulation,” Population Research and Policy Review 12(2): 93101.
  • Ezeh, Alex Chika. 1993. “The influence of spouses over each other's contraceptive attitudes in Ghana,” Studies in Family Planning 24(3): 163174.
  • Halpern, V., David A. Grimes, I. Lopez and M.F. Gallo. 2006. “Strategies to improve adherence and acceptability of hormonal methods of contraception.” Cochrane Database Systematic Review: CD004317.
  • Imasiku, Eunice N.S. 2013. “Unmet need for contraception among men in Zambia: Implications for family planning programs.” Paper presented at the Annual Meeting of the Population Association of America, 11–13 April, New Orleans, LA.
  • Jain, Anrudh K., Arshad Mahmood, Zeba A. Sathar, and Irfan Masood. 2014. “Reducing unmet need and unwanted childbearing: Evidence from a panel survey in Pakistan,” Studies in Family Planning 45(2): 277299.
  • Jain, Anrudh K., Francis Obare, and Saumya RamaRao. 2013. “Reducing unmet need by supporting women with met need,” International Perspectives on Sexual and Reproductive Health 39(3): 133141.
  • Jejeebhoy, Shireen J., K.G. Santhya, and A.J. Francis Zavier. 2014. “Demand for contraception to delay first pregnancy among young married women in India,” Studies in Family Planning 45(2): 183201.
  • Jones, Elise F. 1984. “The availability of contraceptive services,” World Fertility Survey Comparative Study No. 37. Voorburg, Netherlands: International Statistical Institute.
  • Machiyama, Kazuyo and John Cleland. 2014. “Unmet need for family planning in Ghana: The shifting contributions of lack of access and attitudinal resistance,” Studies in Family Planning 45(2): 203226.
  • Malarcher, Shawn and Chelsea B. Polis. 2014. “Using measurements of unmet need to inform program investments for health service integration,” Studies in Family Planning 45(2): 263275.
  • Ngom, Pierre. 1997. “Men's unmet need for family planning: Implications for African fertility transitions,” Studies in Family Planning 28(3): 192202.
  • Odumosu, O.F., A.O. Ajala, E.N. Nelson-Twakor, et al. 2005. “Unmet need for contraception among married men in urban Nigeria,” in Susana Lerner and Eric Vilquin (eds.), Reproductive Health, Unmet Needs, and Poverty: Issues of Access and Quality of Services. Paris: Committee for International Cooperation in National Research in Demography, pp. 201223.
  • Pearson, Erin and Stan Becker. Forthcoming. “Couples' unmet need for family planning and application to three West African countries,” Studies in Family Planning.
  • Pritchett, Lant H. 1994. “Desired fertility and the impact of population policies,” Population and Development Review 20(1): 155.
  • Ravenholt, Reimart and John Chao. 1978. “Availability of family planning services: The key to rapid fertility transition,” Family Planning Perspectives 6(4): 217223.
  • Rossier, Clémentine, Leigh Senderowicz, and Abdramane Soura. 2014. “Do natural methods count? Underreporting of natural contraception in urban Burkina Faso,” Studies in Family Planning 45(2): 171182.
  • Rutenberg, Naomi and Susan Cotts Watkins. 1997. “The buzz outside the clinics: Conversations and contraception in Nyanza Province, Kenya,” Studies in Family Planning 28(4): 290307.
  • Sedgh, Gilda and Rubina Hussain. 2014. “Reasons for contraceptive nonuse among women having unmet need for contraception in developing countries,” Studies in Family Planning 45(2): 151169.
  • Sinding, Steven, John Ross, and Alan Rosenfield. 1994. “Seeking common ground: Unmet need and demographic goals,” International Family Planning Perspectives 20(1): 2327, and 32.
  • Singh, Susheela and Jacqueline Darroch. 2012. “Adding it up: Costs and benefits of contraceptive services—estimates for 2012.” New York: Guttmacher Institute.
  • Singh, Susheela, Gilda Sedgh, and Rubina Hussain. 2010. “Unintended pregnancy: Worldwide levels, trends, and outcomes,” Studies in Family Planning 41(4): 241250.
  • Stash, Sharon. 1999. “Explanations of unmet need for contraception in Chitwan, Nepal,” Studies in Family Planning 30(4): 267287.
  • Tsui, Amy O. 1985. “Community effects on contraceptive use,” in John B. Casterline (ed.), The Collection and Analysis of data on Community and Institutional Factors. Voorburg, Netherlands: International Statistical Institute, pp. 7799.
  • Tsui, Amy O. and Luis H. Ochoa. 1989. “Service proximity as a determinant of contraceptive behaviour: Evidence from cross-national studies of survey data.” Report 89–05. Chapel Hill: University of North Carolina, Carolina Population Center.
  • United Nations (UN), Department of Economic and Social Affairs, Population Division. 2013a. “Model-based estimates and projections of family planning indicators, 2013 revision.” New York.
  • United Nations (UN), Department of Economic and Social Affairs, Population Division. 2013b. “World contraceptive patterns 2013.” Wall chart. New York.
  • Wellings, Kaye, Martine Collumbien, Emma Slaymaker. 2006. “Sexual behaviour in context: A global perspective,” The Lancet 368(9548): 17061728.
  • Westoff, Charles F. 1978. “The unmet need for birth control in five Asian countries,” Family Planning Perspectives 10(3): 173181.
  • Westoff, Charles F. 2012. “Unmet need for modern contraceptive methods,” DHS Analytical Studies No. 28. Calverton, MD: ICF International.
  • Westoff, Charles F. and Akinrinola Bankole. 1998. “The time dynamics of unmet need: An example from Morocco,” International Family Planning Perspectives 24(1): 1214 and 24.
  • Westoff, Charles F. and Luis Ochoa. 1991. “Unmet need and the demand for family planning,” DHS Comparative Studies No. 5, Calverton, MD: Macro International.