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Indian Journal of Community Medicine

Study of Unmet Need for Family Planning Among Married Women of Reproductive Age Attending Immunization Clinic in a Medical College of Calcutta

Author(s): Mrs. Rama Ram, M.N. Ghosh, Salil Bhattacharya, Anima Haldar, Chitra Chatterjee, Narendranath Naskar

Vol. 25, No. 1 (2000-01 - 2000-03)

Deptt. of Community Medicine, Calcutta National Medical College, Calcutta.


Research question: What is the extent and reasons of unmet need for family planning among urban mothers of reproductive age attending immunisation clinic of a Medical College Hospital and its association with some demographic and social factors?

Objectives: 1. To find out the extent of unmet need among mothers of reproductive age. 2. To identify the demographic and social factors influencing unmet need. 3. To find out the possible reasons of unmet need.

Setting: Immunisation clinic of Calcutta National Medical College (Department of Community Medicine)

Study design: Cross-sectional study.

Sample size: 20% sample of all mothers attending the immunisation clinic for a period of 6 months by systematic random sampling method.

Study variables: Age, parity, literacy, lack of information, unsatisfactory service etc.

Results: The extent of unmet need among married women of reproductive age was 23.1%. Majority of the mothers belonged to the age group 21-30 years (53.5%), had 2 or more children (92%) and were illiterate (49.5%). The main reasons for unmet need were lack of information (26%), health concerns and side effects (25.25%), inconvenient and unsatisfactory service (27.50%) and opposition from husband etc. (12%).

Conclusion: Improving the quality of service and access to convenient methods, improving communication and focussing on men as well as women will reduce unmet need.

Keywords: Unmet need, Family planning, Cross-sectional survey


Millions of women who are sexually active would prefer to avoid becoming pregnant either right way or otherwise, but they are not using any methods of contraception. These women are considered to have an "unmet need" for family planning. The concept of unmet need points to the gap between some women reproductive intentions and contraceptive behaviour of women1. In doing so, it poses a challenge to family planning programme of reaching and serving millions of women whose reproductive attitudes resemble those of contraceptive users but who, for some reason or combination of reasons, are not using contraception2.

Among the common reasons for unmet need are inconvenient or unsatisfactory services, lack of information, fears about contraceptive side effects and opposition from husbands, relatives or others. By responding to the concerns of women with unmet need, programmes can serve more people and in a better way.

In view of the above, the present study was carried out.

Material and Methods:

The study was undertaken in the Immunisation Clinic run by the department of Community Medicine of Calcutta National Medical College, Calcutta, among the mothers of reproductive age who were attending the clinic with their children for vaccination. The total period of study was about 6 months or 144 working days, as the clinic runs for 6 days in a week. As the daily attendance in the clinic is about 60, so the total number of mothers came to be about 8640 and out of this 20% sample was chosen using systematic sampling method. As a result, the total number of married women of reproductive age group eligible for study was about 1728, who were interviewed to screen out the unmet need group using the standard formulation which included all fecund women who were married and presumed to be sexually active, who were not using any method of contraception and who either did not want to have any more children or wanted to postpone their next birth for at least two more years. The unmet need group also included all those pregnant and lactating mothers whose current or previous pregnancies were unintended or mistimed.

By interviewing the women of the "unmet need group" information was collected about different demographic and socio-economic factors and also about the main reasons of not using contraception on predesigned and pretested proforma.

Results and Discussion:

Table I: Age-wise distribution of mothers

Age Number Percentage
<15 1 0.25
15-20 83 20.75
21-25 86 21.50
26.30 128 32.00
31-35 80 20.00
36-40 15 3.75
40+ 7 1.75
Total 400 100

The number of mothers who fulfilled the criteria of standard formulation was 400, which revealed that about 23.1% of married women of reproductive age had unmet need.

More than 50% of the mothers belonged to the age group 21-30, which is the most active period and most important for child bearing. Few mothers were there at the extremes of ages.

The overall unmet need was low at the beginning of reproductive age, but it increased and reached a peak in late twenties and then declined.

Table II: Distribution of mothers according to number of children

No. of children No. of mothers Percentage
1 32 8.00
2 92 23.00
3 98 24.5
4 113 28.25
5 65 16.25
Total 400 100

92% of the mothers had 2 or more children. This shows that women become more interested in controlling fertility after the birth of the first child and this increased with each additional child. There is no apparent relationship between number of children and overall level of unmet need4.

