Determinants of unmet needs for family planning

Despite the importance of reproductive and sexual health care services, few women who are of reproductive age have access to them (1). According to SDG 3.7, access to family planning, education, and sexual and reproductive health services is a universal right for everyone.

The capacity of individuals and couples to predict and have the number of children they desire while arranging for the spacing and timing of their births is known as family planning. It is accomplished by using contraceptive methods and by treating unintentional infertility (2). These methods lower maternal mortality by reducing unwanted pregnancies and unsafe abortions

Even with improved accessibility and effectiveness of various family planning techniques, a significant number of unintended pregnancies continue to occur in our communities and remain a significant public health concern. Every year, 74 million women worldwide who reside in low- and middle-income nations become pregnant unintentionally (3). As a result, there are 25 million unsafe abortions performed each year and 47 000 maternal fatalities (4). According to the Guttmatcher Institute, Sub-Saharan Africa is the most afflicted region, with 91 unwanted pregnancies per 1,000 women(5) and this more recurrent amongst women aged 18 – 24 years (6) . Women who don’t utilize any form of contraception are more likely to experience these unexpected pregnancies. One of the prominent causes of unwanted pregnancies is an unmet demand for family planning.

Unmet need for family planning is the percentage of women who are fecund and sexually active and do not want to get pregnant but do not use any contraceptive method (7).  It offers a gauge of women’s capacity to have the number of children and spacing between them that they wish. It is an indicator that was created to measure the percentage of women who do not have access to family planning. It also shows how effectively reproductive health programs have been able to meet the demand for services. By highlighting the additional level of need to postpone or reduce births, unmet need serves as a complement to the prevalence rate of contraception. Unmet need is a rights-based metric that indicates how well a nation’s social and health systems support women’s ability to adhere to their declared decision to postpone or limit births(7).

In sub-Saharan Africa the prevalence of unmet need for contraception is 26.90% (8), translating the persistently high rate of undesired pregnancy, clandestine abortion and non-use of contraception.

This article thus has as objective to present some determinants of this high prevalence of unmet need in sub-Saharan Africa and to suggest some propositions in order to reduce these unmet needs.

Possible reasons for a high unmet need for family planning

  • Fear of side effects and health risksof contraceptives

There are many side effects associated with the use of modern contraceptive methods some of which can induce women to discontinue use (9). Side effects however are not the norm and most users will be free of side effects. Counselling women on contraception enrolment to understand the acceptable risks and empowering them to recognize side effects in order to seek medical attention when required is usually absent. In addition, women suffering from certain diseases such as heart disease and others with allergic conditions may not be eligible for certain forms of contraceptive methods (10).

  • Disapproval of partner

One of the most reported reason for unmet need is the refusal of partner (9) or husbands who fears infidelity(11). Most of the communication done regarding family planning is directed towards women and men are most often left out of the discussion which will later on lead to refusal to use due to lack of awareness on contraception or confidence in the woman.

  • Perceived low risk of getting pregnant

It is not taken enough into consideration, but there are so many women who feel like they are not prone to become pregnant. Many think that they cannot get pregnant at first sex, or if they had sex standing up or infrequently (12). This situation may arise due to the fact that, these women lack enough information on sexuality which will later lead to non-usage of contraceptive measures.

  • Inconsistency with culture

In certain cultures, for fear of reprisals, young (especially the girl) receive a very rigid education, where the matters related to men and sexuality are taboo subjects (13). Certain religious denominations are against the use of modern contraceptive methods (14) and in certain contexts in the African culture, it is thought that having many children is a sign of man power and authority. Having many children is perceived as an asset as it is particularly important in farm work and also for being seen as an influential person in some rural communities.

  • Difficulty to use contraceptives

Some contraceptives are not user-friendly in their usage. Complicated insertion, application or utilization techniques cause women and their partners to shy away. The female condom, the contraceptive ring and the contraceptive sponge are examples that present with usage difficulties (15).

  • Knowledge and Access

Despite significant efforts made in providing information and access to contraceptive methods, inequities and inequalities remain regarding access to information. Most rural communities are unreached when it comes to reproductive health education and information on contraceptive methods in particular (15).

Recommendations

Family planning aims to make contraceptive options available to all people worldwide, regardless of location. Our recommendations for improving the family planning system are as follows:

  • Introduce Comprehensive Sexuality Education (CSE) among adolescents in both learning institutions and hospitals.
  • Include partners in family planning talks and interventions.
  • Take into consideration the cultural aspect of communities when carrying out family planning related interventions.
  • Enhance the qualities of the contraceptive technologies that are currently accessible; this strategy is predicated on the idea that women will stick with their current technique or elect to go back to it if it is more convenient, well-tolerated, and inexpensive.
  • Organize campaigns to improve rural residents’ access to and knowledge of contraception options.
  • Communicate with the public to increase understanding of family planning, especially among partners (men and women) between the ages of 15 and 24year old as unintended pregnancy is more frequent in this population.
Evrard Kepgang
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Kepgang Evrard is a young research and humanitarian passionate. He holds a master’s degree in Public health and epidemiology at the University of Dschang.

Dr Valery Ngo
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Dr. Ngo Valery Ngo is a Medical Doctor and a Senior Health Researcher at Nkafu Policy Institute, a think tank at the Denis & Lenora Foretia Foundation in Yaoundé, Cameroon. Before his appointment, he was a volunteer research assistant under Professor Bright Nwaru at the Krefting Research Centre in Gothenburg, Sweden, during which he conducted various researches in global health and contributed to various systematic reviews to synthesize existing evidence on major global health issues.

Dr. Bruna Djeunang Dongho
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Ghyslaine Bruna Djeunang Dongho, Ph. D., is the Senior Researcher in Global Health and Public Health at the Nkafu Policy Institute.

Regina Sinsai
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Regina Sinsai holds a Bachelor of Arts Degree in Psychology from the United States International University – Africa, in Nairobi and an HND in General Nursing from the Humanity Health Professional Training Center (HHPTC) in Yaoundé.

Solange Dabou
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Solange DABOU holds a Master of science in Clinical Biochemistry from the University of Dschang and have followed a distance learning training in epidemiology and health statistics from Aix Marseille University.

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Dr Ronald Gobina is a Nephrologist, working with the Regional Hospital in Buea. He is a Health Fellow and the Director of the COVID-19 taskforce for the DLF foundation. He is member of the International Society of Nephrology (ISN) and the Initiative to Strengthen Health Research Capacity in Africa (ISHReCA).

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