Unmet Needs

  • Blog post

    This post by Babatunde Osotimehin, Executive Director of the U.N. Population Fund (UNFPA), originally appeared on Devex. Babatunde and UNFPA are "calling for a youth goal to be included in the coming post-2015 development agenda" noting that by making "small investments in women’s and children’s health,...it would be possible to not only avoid unnecessary deaths, but also have healthier, more productive individuals, communities and countries." At the recent International Conference on Family Planning, there was much talk about the unmet need for family planning among young people. Ministers of Health from across Africa visited clinics around Addis Ababa and held an all-day meeting titled The Youth Dividend: Return on Investment in Family Planning. The solutions range from the grand policy solution to nuancing a media message. Free primary education is a preventive factor for early pregnancy, and has been implemented in Kenya and other countries. On a smaller scale, behavior change communications materials might benefit from using language other than 'family planning' when talking with young people who have an unmet need for contraception, but who are not thinking in terms of planning their families. What are the best ways to meet the unmet need for family planning among young people? Tell us in the comments.

    A mother and her newborn at a maternity ward in Dili, Timor Leste

    A mother and her newborn at a maternity ward in Dili, Timor Leste. Small investments in women's and children's health will yield a large return, according to the Global Investment Framework for Women's and Children's Health.

    Photo by: Ron Haviv / UNFPA


    A recent study published in The Lancet found that an increase of only $5 per capita per year in 74 of the poorest countries in the world can result in a nine-fold social and economic return.

    The Global Investment Framework for Women’s and Children’s Health — supported by the U.N. Population Fund, the World Health Organization and other partners — shows that small investments in women’s and children’s health will yield a large return. By making the additional investments needed for life-saving interventions, it would be possible to not only avoid unnecessary deaths, but also have healthier, more productive individuals, communities and countries.

    The social and economic benefits would include preventing the needless deaths of 5 million women, 147 million children, and 32 million stillbirths by 2035. Nearly all of the averted maternal deaths would be in low- or lower-middle-income countries, two-thirds of them in sub-Saharan Africa. The benefits would also include greater GDP growth through increased employment, productivity and personal income.

    From UNFPA’s perspective, the framework touches a key development area: sexual and reproductive health. A key finding of the analysis reconfirms what UNFPA has always said — that reducing the unmet need for family planning is a primary driver of the benefits, accounting for half of all the deaths prevented in the accelerated investment scenario.

    The push by the international community to ensure universal access to sexual and reproductive health, including maternal health, is rightly putting family planning and choices at the heart of our combined efforts. And, to achieve and sustain inclusive development, we must also focus on young people, in particular young women and girls.  

  • Blog post
    This chart shows the methods available at a health center in Holeta, Oromia, Ethiopia

    Providing a range of contraceptive methods is crucial in meeting unmet need for family planning. This chart shows the methods available at a health center in Holeta, Oromia, Ethiopia.

    © 2013 Sarah V. Harlan/CCP, Courtesy of Photoshare

    The theme of last month’s International Conference on Family Planning was Full Access, Full Choice, and there was a strong emphasis on employing a rights-based approach to family planning (FP) provision—one that accounts for unmet need and ensures that all women who want to access contraception are able to do so. But what are some strategies for making this happen?

    First of all, operationalizing the concept of “meeting unmet need” means offering the full range of contraceptive options—including long-acting and permanent methods (LAPMs)—in order to meet different contraceptive needs over the course of a woman’s lifetime. Recognizing that a woman’s reproductive preferences change during different stages of her life is crucial to providing optimal contraceptive care. Young women who want to delay pregnancy will likely have different needs than women who already have children who are looking to space or limit births. Thus, it is important to make a range of options available in every healthcare setting, as there is no “one size fits all” in FP service delivery.

  • Blog post

    Last week, a great piece was posted to the Impatient Optimists blog about the USAID-funded Integrated Family Health Program (IFHP), which uses task-shifting and a unique service delivery model to improve access to a wider range of contraceptive methods among women in rural areas of Ethiopia. (Read more about IFHP here).

    A group of Ethiopian women practice implant insertion on a model

    A group of Ethiopian women practice implant insertion on a model.

    © 2009 Mengistu Asnake, Courtesy of Photoshare

    Having worked on the K4Health needs assessment and Network-Mapping study among family planning and reproductive health (FP/RH) stakeholders in Ethiopia, this topic was of particular interest to me. While Ethiopia has made huge strides in FP in the past couple of decades, only about 27% of women use a modern contraceptive method, and 25% of women still have an unmet need for family planning. Further, there is a stark contrast between urban and rural areas; use of modern methods is 56% in Addis Ababa, but is less than 10% in some of the most remote areas (Ethiopia DHS, 2011). Women—particularly those in rural areas—are clearly not receiving optimal care. And this is the case for millions of other women in hard-to-reach areas throughout the world.

