Women still unable to control their fertility: issue of unmet need.

Women have an unmet need for family planning if they express a desire to space or limit births but are not relying on any form of contraception, be it modern or traditional. Taking control of one's own sexual and reproductive health, including one's fertility, is a right guaranteed in many international treaties and agreements including the ICPD Programme of Action (POA).

"All countries should, over the next several years, assess the extent of national unmet need for quality family planning services and its integration in the reproductive health context, paying particular attention to the most vulnerable and underserved groups in the population" (ICPD POA 7.16). The ICPD + 5 review went further to state: "Where there is a gap between contraceptive use and the proportion of individuals expressing a desire to space or limit their families, countries should attempt to close this gap by at least 50% by 2005" (Para 58 ICPD+5).

The eight-country NGO study coordinated by ARROW on Monitoring ICPD Ten Years On reported that measurement of contraceptive prevalence rates and unmet need assessments continue to focus only on married couples, excluding groups like young and unmarried people. Over the last decade, although contraceptive prevalence rose in all the countries, the unmet need for contraception continues to stay high (see table). The current unmet need percentages vary from a high 33% in Cambodia and Pakistan to 19% in the Philippines and a low 9% in Indonesia. The problem of unmet need may lead to unplanned pregnancies, abortions and unwanted children. Women, especially the poor and marginalised who often lack access to healthcare services, often opt for unsafe abortions.

Multiple factors underlie the high levels of unmet need for contraception. In Pakistan, surveys revealed that the gap between desire and behaviour, was largely due to lack of accessibility to health services, fear of side effects, poor understanding of women's sexual rights and the requirement for spousal consent to practice contraception. Two critical barriers identified in the South Asian and Cambodian country NGO monitoring reports, were inadequate access to effective reproductive health services and the lack of appropriate contraceptive choices. The National Family Planning Programme in India provides only five contraceptive methods: male and female sterilisation, intrauterine devices, oral pills and condoms with an aggressive push by the government for female sterilisation. Providers do not offer complete information about the variety of methods available so men and women do not have the opportunity to exercise their right to contraceptive choice. Research findings from the ARROW study also point to persistently low use of modern methods of contraception in the Philippines, Pakistan and Malaysia. Only 28% and 30% of women in the Philippines and Malaysia respectively use modern methods. Women-controlled methods like the female condom, diaphragm/cervical cap and foam/ jelly are the least available and used modern methods in all the eight countries.

Governments urgently need to evaluate family planning services more closely to identify the above barriers and take the necessary steps to improve the availability and quality of health services.

* By Sai Jyothi Racherla, Independent Researcher. Email: [e-mail]

Unmet Need for Contraception (Asia-Pacific)

Countries        Post-ICPD Year 2000 %                 Before ICPD%
(except China)

Cambodia         33                                    NA
India            16                                    20 (1992)
Indonesia        9                                     14 (1991)
Malaysia         30 (Malay) 15 (Chinese) 31 (Indian)   NA
Pakistan         33                                    32 (1990-91)
Philippines      19                                    26(1993)
Nepal            28                                    28 (1991)

Source: ARROW ARROW. 2004. Monitoring ICPD Ten Years On. Kuala Lumpur:
ARROW. [Unpublished] Website: www.arrow.org.my