Measurement of Unmet Need for Contraception: A Counterfactual Approach

Abstract

Unmet need plays a critical role in reproductive health research, evaluation, and advocacy. Although conceptually straightforward, its estimation suffers from a number of methodological limitations, most notably its reliance on biased measures of women's stated fertility preferences. We propose a counterfactual‐based approach to measuring unmet need at the population level. Using data from 56 countries, we calculate unmet need in a population as the difference between: (1) the observed contraceptive prevalence in the population; and (2) the calculated contraceptive prevalence in a subsample of women who are identified to be from “ideal” family planning environments. Women from “ideal” environments are selected on characteristics that signal their contraceptive autonomy and decision‐making over family planning. We find significant differences between our approach and existing methods to calculating unmet need, and we observe variation across countries when comparing indicators. We argue that our indicator of unmet need is preferable to existing population‐level indicators due to its independence from biases that are generated from the use of reported preference measures, the simplicity with which it can be derived, and its relevance for cross‐country comparisons as well as context‐specific analyses.

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“…There was a bias to the approach involved relying only on a woman's preferences without considering men's preferences about knowing the ideal number of children that she would like to have over her lifetime if she could go back to the time when she did not have children, especially the empirical evidence on the measurement of this variable has shown that a considerable percentage of survey women respondents are either unsure about their desire for the ideal number of children or don't prefer a numeric response to this question without their partner (Karra 2021). Another study has disclosed the negative significance of correlation coefficient between the age of youth Empowerment and ideal number of children in all 10 study countries which covered both Ethiopia, Haiti, Malawi, Mali, Nepal, Nigeria, Philippines, Senegal, Uganda, and Zambia (Kerry 2021).…”

Unwanted Family Planning: Prevalence Estimates for 56 Countries

“…An alternative approach is to construct measures based on contraceptive and reproductive autonomy (Upadhyay et al 2014;Bradley et al 2012;Karra 2021). Recent work by Senderowicz (2020) presents a framework of contraceptive autonomy by highlighting the importance of concordance between desired and actual family planning in the form of either autonomous contraceptive use or autonomous nonuse (Senderowicz 2020).…”

Introduction to the Special Issue: Indicators in Sexual and Reproductive Health and Rights

“…Several of the contributions discussed the strengths and limitations of the operationalization of this construct (Bradley and Casterline, 2014; Cleland, Harbison, and Shah, 2014). More recently, Bell and Bishai (2017) suggested that unmet need as currently operationalized may exaggerate the extent of need by failing to account fully for variations in coital frequency; Rominsky and Stephenson (2019) suggested incorporating method dissatisfaction into the operationalization of unmet need; Rothschild, Brown, and Drake (2021) explored implication of doing so; and Karra (2022) suggested a radically different approach to operationalizing unmet need. The limitations of unmet need also served as a key motivation for Senderowicz's (2020) introduction of contraceptive autonomy as a new indicator for family planning programs.…”