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      Unwanted Family Planning: Prevalence Estimates for 56 Countries

      1 , 2
      Studies in Family Planning
      Wiley

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          Abstract

          While there is a large literature on the prevalence of unmet need for family planning, there is no matching quantitative evidence on the prevalence of unwanted family planning; all contraceptive use is assumed to represent a “met need.” This lack of evidence raises concerns that some observed contraceptive use may be undesired and coercive. We provide estimates of unwanted family planning using Demographic and Health Survey data collected from 1,546,987 women in 56 low‐ and middle‐income countries between 2011 and 2019. We estimate the prevalence of unwanted family planning, defined as the proportion of women who report wanting a child in the next nine months but who are using contraception. We find that 12.2 percent of women have an unmet need for family planning, while 2.1 percent have unwanted family planning, with estimated prevalence rates ranging from 0.4 percent in Gambia to 7.1 percent in Jordan. About half of unwanted family planning use can be attributed to condoms, withdrawal, and abstinence. Estimating the prevalence of unwanted family planning is difficult given current data collection efforts, which are not designed for this purpose. We recommend that future surveys probe the reasons for the use of family planning.

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          Most cited references38

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          Accelerate progress—sexual and reproductive health and rights for all: report of the Guttmacher– Lancet Commission

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            Unmet need for contraception: issues and challenges.

            Unmet need for contraception has been a central indicator for monitoring the progress of family planning programs for 25 years. The purpose of this article is to provide a broad context for the more focused contributions that follow in this special issue. The validity and measurement of the concept of unmet need are discussed. We then present regional trends among married women since 1970. Major reductions in unmet need have been achieved, with the clear exception of sub-Saharan Africa. Less success can be claimed in addressing the needs of sexually active unmarried women, who contribute nearly 20 percent to overall unmet need in developing countries. Prominent reasons for unmet need in settings where contraceptive uptake is low include social resistance and insufficient information concerning methods. As contraceptive use increases, the importance of these reasons wanes, but concerns regarding side effects and health impact remain a barrier, and discontinued users now constitute a large proportion of those with unmet need. Drawing on these reasons, we outline measures to further reduce unmet need.
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              Contraceptive Autonomy: Conceptions and Measurement of a Novel Family Planning Indicator.

              Since the 1994 International Conference on Population and Development, there has been increased attention to high-quality and rights-based family planning, but these concepts have been difficult to measure. Perhaps due to an intellectual history intertwined with population control, contemporary family planning programs and researchers often use (modern) method use as a primary marker of success, with indicators focusing narrowly on contraceptive use and fertility. This results in a fundamental misalignment between existing metrics and the stated family planning goals of promoting reproductive health and rights. This report describes the rationale for a novel family planning indicator called "contraceptive autonomy" and proposes a methodology for measuring this concept at the population level. Defining contraceptive autonomy as the factors necessary for a person to decide for themself what they want in relation to contraception and then to realize that decision, this indicator divides the contraceptive autonomy construct into subdomains of informed choice, full choice, and free choice. By acknowledging that autonomous nonuse is a positive outcome,aiming to maximize contraceptive autonomy rather than use could help shift incentives for family planning programs and reduce some common forms of contraceptive coercion, as our measurement approach is realigned with our focus on high-quality rights-based care.
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                Author and article information

                Contributors
                Journal
                Studies in Family Planning
                Studies in Family Planning
                Wiley
                0039-3665
                1728-4465
                March 2023
                January 27 2023
                March 2023
                : 54
                : 1
                : 75-93
                Affiliations
                [1 ] Department of Global Health and Population Harvard T.H. Chan School of Public Health Boston MA 02115 USA
                [2 ] Frederick S. Pardee School of Global Studies Boston University Boston MA 02215 USA
                Article
                10.1111/sifp.12230
                c4a5add1-38cd-4356-8d17-2849b13bb4a9
                © 2023

                http://creativecommons.org/licenses/by-nc-nd/4.0/

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