The Totally Phony Notion of “Unmet Need” for Contraception
As the UN puts polishing touches on their ambitious global plan to curb poverty, attention shifts from the political to the technical: how to measure progress and ensure targets are clearly defined?
The new Sustainable Development Goals (SDGs) provide an opportunity to reassess the “indicators” or benchmarks for reaching the expiring Millennium Development Goals (MDGs) and make changes where appropriate. One outgoing indicator—“unmet need” for family planning—was controversial when it was first adopted and has gotten even more controversial in the hands of activists.
The concept of “unmet need” emerged in the wake of horrific population control programs that forcibly sterilized and aborted the children of poor women. “Unmet need” was an attempt to find common ground between women’s rights advocates and population control groups. As defined in the MDGs, “unmet need” described women who were married, presumably fertile, expressed a preference not to have a child in the next two years, and who were not currently using modern contraception.
Critics pointed out that such a definition was inadequate since it excluded women who had health, religious or other objections to using contraception. Others complained that the definition of modern methods excluded natural fertility-awareness-based methods despite their high level of accuracy and user satisfaction.
A closer look at the method used to measure “unmet need” is quite revealing.
While women’s attitudes toward childbearing and contraceptive use may be related, they are by no means equivalent. Before 2003, surveyed women expressing a desire to space births were asked a follow-up question about how strongly they wanted to avoid becoming pregnant.
Many of them said it would be a small problem or no problem at all if they found out they were pregnant in the next few weeks. That survey question is no longer asked, reducing a complex matter to a simple yes or no.
When women classified as having “unmet need” were asked why they did not use contraceptives, many were concerned about side effects, opposed using them for religious or other reasons, or cited breastfeeding or infrequent sex as the reason. In fact, only 4-8% of married women with “unmet need” in developing countries said they could not access modern contraceptives.
It is widely reported that 225 million women globally have an “unmet need” for family planning. A recent report from the pro-abortion Guttmacher Institute and the United Nations Population Fund calls for $9.4 billion dollars annually to meet that “need.” This request is based on the assumption that “all women with unmet need would use modern contraceptives”—despite strong evidence that many of these women have no intention of doing so.
“Unmet need” does not measure women’s access to or desire for contraceptives. But most of the top organizations promoting family planning use “unmet need” synonymously with “lack of access” to contraception.
Planned Parenthood even ran a billboard in New York’s busy Times Square claiming, “Over 200 million women want access to contraception but can’t get it.”
Despite this dubious history, a proposed indicator to measure the success of the UN’s new goals is “met demand” for family planning. This perpetuates the same underlying problem as “unmet need”: it presumes that delaying childbearing is equivalent to wanting contraception.
And it will channel billions of dollars toward family planning advocates and providers to reach an elusive goal – that every targeted women, whether she wants to or not – use contraception.
