Unmet Need for Contraception in Developing Countries: Examining Women’s Reasons for Not Using a Method

BackgroundAn estimated 225 million women in low- and middle-income regions have an ‘unmet need’ for modern contraception. This is generally defined as fertile women aged 15-49 who are married and are not using a modern contraceptive method, despite not wanting a child in the next two years or at all. In this definition women who are using traditional methods of family planning (such as withdrawal or fertility awareness-based methods) are grouped with women who do not use any method, and if they wish to avoid having a baby in the next two years, are considered to have an unmet need for (modern) contraception.MethodsDemographic and Health Surveys (DHS) have been conducted in over 90 low- and middle-income countries since 1984. These household surveys focus on fertility, family planning, reproductive, maternal and child health, among other topics. This report presents analysis of data from 52 countries in Africa, Asia, and Latin America and the Caribbean where a DHS was conducted between 2005 and 2014. It looks specifically at the reasons why women do not use modern contraceptives despite wanting to avoid pregnancy.Key PointsWomen rarely reported the reason for having ‘unmet need’ for modern contraception as being because they are unaware, do not have access to it, or because it costs too much. The only places where these reasons were reported for more than 10% of women were in West and Middle Africa.The proportion of married women aged 15 to 49 using modern contraception varied widely in the countries included in the analysis. The most common reasons for married women not using contraception despite wanting to avoid a pregnancy were:

• Concerns about contraceptive side effects and health risks (26 per cent)
• Infrequent or no sex (24 per cent)
• Objections to modern contraception (either personal objections or objections from those around them) (23 per cent)
• Breastfeeding and/or having not yet started menstruating again after a birth (20 per cent)

The authors also found that married women’s answers about their reasons for non-use were consistent with their experience, for example women who reported not using contraception due to infrequent sex were also more likely to report not having had sexual intercourse in the three months preceding the survey than women who reported other reasons. Similarly, women who said they had objections to family planning were more likely to have never used a contraceptive method before and women who reported being concerned about side effects and health risks were more likely to have used a method in the past, and be speaking from experience.Separately, the authors looked at sexually-active women who had never married and who wanted to avoid pregnancy. Among these women, the most common reasons for not using contraception despite wanting to avoid a pregnancy were:

• Infrequent or no sex (49 per cent)
• Not being married (29 per cent)
• Concerns about contraceptive side effects and health risks (19 per cent) 

ConclusionsThis analysis shows that women rarely have an ‘unmet need’ for contraception because of lack of knowledge or access to affordable supplies. Instead, larger proportions of women now report concerns about side effects and infrequent sex as reasons for non-use. The authors recommend improving information and counselling on contraception, as well as the range of contraceptive methods women are offered. They conclude that all sexually active women, whether they are married or not, need information about their risks of pregnancy and the choices of methods available to them.To read the full report for free, click here.Sedgh, G., Ashford, L., & Hussain, R. (2016). Unmet Need for Contraception in Developing Countries: Examining Women’s Reasons for Not Using a Method. New York: Guttmacher Institute.