Percent of postpartum women with unmet need for contraception
The percent of women (ages 15 to 49) within the first year following the birth of their most recent child who desire to either stop or postpone childbearing who are at risk or have returned to fertility, but are not currently using a contraceptive method.
In its definition of unmet need, the Demographic Health Survey (DHS) includes women who are currently married who say they prefer not to have another child either within the next two years or ever again, as well as women who are pregnant or less than six months postpartum who did not intend to become pregnant at the time they conceived and were not using a contraceptive method. The definition excludes women who declare that they are infecund, have had a hysterectomy, or are in menopause (MEASURE DHS, 2007).
Based on the ACCESS-FP program’s reanalysis of the DHS data on family planning (FP) need among postpartum women undertaken in 17 countries, the recommendation is to calculate prospective unmet need, or fertility preferences looking forward, because it is most likely to correlate with the need for FP in the extended postpartum period. The reanalysis report states, “Since women’s return to fertility varies and it is difficult to predict that return, all women who are postpartum and not using a method could be considered to have an unmet need for FP” (Borda and Winfrey, 2010). The calculation is based on women who are currently pregnant or in the postpartum period without the resumption of menses, and have or will have an unmet need for FP in the first year following birth. Thus, the prospective definition of unmet need produces a two- to three-fold increase relative to the usual unmet need definition.
In response to the question, “Would you like your next child within the next two years or would you like no more children?”, this indicator is calculated as:
(Number of women who respond that they do not want a child within the next two years or do not want more children / Total number of women surveyed who are up to one year postpartum)
The actual calculation of unmet need is fairly complex, as depicted in the United Nations Population Division’s
2009 Metadata on Unmet Need and MEASURE DHS (2007).
Data from responses to the following survey questions used to calculate unmet need, disaggregated for women with an interval of one year or less since their most recent birth:
- Month and year of a woman’s most recent birth
- Desire for additional children and, if so, the desired length of birth interval
- Current contraceptive use status
- Current fecundity, pregnancy, and amenorrhea status for women not currently using a contraceptive method
- The planning status (with respect to number and/or timing) of the current/last pregnancy for women currently pregnant or amenorrheic
- Use (or not) of a contraceptive method at the time of the current/last pregnancy
Data can be further disaggregated by duration postpartum, breastfeeding status, age, parity, education, and type of contraceptive method used.
Population-based surveys, such as DHS and Reproductive Health Surveys
This indicator estimates women’s unmet need for postpartum FP and can be used to compare and track trends in demand for postpartum FP services. The indicator can also serve as a proxy for the level of women’s access to postpartum FP services. Studies have shown that over 90 percent of women during their first year postpartum want to space or limit their next pregnancy, yet about one fourth of birth intervals are less than 24 months (USAID/ ACCESS-FP/ Frontiers, 2008). FP use during the first year postpartum has the potential to significantly reduce the number of unplanned pregnancies and research has shown a large unmet need among women in the extended postpartum period. Meeting these needs could substantially increase contraceptive prevalence, reduce the percentage of birth intervals that are dangerously close, and reduce maternal and child mortality (Cleland et al., 2006).
Many postpartum women are not aware that they are at risk of pregnancy and they wait for menses to return before seeking FP. Additionally, health care workers may be uninformed about fertility return and the need for contraception during the extended postpartum period. The integration of postpartum FP training, counseling and provision of methods with MCH programs and services allows women to have multiple contacts with these services during the antenatal and the postpartum periods, which, in turn, have been shown to increase women’s use of FP methods by six months postpartum and decrease unmet need for FP (USAID/ACCESS/ Frontiers, 2008). The benefits associated with combining FP and MCH services are directly related to achieving Millennium Development Goals #4 reduce child mortality and #5 improve maternal health.
For a detailed discussion of issues associated with approaches to estimation of this indicator, see the Unmet need for family planning indictor in the Family Planning section of this database. Specific issues related to calculating this indicator for women during the postpartum include women having difficulty recalling the exact date or month of their most recent birth, when they returned to menses, began using a contraceptive method, or for women using the lactational amenorrhea method (LAM), the date when they no longer met the criteria for LAM and when they transitioned to another method.
commodity, safe motherhood (SM), access, family planning, policy, newborn (NB)
Cleland J, Bernstein S, Ezeh A, Faundes A, Glasier A, Innis J, 2006, Family Planning: the Unfinished Agenda, Geneva: WHO Sexual And Reproductive Health (3) Journal Paper. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(06)69480-4/fulltext
MEASURE DHS, 2007, New Estimates of Unmet Need and the Demand for Family Planning: DHS Comparative Reports No. 14, Calverton Md: Macro Int’l. http://www.measuredhs.com/pubs/pdf/CR14/CR14.pdf
Borda M and Winfrey W, 2010. Postpartum Fertility and Contraception: An Analysis of Findings from 17 Countries. USAID/ACCESS-FP. http://reprolineplus.org/system/files/resources/ppfp_17countryanalysis.pdf
United Nations Population Division/DESA: Fertility and Family Planning Section, World Contraceptive Use 2009: Unmet Need for Family Planning.
USAID/ ACCESS-FP/ Frontiers, 2008, Strengthening Postnatal Care Services Including Postpartum Family Planning in Kenya, New York: The Population Council. http://reprolineplus.org/system/files/resources/accessfp_kenyappfp.pdf