"When you least expect, this happens, it's already growing": Problematizing the definition of unmet need for family planning.

Abstract

Background: Unmet need is an important indicator to understand baselines and set goals for family planning interventions. Women may not fall neatly in categories of met or unmet need for family planning as defined by the demographic and health surveys (DHS). We explore women's experiences of unmet need for family planning and provide empirical examples of how the static, binary DHS definitions of met and unmet need for family planning may be problematic. Methods: Based on Social Cognitive Theory, we conducted elicitation interviews with 16 married young women between the ages of 20 and 24 in Chimaltenango, Guatemala to explore barriers to accessing and using family planning. Half the participants (n=8) were using a modern method of family planning and half (n=8) were not. The current analysis focuses on data that was coded as ambiguous or unclear for unmet need status. Results: We identified framings of ambiguity from the women's narratives that are silenced by the dominant binary of met and unmet need. We show inconsistencies between women's lived experiences of unmet need and how their experiences would likely be represented in DHS questionnaires: 1) successful use of natural methods; 2) the complexity of "wantedness"; 3) conceptualizing met or unmet need as a trajectory; and 4) laughter obscuring clear response. Conclusion: Family planning status is a complex trajectory that the DHS may not accurately capture. As a way to reflect the diversity of women's family planning experiences, we suggest modifying the DHS classifications to incorporate latent met and unmet need as sub-classifications.