Population Council Projects | Unintended Fertility

PROJECT
Unintended Fertility

Unintended fertility remains a major concern in developing countries. Most unintended births would be averted if couples who wish to avoid pregnancy but are not practicing contraception were to become effective contraceptive users. At least 120 million women in the developing world have an unmet need for contraception, that is, they want to postpone childbearing or limit the size of their families but are not using a method of family planning.

The Population Council has conducted research on unmet need for family planning and related issues for several decades. In recent years, the focus has shifted from documenting levels and trends in unmet need to exploring the causes. A multi-country project conducted in the late 1990s in Bangladesh, Egypt, Ghana, Pakistan, the Philippines, and Zambia demonstrated that multiple factors underlie unmet need. Women with an unmet need may not be fully committed to their childbearing preferences. They may fear actual or perceived detrimental side effects of contraception, have husbands who desire comparatively more children, and/or believe they are unlikely to conceive.

The conclusion from this research was that poor geographic access to services is by no means the only cause of unmet need, and that family planning programs must attempt to address other obstacles to use. Individuals must be educated about the advantages of smaller families and informed of the actual side effects of contraceptives.

Some have argued that as contraceptive prevalence increases, programs should devote more effort to retaining women who are contraceptive users and less effort to recruiting new users (women with unmet need), because women who discontinue use are the predominant source of unintended pregnancies.

Analysis of longitudinal data from Upper Egypt shows that this is not the case in this setting: The majority of unintended pregnancies are among women who have never used contraception or who discontinued use some time ago. Furthermore, evidence from Egypt and elsewhere shows that the reasons for not using contraception in the first place and for discontinuing use are largely the same. The study confirms that attacking the obstacles to contraceptive use—the causes of unmet need—must be a primary strategy for reducing the incidence of unintended pregnancies.

Pregnancies that are unwanted are sometimes deliberately aborted. Induced abortion is a difficult topic to investigate, but it is known to be common in many developing countries, even where it is illegal and against religious norms. Induced abortions also pose health risks when they are not carried out with appropriate medical expertise and technology. In many countries they are a dominant cause of maternal mortality.

The Population Council office in Pakistan conducted a pioneering national study of induced abortion. The project was multifaceted, including demographic estimation of the abortion rate (using methodology developed by the Alan Guttmacher Institute), semi-structured interviews that explore the decisionmaking that leads to induced abortion, and “exit interviews” at facilities where women go who have postabortion complications.

The study findings, released in October 2004, revealed that induced abortion is far more common, and more accepted, in Pakistan than was heretofore recognized, with roughly one out of seven pregnancies terminating in an induced abortion. The estimated abortion rate implies an average of one abortion per woman during her lifetime. Postabortion complications are common and present a significant public health challenge.

Location

Selected developing countries

Duration

1997–2005

Population Council researchers

John Bongaarts, Minhaj ul Haque, Zeba Sathar

Non-Council collaborators

John B. Casterline (Pennsylvania State University)

Fatma El-Zanaty, Laila El-Zeini (Cairo University)

Donors

The William and Flora Hewlett Foundation

The Andrew W. Mellon Foundation

The David and Lucile Packard Foundation

US Agency for International Development

Publications/Resources on this project