Unmet need of family planning
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Here is a thorough overview of the unmet need for family planning, drawn from Park's Textbook of Preventive and Social Medicine (reference number 111).
Unmet Need for Family Planning
Definition
Unmet need refers to women who are sexually active (or married) and would prefer to avoid or delay pregnancy but are not using any contraceptive method (including use by their partner). In short, it is the gap between a woman's reproductive intention and her contraceptive behaviour.
Historical Background
- The concept originated in the 1960s from KAP (Knowledge, Attitude, and Practice) surveys, which revealed a gap between women's reproductive intentions and their contraceptive behaviour - this gap was called the "KAP-gap."
- The term "unmet need" first appeared in print in 1977.
- In 1978, Charles Westoff published the first comparative estimates of unmet need for limiting births, using World Fertility Survey data from five Asian countries.
Types of Unmet Need
Unmet need is classified into two categories:
| Type | Meaning |
|---|---|
| For spacing | Women who want to delay their next birth but are not using contraception |
| For limiting | Women who want no more children but are not using contraception |
Who Is Included?
- Traditionally applied to married women, but conceptually applicable to any sexually active, fecund woman.
- Measurement has historically been limited to married women in most surveys.
Reasons for Unmet Need
Among the most common reasons are:
- Inconvenient or unsatisfactory services
- Lack of information about contraceptive methods
- Fears about contraceptive side-effects
- Opposition from husband or relatives
Unmet Need in India (NFHS-4, 2015-16)
By Age Group
| Age Group | For Spacing (%) | For Limiting (%) | Total (%) |
|---|---|---|---|
| 15-19 | 19.9 | 2.3 | 22.2 |
| 20-24 | 15.7 | 6.5 | 22.3 |
| 25-29 | 8.4 | 10.3 | 18.7 |
| 30-34 | 3.1 | 9.4 | 12.5 |
| 35-39 | 1.0 | 7.3 | 8.3 |
| 40-44 | 0.3 | 5.5 | 5.8 |
| 45-49 | 0.1 | 3.3 | 3.4 |
Key observation: Unmet need is highest (22.2-22.3%) among women aged 15-24 years and is almost entirely for spacing births. In women 30 years and above, it shifts predominantly to limiting births.
By Residence
| Residence | For Spacing (%) | For Limiting (%) | Total (%) |
|---|---|---|---|
| Urban | 5.1 | 7.0 | 12.1 |
| Rural | 5.9 | 7.3 | 13.2 |
Unmet need is higher in rural areas than urban areas.
By Religion
| Religion | Total Unmet Need (%) |
|---|---|
| Hindu | 12.4 |
| Muslim | 16.4 (highest) |
| Christian | 12.9 |
| Sikh | 6.4 (lowest) |
| Buddhist/Neo-Buddhist | 11.1 |
| Jain | 12.1 |
By Education
Unmet need varies within the range of 11-17% by level of schooling.
Significance / Public Health Importance
Unmet need is a powerful indicator for family planning programmes because:
- It identifies the challenge to reach millions of women whose reproductive attitudes resemble those of contraceptive users - but who, for some reason, are not using contraceptives.
- Studies show that if the current unmet need for family planning were fulfilled over 5 years, it would prevent approximately 35,000 maternal deaths and 1.2 million infant deaths.
- It is one of the key metrics used in District Rapid Household Surveys and national health targets (with a goal of reducing unmet need at an annual rate of 8%).
Recent Evidence (2024-2026)
Recent systematic reviews highlight ongoing global relevance:
- A 2024 umbrella review (PMID 39088583) on Ethiopian women found high unmet need with associated factors including educational level, age, parity, and partner opposition.
- A 2026 systematic review and meta-analysis (PMID 41943040) found significant unmet need among women living with HIV in Africa, underscoring the intersection of reproductive health and HIV care.
Source: Park's Textbook of Preventive and Social Medicine, p. 598, Section 111
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Unmet Need for Family Planning
Definition
Women who are sexually active (married), want to avoid or delay pregnancy, but are NOT using any contraceptive method are said to have an "unmet need" for family planning.
- Unmet need for spacing - want to delay next birth
- Unmet need for limiting - want no more children
Historical Background
- Concept arose in 1960s from KAP surveys - called the "KAP-gap"
- Term "unmet need" first used in 1977
- First comparative estimates published by Charles Westoff (1978)
Common Reasons
- Lack of information
- Fear of side-effects
- Inconvenient services
- Opposition from husband/relatives
Key Facts (NFHS-4, India)
- Highest unmet need in 15-24 age group (~22%) - mainly for spacing
- After age 30 - mostly for limiting
- Higher in rural than urban areas
- Muslim women have higher unmet need than Hindu/Christian women
Significance
- Powerful tool to identify women who want to avoid pregnancy but are not protected
- If fulfilled, can prevent 35,000 maternal deaths and 1.2 million infant deaths in 5 years
- Key indicator in national health surveys (NFHS, District surveys)
Word to remember: "KAP-gap" = gap between Knowledge/Attitude and actual Practice of contraception
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