Unmeet Need and Demand Satisfied
Indicators 3–
Across the FP2020 countries, we estimate that almost 134 million married or in-union women of reproductive age have an unmet need for modern methods of contraception in 2016.
While the first two Core Indicators look at modern family planning use, Core Indicator 3 (Estimate Table 3), unmet need for modern contraception, and Core Indicator 4 (Estimate Table 4), demand satisfied for modern contraception, take a wider view to also include women who want to avoid pregnancy but are not using modern contraception. These measures help to assess the degree to which governments and the global community are meeting the commitment to make family planning services available to all who want them. Core Indicator 4 is also an indicator for the Sustainable Development Goals (SDG) target 3.7,16 which includes ensuring, by 2030, universal access to family planning.
Core Indicator 3, unmet need for modern contraception, captures women who are not using modern contraception, are at risk of becoming pregnant, and say that they do not want to have a child soon or that they do not want to have any more children.17 It includes women currently not using a method as well as those using traditional methods, who are considered to have an unmet need for a more effective modern method. Most of the available data for this measure are currently available for married or in-union women, though in coming years FP2020 aims to provide annual estimates of unmet need and demand satisfied for all women.
In 2016, 22% of married or in-union women of reproductive age across the FP2020 focus countries had an unmet need for modern methods of contraception. There are large variations among countries, ranging from 11% in Nicaragua to 40% in DR Congo. The high levels of unmet need for a modern method in DR Congo are partially due to high levels of traditional method use (13.7% of married or in-union women were using traditional methods in 2016).
The reasons for unmet need are complex. There are many potential reasons why a woman who does not want to become pregnant would not use modern contraception, including limited access to contraception, perceived health side effects, or social disapproval. Understanding the barriers to use within each country’s context is important to ensure that programs are able to address the needs of women across different settings and situations. In addition, it is important to consider levels of unmet need within the context of a country’s wider situation. Historic patterns tell us that in countries with very little contraceptive use and high fertility desires, unmet need tends to be low. Over time, as these dynamics change and contraceptive use begins to rise, unmet need often also rises—since the demand for contraception often outpaces a country’s ability to expand contraceptive services to meet this increased demand.
Core Indicator 4, demand satisfied with a modern contraceptive method, is constructed based on mCPR and unmet need for modern methods, with total demand assumed to encompass current users and those with unmet need for modern methods. The proportion of these women using a modern method is termed “demand satisfied,” and is also affected by the dynamics of unmet need.18 In a country where unmet need is low because fertility desires remain high, overall demand for contraception will be lower—meaning a smaller number of users (i.e., a lower mCPR) can result in a relatively high demand satisfied (see "Understanding Demand Satisfied" below).
Levels of demand satisfied with a modern method vary greatly across FP2020 countries. In 2016, there were 5 countries with demand satisfied of less than 25%, 27 countries with demand satisfied between 25% and 50%, 25 countries with demand satisfied between 50% and 75%, and 11 countries with demand satisfied greater than 75%. As more countries accelerate toward their FP2020 goals, they will be better positioned to achieve higher levels of demand satisfied and reach the proposed SDG benchmark of 75% of demand satisfied with a modern method.
These three indicators are illustrated together in the figure above, which shows regional variations in mCPR, unmet need for modern methods, and demand satisfied with a modern method among married and in-union women in 2016.19 It can be seen that overall demand (the height of the bar) is comprised of the combination of mCPR and unmet need, and is lowest in Western Africa and highest in Latin America and the Caribbean. Demand satisfied with a modern method, however, is the portion of the bar filled by mCPR, and is lowest in Central Africa and highest in Eastern and Central Asia.
A Closer Look: Demand Satisfied
The complexity of this new SDG indicator can be illustrated by comparing Niger and Djibouti. Both countries had nearly identical levels of demand satisfied by a modern method in 2016 (42.5% and 43.3%), but modern contraceptive prevalence among married or in-union women in Djibouti is nearly one and a half times greater than in Niger. The reason for the relatively high demand satisfied in Niger despite this lower mCPR is that unmet need for modern contraceptives is low (19.5%) as compared to Djibouti (30.5%). As can be seen in the figure below, 35 out of 100 married or in-union women
in Niger have a demand for modern contraception, compared to 54 out of 100 in Djibouti. This means that in Niger, the majority of married or in-union women (65 in 100) are considered to not have a need for family planning. Because of the much lower overall need in Niger, they are able to have a similar level of demand satisfied as Djibouti with much lower levels of contraceptive use. Based on experience from other countries, we expect the need for modern contraception to increase as fertility desires begin to shift, and more women want to limit their family sizes.
16. By 2030, ensure universal access to sexual and reproductive healthcare services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs
17. Women who are currently pregnant or postpartum amenorrheic whose pregnancy/last births were wanted at the time are considered not to be in need. However, pregnant or postpartum amenorrheic women whose pregnancy/last births were wanted later or not at all are considered to have an unmet need.
18. Fabic MS, Choi Y, Bongaarts J, Darroch JE, Ross JA, Stover J, et al. Meeting demand for family planning within a generation: the post-2015 agenda. Lancet. 2014; 385: 1928–31. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393371/
19. Note: these figures represent weighted regional averages.
