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The concept of unmet need for contraception has been under research for more than forty years, but it was never taken into consideration so desperately by the developing countries until recently. By using safe and effective methods of contraception couples can determine the number and spacing of their pregnancies. Access to the use of safe and effective methods of contraception was deemed a fundamental human right by the 1994 International Conference on Population and Development (ICPD).

ICPD is a forum which encourages the countries committed to work towards achieving the goal of universal access to reproductive health services, including effective contraceptives. By improving the use of effective contraception, the burden of reproductive ill health, mortality and morbidity of unwanted pregnancies will be reduced [1, 2]. It also reduces the fertility, which plays a crucial role in reduction of poverty [3, 4].

In the 1994 International Conference on Population and Development, there is a focus on helping individuals— both women and men to achieve their preferences for smaller families and having children at the time that feels appropriate for them [5]. . Research indicates that addressing unmet needs will help women to achieve their goals thereby relieving population pressures and also will result in contraceptive prevalence rates that exceed many countries’ targets. [6]

The measurement of unmet needs is becoming increasingly important in the context of the United Nations (UN) Millennium Development Goals (MDGs). The MDGs, conceived at the UN Millennium Summit in 2000, brought some major developments in the objectives that were proposed at the ICPD in 1994. The goals consist of eight agenda items including topics such as education, gender equality and health. [7] The benefits of helping women and couples include the prevention of health risks associated with unwanted and unsafe pregnancies.

Increased access to family planning improves women’s education and employment opportunities on a broader scale and also encourages their participation in social and political domains [8]. Usually couples with the means to control their fertility are capable of investing more resources in each child, which ultimately raises the standard of health, education and wealth in a population. Investments in family planning advance general social and economic growth and development of a community [9].

The measure of unmet need has been developed and refined over the past four decades, being advanced in the conceptualization of the phenomenon, survey methodology, analytic tools and in-depth studies. The international community has now settled on a measure of unmet need which was initially developed by Princeton University demographer, Charles Westoff. This measure consists of data collected through large-scale, nationally representative surveys of women and the Demographic and Health Surveys (DHS), which are conducted in many countries throughout the developing world.

DATA AND METHODOLOGY According to the DHS definition, never-married women were assumed to be sexually active if they had sexual intercourse in the month prior to the survey. But it is specified in this report that a never-married women who had sex in the three months prior to the survey were assumed to be sexually active Social and demographic characteristics After examining the levels of unmet need among social and demographic subgroups within each country in this study, it will be easy to identify populations with the greatest levels of unmet need.

reasons for nonuse of family planning in these subgroups were also explored. Variables used in this exploration include women’s age (15–24, 25–34 and 35–49 years old); parity (defined as 0–1 live birth, 2–3 births and 4 or more births among married women, and 0 births or ? 1 birth for never married women); area of residence (urban or rural); education (usually defined as fewer than 7 years of schooling and 7 or more years of schooling); and wealth status.

Our main objective was to develop categories that correspond with groupings of women, within which the circumstances surrounding unmet need are likely to be similar, while also accounting for sample size limitations that prevent us from slicing the populations too finely. Nulliparous women and women with one live birth were grouped together in analyses because nulliparous women might have different family planning needs than women who have begun childbearing.

In most countries unmet need among women with fewer than seven years of schooling and women with seven or more years of schooling were analyzed. As the countries like Armenia, Kazakhstan, the Kyrgyz Republic and Uzbekistan, have a relatively higher level of education, we instead look at women who have completed secondary school and those who have not. The household wealth index variable was drawn from the extensive information collected by the DHS, on women’s household assets, including various household possessions [10]. Why Aren’t They Using Contraception?

Reasons for Nonuse among Married Women with Unmet Need More than 60% in the North Africa and West Asia region, nearly half of women in the Latin America region and more the a third of women in South and Southeast Asia and Sub-Saharan Africa indicated they were not using contraceptives because they did not believe they were at risk of getting pregnant. The remaining 38% of women in these regions gave reasons like lack of knowledge of family planning, access to contraceptives or method-related concerns. Never-Married Women with Unmet Need: Reasons for Not Using Contraception

The most common reasons for nonuse were – perceived low risk of pregnancy because of infrequent sexual activity, a perception that they don’t need to use contraception because they are unmarried and concerns about the side effects or health consequences of contraception. A mere number (0–2%) of never-married women at risk for an unintended pregnancy in the Latin American and Caribbean countries mentioned here said that they were unaware of any methods to prevent pregnancy. Cost and lack of access are not precisely the major reasons for nonuse among these women.

