Unmet need and unintended fertility: Longitudinal evidence from upper Egypt

Context: Although unmet need for family planning is a standard measure for evaluating programs\u27 effectiveness in meeting the reproductive needs of individuals, its validity and accuracy in identifying women most at risk of unintended pregnancy have been questioned. Methods: Women who participated in the 1995 Egypt Demographic and Health Survey in two governorates in Upper Egypt (Assuit and Souhag) were followed for two years (N=2,444); in-depth data on their fertility preferences, contraceptive use and births were gathered in 1996 and 1997. Transitions among contraceptive need categories from 1995 to 1997 are examined, and rates of unintended (mistimed and unwanted) births are calculated according to contraceptive need status at baseline. Results: In the aggregate, unmet need increased by six percentage points, from 28% to 34%. This change was the net outcome of 14% moving out of unmet need and 20% moving into unmet need (i.e., substantial satisfaction of unmet need was offset by increased demand for contraception). The rate of unintended fertility was far higher among women with unmet need at baseline than among contraceptive users in 1995. Women with unmet need made up about one-quarter of the baseline sample, but they contributed almost one-half of mistimed and unwanted births during the two years. The majority of unintended births were to women who had never practiced contraception, whereas fewer than one-fifth were to women with recent contraceptive experience (including contraceptive failure). Conclusions: Unmet need for family planning remains a useful tool for identifying and targeting women at high risk of unintended pregnancy