Reasons for unmet need for family planning, with attention to the measurement of fertility preferences: protocol for a multi-site cohort study

Abstract

BackgroundUnmet need for family planning points to the gap between women’s reproductive desire to avoid pregnancy and contraceptive behaviour. An estimated 222 million women in low- and middle-income countries have unmet need for modern contraception. Despite its prevalence, there has been little rigorous research during the past fifteen years on reasons for this widespread failure to implement childbearing desires in contraceptive practice. There is demographic survey data on women’s self-reported reasons for non-use, but these data provide limited insight on the full set of possible obstacles to use, and one may doubt the meaningfulness of explanations provided by non-users alone. To rectify this evidence gap, this study will gather extensive information on women’s perceptions of contraception (generic and method-specific) and their past contraceptive experience, and it will allow for more complexity in fertility preferences than is standard in demographic surveys.MethodsA multi-site cohort study will be conducted in urban Kenya, rural Kenya, and rural Bangladesh. In each setting trained fieldworkers will recruit and interview 2600 women, with participants re-interviewed at 12 and 18 months. Data will be collected using a questionnaire whose development was informed by a review of existing literature and instruments from past studies in both developed and developing countries. Dozens of experts in the field were consulted as the instrument was developed. The questionnaire has three main components: a sub-set of Demographic and Health Survey items measuring socio-demographic characteristics, reproductive history, and sexual activity; additional questions on prospective and retrospective fertility preferences designed to capture ambivalence and uncertainty; and two large blocks of items on (i) generic concerns about contraception and (ii) method-specific attributes. The method-specific items encompass eight modern and traditional methods.DiscussionPolicy and programmes intended to reduce unmet need for contraception in developing countries should be informed by clear understanding of the causes of this phenomenon to better reflect the population needs and to more effectively target planning and investments. To this end, this study will field an innovative instrument in Kenya and Bangladesh. The information to be collected will support a rigorous assessment of reasons for unmet need for family planning.

Method‐Specific Attributes that Influence Choice of Future Contraception Among Married Women in Nairobi's Informal Settlements

“…The rationale and protocol for this study have been published elsewhere (Machiyama et al. 2017), but in summary it seeks to advance knowledge of unmet need and unintended pregnancy, including contraceptive uptake and continuation. Causal factors hypothesized to influence these outcomes are measured at baseline and their relative power to explain subsequent reproductive and contraceptive behavior will be assessed by follow‐up surveys.…”

“…The study draws on baseline data collected in urban slums in Nairobi, Kenya as part of the multi-country prospective study, Improving Measurement of Unintended Pregnancy and Unmet Need for Family Planning, which was conducted in Nairobi, rural Kenya, and Bangladesh. The rationale and protocol for this study have been published elsewhere (Machiyama et al 2017), but in summary it seeks to advance knowledge of unmet need and unintended pregnancy, including contraceptive uptake and continuation. Causal factors hypothesized to influence these outcomes are measured at baseline and their relative power to explain subsequent reproductive and contraceptive behavior will be assessed by follow-up surveys.…”

How the Community Shapes Unmet Need for Modern Contraception: An Analysis of 44 Demographic and Health Surveys

“…Unmet need is commonly viewed as a function of both the fertility preferences of the woman and her access to contraception (Machiyama et al. ). Prevalence of unmet need varies widely, ranging from 5 percent in East Asia to 24 percent in West Africa, with much higher rates at the country and local levels (Alkema et al.…”

“…Unmet need for spacing occurs when a woman wants to increase the interval between births, while unmet need for limiting occurs when a woman wants to stop having children altogether. Unmet need is commonly viewed as a function of both the fertility preferences of the woman and her access to contraception (Machiyama et al 2017). Prevalence of unmet need varies widely, ranging from 5 percent in East Asia to 24 percent in West Africa, with much higher rates at the country and local levels (Alkema et al 2013;United Nations 2015).…”

Drivers of Unmet Need for Family Planning among Women of Advanced Reproductive Age in Urban Western Africa

“…This has made further investigation of the socio-demographic drivers of unmet need for family planning imperative in the regions. Several studies across developing countries have examined the determinants of unmet need for family planning [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. These studies observed varying prevalence of unmet need for family planning in different countries, identified key determinants of unmet need for family planning (such as women's education, decision-making autonomy, parity, access to mass media, partner desire for more children, spousal violence and place of residence), and also provided context relevant information for the development of appropriate interventions for reducing unmet need for family planning.…”