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June 2001, Vol. 7, No. 2Unmet Need Focus-group discussions and in-depth interviews have revealed many reasons why some women who do not want to become pregnant nevertheless do not use contraception, a situation known as unmet need for family planning. Some women with unmet need fear side effects from contraceptives, for example, and others have limited access to family planning methods. Few researchers, however, have investigated quantitatively which factors present the biggest barriers to women’s achieving their fertility goals. Data on the strength of various obstacles would prove valuable for program managers designing policies and interventions to help women overcome these hurdles. With this aim in mind, Population Council researchers John B. Casterline, Zeba A. Sathar, and Minhaj ul Haque investigated the effects of six major obstacles to contraceptive use in Punjab, Pakistan. Unmet need in Pakistan The researchers developed a survey that explored many facets of each of these six factors. For instance, to determine the strength of a woman’s motivation to avoid pregnancy, the researchers inquired about whether she wanted to have more children; the number of her concerns about having another child; whether she would be distressed if she became pregnant in the near future; and her perception of her husband’s desire for another child. They administered the survey to 1,310 currently married women aged 20–44 years and 554 of their husbands in urban and rural Punjab. The analysis of reasons for unmet need was restricted to 579 married women who wanted to avoid pregnancy but were not using a contraceptive method at the time of the interview. The investigators treated the six obstacles as separable and competing reasons for nonuse, but acknowledge that doing so simplifies the true situation. “We feel the cost of this simplification is more than offset by our gaining the ability to offer a quantitative assessment of the relative strength of each obstacle,” says Sathar. In the statistical analysis, the researchers examined each of the six obstacles in relation to the women’s intention to use contraception in the future. “Stated intention to use contraception is a pretty good predictor of actual future use,” explains Casterline. The statistical modeling revealed that the key obstacles to contraceptive use in Punjab are the perceived social and cultural unacceptability of contraception and wives’ perceptions that their husbands are opposed to family planning. These two barriers are essentially equal in strength. About two-thirds as strong is lack of contraceptive knowledge. “Accessibility of contraceptives is not sufficient in itself. There are many other barriers to family planning practice,” explains Casterline. In the past, some researchers have downplayed the barrier posed by wives’ perceptions that their husbands are opposed to family planning. This analysis, however, showed these perceptions to be high hurdles. But are wives making accurate assumptions about their husbands’ views? The researchers examined survey responses from husbands and found a considerable discrepancy between wives’ perceptions and the responses provided by their husbands. For example, “among couples in which the wives felt that their husbands did not approve of contraception, 61 percent of the husbands indicated that they did approve of it,” says ul Haque. The investigators emphasize that the findings are specific to Punjab in the late 1990s, and might differ in other provinces or at other times. Recommendations Source | |||||||||||||||||||||||||||||||||||||||||||||||
