“Supply‐Side Versus Demand‐Side Unmet Need: Implications for Family Planning Programs”: A Comment

Abstract

I review a study by Senderowicz and Maloney (2022), which proposes an approach to classifying women's reasons for not using contraception as either being driven by supply‐side factors or by a lack of demand. Using Demographic and Health Survey (DHS) data from seven countries, the authors conclude that most unmet need can be attributed to demand‐side reasons for non‐use. I replicate the analysis and find errors in the authors’ calculations. When corrected, the relative differences between demand‐side and supply‐side reasons are smaller, and the proportion of women reporting supply‐side reasons is larger than demand‐side reasons in two countries. In addition, the approach does not account for endogeneity between supply and demand, which cannot be disentangled using cross‐sectional data like the DHS. Using longitudinal data, I find that more than four out of five women with “demand‐side unmet need” use contraception after receiving an intervention that reduced supply‐side barriers. I discuss the extent of inference gained by these indicators for informing programs, noting that women's true reasons for non‐use may be poorly proxied with cross‐sectional data, and prioritizing resources based on these reasons would fail to reach a nontrivial proportion of non‐users who would have preferred to contracept if access were improved.