Introduction

The question “Why some women, who want to control their fertility, are not using contraception in spite of their real intention?” is the core stone of the present article. Unmet need is a concept which points to a gap between women's reproductive intentions and contraceptive
behaviour (1).

The unmet need group includes all fecund women who are married or living in union and thus presumed to be sexually active, who are not using any method of contraception and who either do not want to have any more children or want to post-pone their next birth for at least two more years. The unmet need group also includes all pregnant married women whose pregnancies are unwanted or mistimed and who became pregnant because they were not using contraception. Similarly, women who have recently given birth but are not at risk of becoming pregnant because they were amenorrheic postpartum are considered to have an unmet need if their pregnancies were unintended (2). Family planning is one of the fundamental pillars of safe motherhood and a reproductive right. More than 100 million women in less developed countries or about 17% of all married women would prefer to avoid a pregnancy but are not using any form of family planning (3). More than one-fourth of the births world-wide are
unplanned (4).

Keeping all these aspects in view, the present study was undertaken, so as to find the extent of unmet need, and to identify factors influencing the unmet need.

Material and Methods

This cross sectional study was undertaken in the immunization clinic, run by the Department Of Community Medicine, Government Medical College, Patiala among the mothers of reproductive age group who were attending the immunisation clinic with their children for vaccination. The study continued for about ten months in the year 2005 .On an average 30-40 new cases attend the immunisation clinic every day. Every tenth woman attending the immunization clinic was included for the study purposes and in all 1000 married women of reproductive age group were interviewed to screen out the unmet need group using standard formulation of unmet need for family planning (2). A detailed, precoded, pre-tested, structured, closed questionnaire was used to collect the data after informed consent was obtained. By interviewing the women of the unmet need group; information was collected about different demographic factors. Data analysis was done using Epi Info.

Results

Figure 1

Table1.Background characteristics of the study population (n=1000)

Maximum number of women (>50%) were in the age group 21-30 years, which is the most active period and most important for child bearing. Most (48.4%) women were of parity 2. More than 50% (53.1%) were literates < matric followed by graduates and above (26.3%) and minimum were the illiterates (9.9%).

No. of women who fulfilled the criteria of standard formulation of unmet need were 160, which revealed that 16% of women of reproductive age had unmet need.

Figure 2

Table 2. Proportion of respondents with unmet need stratified by biosocial characteristics

The overall unmet need was low (10.18% in under 20 yrs age group) at the beginning of reproductive age, but it increased and reached a peak in late twenties (26-30 yrs) (21.15%) and then declined. Maximum unmet need was after the birth of one (19.93%) child. Unmet need was highest for illiterate women (23.26%) and it decreased to 16.76% in case of
literates

Discussion

16% of women of reproductive age had unmet need. International institute for population sciences reported that unmet need for family planning was 13% in Punjab (5). Similar results were observed by National Family Health Survey (NFHS) 1998, where 16% of currently married women in India were having an unmet need for family planning (6). Also, results were comparable with findings of Robey et al where he stated that unmet need effect on an average 20% or more of reproductive age in developing world(7).

The overall unmet need was low (10.18% in < 20 yrs age gp) at the beginning of reproductive age, but it increased and reached a peak in late twenties (21.15%) and then declined. The above results were found to be statistically highly significant (P value<0.001). This shows that unmet need is higher in more fertile age group; therefore family planning programme should address women with unmet need, focusing this age group so as to increase contraceptive use and decrease unmet need.

Harbison S also observed that compared with women aged
40-49 years, women in the youngest age group (15-29 years) were most likely to fall into the unmet need category(8). Similar trend was observed by Ram et al in a study done in Calcutta, where unmet need was low at the beginning, then similarly increased and reached a peak in late twenties and then declined (9).Devi et al also observed that unmet need was higher in younger women in a study done in U.P(10).

Maximum unmet need was after the birth of one child (19.93%) and decreased with each additional child. This shows women became more interested in controlling fertility after the birth of first child. However the above results were not found to be significant (p>0.05).Results were similar to study done in Vietnam in 1997, where unmet need was highest (34%) after the birth of first child (11).

Unmet need varies inversely with the education of women. This may be because educated women are better informed about various methods, availability and have greater access to family planning. Klijzing observed the similar results, where the less educated respondents were having the highest level of unmet need(12). Khokhar also observed similar results in a study done in Delhi (13).

Unmet need was higher (29.27%) where husbands were illiterate as compared to the literate ones. The above results were found to be statistically significant (p Value <0.001) .Similar results were observed in a study done by Thiagarjana and Adhikari in U.P. where the education level of husband positively affected contraceptive use (14).

Unmet need was more (18.49%) for females belonging to joint family than the nuclear family (13.30%). Similar results were observed by Devi et al in a study done in UP where unmet need was higher in joint families (10). This may be because nuclear families lack relatives in the home to help with child care and they tend to have more privacy in discussing about using family planning.

Unmet need was more in rural area (19.02%) than the urban area (13.04%). This could be because women in rural area have limited availability, accessibility and acceptability to contraceptives Similar results were observed by Thiagarjana and Adhikari in a study done in UP where unmet need was found to be more in rural women than urban women(14). Devi et al, Barkat-e-khuda et al, Harel K also observed that the extent of unmet need was found to be higher in rural than urban area (10, 15, 16).

Conclusion

Unmet need is higher in more fertile age group, therefore family planning programme should address women with unmet need focusing this age group so as to increase contraceptive use and decrease unmet need. Strategies have to be devised to reach the large segment of the rural community with family planning information and services, Women’s education exert a powerful influence on unmet need. Improving women’s access to education and encouraging continuous and constant exposure would significantly increase use of family planning and reduce unmet need. Also, family planning programmes should target illiterate women in order to inform them about birth control measures.

Acknowledgement

We give an especially high acknowledgment to all staff of immunisation clinic where this study was carried out for their valuable assistance.

Correspondence to

Dr Bhupinder Kaur Anand
E-mail: siffatmarwaha@yahoo.co.in.
Phone: 09612257583