Background: The concept of unmet need for family planning defines the gap between women's reproductive intentions and their contraceptive behavior. Many women, both married and unmarried, do not use any contraceptive method although they want to avoid pregnancy. Studies have shown that reducing levels of unmet need can reduce maternal morbidity and mortality by reducing the number of unintended pregnancies, the number of abortions, and the proportion of births at high risk. In 2006 unmet need for family planning was added to the fifth Millennium Development Goal (MDG) as an indicator for tracking progress on improving maternal health.
Objective: This report examines the levels and trends in unmet need and demand for family planning and factors associated with unmet need in Zimbabwe for the period 1994 to 2006.
Study design and methods: The study uses data from three consecutive Zimbabwe Demographic and Health Surveys (ZDHS) conducted in 1994, 1999, and 2005-06. These surveys collected data from nationally representative samples of women of reproductive age (15-49). The analysis estimated unmet need and its components for all women age 15-49, as well as for women in various categories: never-married, currently married, formerly married (widowed, divorced, or separated), all sexually active women, and never-married sexually active women. The analysis consisted of both descriptive and multivariate logistic regression methods. In the surveys, certain provinces and certain categories of respondents were over sampled. In all our analysis, appropriate weights are used to restore the representativeness of the sample.
Results: The groups of women with the highest prevalence of unmet need include never-married sexually active women, adolescents, uneducated women, poor women, nulliparous women, and women in the two Matebeleland regions. The level of unmet need has decreased over time among all groups except the never-married sexually active women, where it has been increasing. The study results show that higher levels of education, higher household wealth quintile, and work outside home are associated with higher levels of contraceptive use and lower levels of unmet need. After controlling for respondent characteristics, the results show that women with unmet need for spacing births are younger, have fewer children, are less educated and less likely to be working, and live in lower wealth quintile households. Women with unmet need for limiting births are older, more educated, live in higher wealth quintile households, and are less likely to have exposure to family planning messages in the mass media. Total unmet need (spacing plus limiting) is significantly associated with age, educational attainment, work status, wealth status, and the number of living children.
Conclusions: Despite high contraceptive prevalence in Zimbabwe, subgroups of women with unmet need remain, particularly among marginalized women who may face barriers to family planning information and services. There is a need for national contraceptive programs to focus more on satisfying the unmet need for family planning and on reducing unintended fertility. Administrators of health and family planning programs can use this information and analysis based on the ZDHS to help devise strategies that address unmet need for family planning and increase coverage to specific groups with the highest levels of unmet need.