Meeting Reproductive Health Service Needs
Around the world, many sexually active young people who want to avoid pregnancy are not using modern contraceptive methods for various reasons, including a lack of access to services or disapproval by health providers. Evidence of this “unmet need” for family planning services is often indirect, particularly for unmarried adolescents, making it difficult to quantify.
In surveys of reproductive health attitudes and practice, those with an unmet need for family planning are women and men who say they want no more children or want to delay their next birth by more than two years, but are not practising contraception. Those who want no more children have an unmet need for limiting; those who want to delay their next birth have unmet need for spacing.(13)
A significant portion of unmet need is indicated by the high levels of abortion among young women, as reported in surveys and inferred from hospitalizations after unsafe abortions, as well as by estimates of out-of-wedlock pregnancies and young women’s reports to interviewers that their first or second births took place earlier than they desired.
Among young people, most of this unmet need is for spacing and prevention. In most societies, childbearing after marriage is expected and nearly universal, and most newly married young people want to begin childbearing soon after marriage.
Demographic and Health Surveys in 45 countries in the last five years indicate the proportion of young people using family planning and their levels of unmet need.(14) (See Figure 5.) Surveys in sub-Saharan Africa, Central Asia and Latin America often include all women 15-19 years of age. In other regions, nearly all countries have only conducted surveys of ever-married women. This makes the results not strictly comparable, but the overall finding of high levels of unmet need is clear.
In Latin America and the Caribbean an average of 35 per cent of sexually active teens over age 15 use family planning, in sub-Saharan Africa fewer than one fifth do so.(15) As expected, both demand for and use of spacing methods far exceed those for limiting births.
The proportion of total demand (i.e., unmet need plus use) being met varies significantly, ranging from 71 per cent in Central Asia to less than one third in sub-Saharan Africa, with other regions between 45 and 55 per cent.(16)
Data from 94 surveys in 69 countries over the past decade indicate that, on average, unmet spacing needs of young people are 2.3 times higher than those of the adult population as a whole. As overall unmet need declines, the gap is even greater. Young people’s needs are last to be addressed.
In sub-Saharan Africa, on average, 35.7 per cent of teenage women want to delay their next birth; in a few countries, more than half want to.(17) The regional average for meeting these spacing desires is only 30 per cent.
In North Africa, West Asia and Europe, roughly half of the demand for spacing and more than 55 per cent of all demand is being met.(18) In Central Asia more than two thirds of demand was satisfied, but one eighth of teens over 15 still express an unmet need to space their births. The few South and South-east Asian countries studied are meeting less than half of the total demand for family planning among teens but more than half of the spacing needs.
In Latin America and the Caribbean, the region with the highest demand for family planning—more than two thirds of older teens want to limit or space their fertility—unmet demand for spacing among 15-19 year olds exceeds 24 per cent. More than half of the total demand is satisfied, nearly 60 per cent excluding Haiti, the region’s least-developed country.
Regional and national differences in meeting demands for family planning reflect the differences in levels and kinds of demand, marital patterns, institutional capacity and political will to address the needs of the young.