36% of never-married women with unmet need in Haiti stated that they were not using a method because they feared health consequences or side effects and some found contraception too inconvenient to use. Recommendations for overcoming the shortcomings 1. Address unmet need in Sub-Saharan Africa. 2. Focus national efforts on populations with the greatest unmet need in each country. 3. Offer a range of contraceptive methods 4. Include counseling and education to help women sustain contraceptive use 5. Improve contraceptive technologies. 6. Educate women about their risk of getting pregnant.

7. Raise awareness among populations with little knowledge of family planning. 8. Recognize that service provision will not help all women achieve their fertility preferences. Critique The average rates of use of modern contraceptive methods in most developing countries have increased over the past few decades. In countries with 30% of women in the bottom quintile, the prevalence of use ranges from near zero to 24%. South and Southeast Asia show significantly higher rates of modern contraception in the absolute poor, on average 17% higher use rates than the poor in Latin America.

Higher levels of income inequality are responsible for the large gaps between the national average and the poorest. Inequalities in contraceptive coverage reflect overall inequalities in a country. Even after controlling for variables that might be important in determining the use of contraception, there is a strong regional effect, with Latin America showing the largest inequalities in contraceptive use [12]. In Uganda, 945 new DMPA (injectable Depo Provera) users were hired or recruited by community workers, clinic-based nurses and midwives.

Researchers successfully followed 777 (82% follow-up): 449 community worker clients and 328 clinic-based clients. Ninety-five percent of community-worker clients were either satisfied or highly satisfied with the services and 85% of them were reported to have side-effects. There were no serious injection site problems in either group. There was no significant difference between continuations to second injection and also there were no significant differences in other measures of safety, acceptability and quality. [13] CONCLUSION

Community-based distribution (CBD) of injectable contraceptives is now routinely used in some countries in Asia and Latin America, but is practically unknown in Africa which is the country where the need for this practice is greatest. This research reinforces experience from other regions suggesting that well-trained community health workers can safely provide contraceptive injections. [13] REFERENCES 1. Collumbien M, Gerressu M, Cleland J (2004) Non-use and use of effective methods of contraception. In: Ezzati M, Lopez AD, Rodgers A, Murray CJL, editors.

Comparative quantification of health risks: Global and regional burden of disease attributable to selected major risk factors. Geneva: World Health Organization. pp. 1255–1319. 2. Marston C, Cleland J (2004) The effects of contraception on obstetric care. Geneva: World Health Organization. Available: http://www. who. int/ reproductive-health/publications/2004/effects_contraception/index. html. Accessed 29 November 2006. 3. Bloom D, Canning D (2005) Population, poverty reduction, and the Cairo Agenda. Proceedings of the Seminar on the Relevance of Population Aspects on the Achievement of the Millennium Development Goals.

2004 17–19 November; New York, United States. New York: United Nations Population Fund (UNFPA). Available: http://www. un. org/esa/population/ publications/PopAspectsMDG/PopAspects. htm. Accessed 29 November 2006. 4. United Nations Population Fund (2005) Reducing poverty and achieving the Millennium Development Goals: Arguments for investing in reproductive health and rights. New York: United Nations Population Fund 5. Ashford LS, New perspectives on population: lessons from Cairo, Population Bulletin, Washington, DC: Population Reference Bureau, 1995, Vol. 50, Issue 1. 6.

Sinding SW, Ross JA and Rosenfield AG, Seeking common ground: unmet need and demographic goals, International Family Planning Perspectives, 1994, 20(1):23–27 & 32. 7. Bernstein S, UN Population Fund, New York, personal communication, March, 29, 2007. 8. Singh S et al. , Adding It Up: the Benefits of Investing in Sexual and Reproductive Health Care, New York: The Alan Guttmacher Institute (AGI) and UN Population Fund, 2003. 9. U. S. Agency for International Development (USAID), Family Planning and Reproductive Health Programs: Saving Lives, Protecting the Environment, Advancing US Interests, Washington, DC: USAID, 2006.

10. Rutstein SO and Johnson K, The DHS wealth index, DHS Comparative Reports, Calverton, MD: ORC Macro, 2004, No. 6 11. Sedgh G et al. , Women with an unmet need for contraception in developing countries and their reasons for not using a method, Occasional Report, New York: Guttmacher Institute, 2007, No. 37 12. http://medicine. plosjournals. org/perlserv/? request=getdocument&doi=10. 1371/journal. pmed. 0040031#toclink4 13. http://www. who. int/bulletin/volumes/85/10/07-040162-ab/en/

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