Assessing the Suitability of Unmet Need as a Proxy for Access to Contraception and Desire to Use It

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Citation

Senderowicz, Leigh; Bullington, Brooke W.; Sawadogo, Nathalie; Tumlinson, Katherine; Langer, Ana; Soura, Abdramane; Zabré, Pascal; & Sié, Ali (2023). Assessing the Suitability of Unmet Need as a Proxy for Access to Contraception and Desire to Use It. Studies in Family Planning, 54(1), 231-250. PMCID: PMC10257191

Abstract

Unmet need for contraception is a widely used but frequently misunderstood indicator. Although calculated from measures of pregnancy intention and current contraceptive use, unmet need is commonly used as a proxy measure for (1) lack of access to contraception and (2) desire to use it. Using data from a survey in Burkina Faso, we examine the extent to which unmet need corresponds with and diverges from these two concepts, calculating sensitivity, specificity, and positive/negative predictive values. Among women assigned conventional unmet need, 67 percent report no desire to use contraception and 61 percent report access to a broad range of affordable contraceptives. Results show unmet need has low sensitivity and specificity in differentiating those who lack access and/or who desire to use a method from those who do not. These findings suggest that unmet need is of limited utility to inform family planning programs and may be leading stakeholders to overestimate the proportion of women in need of expanded family planning services. We conclude that more direct measures are feasible at the population level, rendering the proxy measure of unmet need unnecessary. Where access to and/or desire for contraception are the true outcomes of interest, more direct measures should be used.

URL

http://dx.doi.org/10.1111/sifp.12233

Reference Type

Journal Article

Year Published

2023

Journal Title

Studies in Family Planning

Author(s)

Senderowicz, Leigh
Bullington, Brooke W.
Sawadogo, Nathalie
Tumlinson, Katherine
Langer, Ana
Soura, Abdramane
Zabré, Pascal
Sié, Ali

Article Type

Regular

PMCID

PMC10257191

Data Set/Study

Contraceptive Autonomy Study

Continent/Country

Burkina Faso

Sex/Gender

Women

ORCiD

Tumlinson - 0000-0001-8314-8219
Bullington - 0000-0002-3341-087X