    Since last year’s London Summit on Family Planning, the group Family Planning 2020 (FP2020) has set the goal of improving access to voluntary family planning information, contraceptives, and services to 120 million women in the poorest countries by 2020. While this is a daunting task, there are number of ways to start. Advocacy is extremely important, as is working with the Ministry of Health and local organizations to ensure that policies are supportive of a range of contraceptive methods. Operations research is crucial in order to be able to design evidence-based programs that respond to actual needs, preferences, and contraceptive use patterns among women—as well as their providers.

    In addition, those of us working in knowledge management (KM) will tell you that knowledge exchange has a crucial role to play in improving access to family planning in hard-to-reach areas.

  • Blog post

    As World Population Day looms on July 11, and the planet’s population clock inexorably ticks toward the 8 billion mark, yet another recent report notes:An estimated 222 million women in the developing world are not using a modern method of contraception but would like to prevent pregnancy—resulting in 80 million unintended pregnancies, 30 million unplanned births and 20 million unsafe abortions.”

    An overcrowded bus in India

    An overcrowded bus in India.

    © 2008 Srikrishna Sulgodu Ramachandra, Courtesy of Photoshare

    As a commentator on one of many K4Health blog posts on unmet family planning need pointed out, the 222 million figure is not static. “It is going to soar as the population bulge of adolescents reaches age 18. Forty percent of the total populations in Malawi and Rwanda, for example, are less than 15 years old. We need to focus on reaching adolescents now if we are to reduce unmet need in the future.” There are in fact 45 other countries where 40% or more of the population is aged 15 or under, with Niger heading the list at 52%, according to the Population Reference Bureau’s World Data Sheet.

    The latest report to talk about unmet need was published in May by the High-Level Task Force for the International Conference on Population and Development (ICPD). It says youth and adolescents remain a “huge underserved demographic group in most countries.” Efforts to reach them effectively remain modest, even though they should be a priority for preventive information and services, for their own health and well-being, as well as because they are the world’s future.“

  • Blog post

    Six months after the London Family Planning Summit there are signs of hope that 2013 will be a positive year toward providing an estimated 120 million more women in the world’s poorest countries with access to contraceptives by 2020 so that they can plan the number of children to have or space their births.

    A health worker counsels a woman on reproductive health and family planning in the Visayas region of central Philippines

    A health worker counsels a woman on reproductive health and family planning in the Visayas region of central Philippines. Voluntary family planning programs are allowing women and couples to plan the number of children they want to have.

    © 2000 Liz Gilbert, Courtesy of Photoshare

    As of January 8, 2013 financial commitments by donors and the private sector at the London Summit reached a total of US$2.625 billion. My colleague Allison Bland wrote in an earlier K4Health blog: “Family Planning 2020 (FP2020) will continue to frame our discussions as governments, civil society, and technical institutions move toward the 2020 target.”

    Also in January, after more than a decade of opposition, Philippines President, Benigno "Noynoy" Aquino, III, signed into law the Responsible Parenthood and Reproductive Health Act of 2012. The new law guarantees universal access to contraceptive methods, sexual education, and maternal care. A guiding principle states: “The provision of ethical and medically safe, legal, accessible, affordable, non-abortifacient, effective and quality reproductive health care services and supplies is essential in the promotion of people’s right to health, especially those of women, the poor, and the marginalized, and shall be incorporated as a component of basic health care.”

    Congratulations to the people of the Philippines for taking a huge move that will undoubtedly reduce the unmet need for family planning and eventually help to lower the total fertility rate for the country, which was estimated at 3.2 children per woman in 2012.

  • Blog post

    A new study by the Guttmacher Institute and the United Nations Population Fund (UNFPA) reveals that the efforts of global family planning programs fall far short of what is needed to effectively address unmet need for family planning in the developing world. The authors of Adding it Up: Costs and Benefits of Contraceptive Services—Estimates for 2012 estimate that the level of unmet need for contraception—defined as the number of fecund, sexually active women who wish to avoid pregnancy but are not using modern contraception—fell only slightly from 226 million in 2008 to 222 million in 2012. Alarmingly, in the world’s 69 poorest countries—home to 73% of all women with unmet need—the number of women with unmet need for contraception has actually increased from 153 million to 162 million since 2008.

    Woman Unmet Need 1

    A smiling woman in Stone Town, Zanzibar, Tanzania.  © 2011 Arturo Sanabria, Courtesy of Photoshare

    While the number of women in the developing world using modern contraceptive methods rose from 603 million to 645 million between 2008 and 2012, a closer look at these numbers reveals that more than half of this increase is due simply to population growth rather than to a higher contraceptive prevalence rate (CPR). CPR increased more noticeably during this time period in Eastern Africa (from 20% to 27%) and Southeast Asia (from 50% to 56%) than in Western Africa and Middle Africa, where little change was observed and fewer than 10% of married women currently use modern contraceptive methods.