Population Research and Policy Review 18: 579–605, 1999.
© 1999 Kluwer Academic Publishers. Printed in the Netherlands.
Unmet need for couples:
An analytical framework and evaluation with DHS data
& ALEX CHIKA EZEH
The Alan Guttmacher Institute, New York, USA;
African Population and Health Research
Center, The Population Council, Nairobi, Kenya
Abstract. While estimates of unmet need continue to be an important measure of the extent
of demand for contraception and family planning programs success in developing countries,
there are various reservations about the validity of these estimates. For instance, the traditional
formulation of the measurement has relied solely on information from women while inferences
from the ﬁndings are often drawn for couples. As more survey data have become available
for both men and women in a number of countries, there is increasing evidence suggesting
that husbands’ preferences are indeed important determinants of the reproductive behavior of
couples. This paper develops an analytical framework for measuring unmet need for couples.
The approach: (1) takes a fresh look at the classiﬁcation of pregnant and amenorrheic women,
and (2) incorporates the contraceptive use and fertility preferences of husband and wife in
estimating the level of unmet need in six sub-Saharan African countries. Our ﬁndings shows
that taking these factors into account results in a 50 to 66 percent reduction in the level of
unmet need in these countries. The importance of husbands’ variables in determining the level
of unmet need is clearly evident when examined among fecund couples in which the wife
is neither pregnant nor amenorrheic. The implications of these ﬁndings for family planning
programs and research are discussed.
Keywords: Couple, Unmet need, Contraception, Fertility, Preferences
Unmet need for contraception for birth control purposes has become an im-
portant concept in the demographic literature. Since the emergence of its ﬁrst
formulation termed the ‘KAP-gap’, the concept has been a signiﬁcant force in
inﬂuencing the development of family planning programs (Bongaarts 1991;
Robey et al. 1996; Westoff 1988a). While the basic idea of unmet need has
remained largely stable over the years, its measurement has witnessed a series
of modiﬁcations aimed at obtaining more objective and realistic estimates.
The most widely known and utilized measure derives from the formulation
developed primarily by Charles Westoff. It deﬁnes unmet need as including
(1) all fecund (not pregnant nor amenorrheic) women who are currently in
union, who are not using contraception and who either want to postpone their