Unmet Need, Intention to Use Contraceptives and Unwanted Pregnancy in Rural Bangladesh

CONTEXT: Unmet need for contraception has become a central concept in the family planning field and one of the most important indicators for program planning and evaluation. The measure has faced criticism however for not taking into account women’s stated intention to use contraceptives. METHODS: Using longitudinal data on more than 2500 rural Bangladeshi women in 128 villages this study links women’s contraceptive adoption and experience of unwanted pregnancy between 2006 and 2009 to their unmet need status and their stated intention to use contraceptives in 2006. RESULTS: Intention to use a method was predictive of subsequent use for both women with and without an unmet need. Three-quarters of the unintended pregnancies reported between 2006 and 2009 occurred among women without an unmet need in 2006. In addition nearly half of women without an unmet need who were pregnant or postpartum in 2006 had experienced an unwanted pregnancy compared with 30% of all women classified as having an unmet need. CONCLUSION: To adequately meet population family planning needs programs must look beyond unmet need and focus on the total demand for acceptable and effective methods.