Table III: Literacy-wise distribution of mothers in relation to reasons of unmet need

Reasons of unmet need Literacy status
Illiterate Just literate Primary Middle & High Graduate Total
Inconvenient 15 (7.6) 3 (7.5) 22 (30.5) 9 (10.7) -   49 (12.25)
Unsatisfactory service 21 (10.6) 5 (12.5) 12 (16.7) 21 (25) 2 (33.3) 61 (15.25)
Lack of information 69 (34.8) 15 (37.5) 13 (18.1) 7 (8.3) -   104 (26)
Health concerns and side effects 39 (19.7) 8 (20) 17 (23.6) 33 (39.3) 4 (66.7) 101 (25.25)
Opposition from husbands, families and communities 30 (15.2) 2 (5) 6 (8.3) 10 (11.9) -   48 (12)
Uncertainty about child bearing 24 (12.1) 7 (17.5) 2 (2.8) 4 (4.8) -   37 (9.25)
Total 198 (49.5) 40 (10) 72 (18) 84 (18) 6 (1.5) 400 (100)

About 50% of the women were illiterate and only 1.5% had higher education which shows that majority of the educated women were already using contraception. Westoff and Bankole3 have shown that in countries outside Africa, although many women at all educational levels want to avoid pregnancy, less educated women face more obstacles in using contraception than more educated women.

Table III also shows the distribution of various reasons of unmet need and their association with literacy. 12.25% of the mothers found the methods available to be inconvenient and 15.25% complained of poor quality of service and unmet need was also high among illiterate and little educated mothers. In most countries, unmet need has been found to be the greatest among mothers with little education who have the least access to family planning programme5.

In Uttar Pradesh, a study found that little interest in contraception was being met because the family welfare programme gave little attention to temporary methods such as oral contraceptives6.

In a peri urban community of Tamil Nadu, unmet need often resulted from the lack of contraceptive choices, sterilisation being the only method available7.

In case of 26% of the mothers, the reason of unmet need was lack of information. Women who are not aware of contraceptive methods or do not know from where these can be obtained, who neither understand their side effects nor know how to use them are more likely to have unmet need.

In case of 25.25% of mothers, concerns about health and contraceptive side effects were responsible for the unmet need. It was also the major reason even in educated mothers. These fears originate from lack of proper information and also from rumors in the communities.

In 12% of mothers, the reason for unmet need was opposition from husband, families and communities. Nag8 noted that a women may have unmet need for family planning because of high social cost of challenging the opposition from her spouse or anyone else in her social influence group.

9.25% of the mothers thought that they were uncertain about child bearing and so were unlikely to be interested in contraception9. They told that they rarely had sexual relations or were too old to conceive. This reason is also predominant among the illiterate mothers.

In view of the above findings, the following recommendations are suggested:

1. As majority of women lack information about contraceptive methods (26%) and also have concerns about health and side effects based on incorrect information (25.25%) and mistakenly believe that they cannot become pregnant (9.25%), so family planning programme should emphasise communication and good counselling to the women, explaining all sorts of information about the availability, sources, side effects etc. about the new contraceptives.

2. As opposition from husband is an important cause of unmet need (12%), so focussing on men as well as women is crucial to meet unmet need as husband often influences his wife's reproductive attitudes and determines whether she is to use contraceptives or not.

3. Good quality services and access to convenient methods are important to meet unmet need.


  1. Conception M.B.; Family formation and contraception in selected developing countries: Policy implications of WFS findings. World fertility survey conference, London, Jul 7-11, 1980, Plenary session No. 3 Voorlurg, Netherlands, International Statistical Institute, 1980, 62.
  2. Sinding SW, Ross JA, Rosenfield AG: Seeking common ground: Unmet need and demographic goals. International Family Planning Perspectives, 1994, Vol. 20, No.1, 23-32.
  3. Westoff CF, Bankole A: Unmet need, 1990-1994. Calverton, Maryland, Macro International, Jun 1995, 55.
  4. Westoff CF, Ochoa LH: Unmet need and the demand for family planning. Columbia, Maryland, Institute for Resource Development, Macro International; 1991, No. 5.
  5. Bulatao RA, Levin A, Bos ER, Green C: Effective family planning programmes. Washington DC, World Bank, 1993, 110.
  6. Devi DR, Rastogi SR, Retherford RD: Unmet need for family planning in Uttar Pradesh; 1996, 46 (unpublished).
  7. Rabindran TKS: Users perspective on fertility regulation methods. Economic and Political weekly, November 1993, 2508-2512.
  8. Nag M: Some cultural factors affecting cost of fertility, regulation. Population bulletin of the United Nation: 1984, 17-38.
  9. Jaccard J, Helbig DW, Wan CK, Gutman MA, Kritz-Silver Stain DC: The prediction of accurate contraceptive use from attitudes and knowledge. Health Education quarterly, 1996, Vol 23, No. 1, 17-33.
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