CLAIM: Zimbabwe has achieved a reduction in the unmet need for family planning from 14 per cent in 2020 to 10 percent in 2022 for all age groups.
SOURCE: Vice President Constantine Chiwenga as quoted in the Herald
VERDICT: True
The claim was made by Vice President and Health Minister Constantine Chiwenga, who was speaking at the international Inter-ministerial Conference on Population and Development, as quoted by the Herald in an article on 14 November 2022.
Understanding Unmet Need
Unmet need in terms of contraceptive access is defined by the World Health Organization as referring to those women who are fertile and sexually active but are not using any method of contraception, and report not wanting any more children or wanting to delay the next child.
The concept of unmet need points to the gap between women’s reproductive intentions and their contraceptive behaviour.
Women who are sexually active and would prefer to avoid becoming pregnant but nevertheless are not using any method of contraception are considered to have an unmet need for family planning.
In a paper by the Population Reference Bureau, the definition is that women with unmet need are broadly defined as those who want to postpone their next birth for two years or more, or not have any more children, but are not using any contraception.
For monitoring, unmet need is expressed as a percentage based on women who are married or in a consensual union.
Excluded from the numerator of the unmet need definition are pregnant and amenorrheic women who became pregnant unintentionally due to contraceptive method failure (these women are assumed to be in need of a better contraceptive method).
Also excluded from the unmet need definition are infecund women. Women are assumed to be infecund if: – They have been married for five or more years and – they have not had a birth in the past five years and – they are not currently pregnant and – they have not used contraception within the preceding five years (or, if the timing of the last contraceptive use is not known, or if they have never used any kind of contraceptive method) or – they self-report that they are infecund, menopausal or have had a hysterectomy, or (for women who are not pregnant or in post-partum amenorrhea) if the last menstrual period occurred more than six months prior to the survey.
Women who are married or in a consensual union are assumed to be sexually active. If unmarried women are to be included in the calculation of unmet need, it is necessary to determine the timing of the most recent sexual activity. Unmarried women are considered currently at risk for pregnancy (and thus potentially in the numerator) if they have had intercourse in the month prior to the survey interview.
In principle, this indicator may range from 0 (no unmet need) to 100 (no needs met). However, values approaching 100 per cent do not occur in the general population of women, since, at any one time, some women wish to become pregnant and others are not at risk of pregnancy.
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.
Why is this even important?
Studies have shown that reducing unmet need can improve maternal survival and health by reducing the number of unintended pregnancies, the number of induced abortions, and the proportion of births at high risk.
Family planning also offers additional health, social, and economic benefits: it can help reduce child and infant mortality, slow the spread of HIV (through correct and consistent condom use), promote gender equality, reduce poverty, and accelerate socioeconomic development.
Another outcome of high unmet need is unplanned pregnancies. In Zimbabwe, 31 percent of pregnancies among married women ages 15 to 24 are unplanned.
Unmet need is a valuable indicator for national family planning programmes because it shows how well they are achieving a key mission: meeting the population’s felt need for family planning.
Data on unmet need can also help family planning programmes target activities by identifying women who are at greatest risk of unintended pregnancy and more likely to adopt a method than other nonusers.
In addition, the concept of unmet need places women’s personal reproductive preferences, rather than numerical targets for fertility and population growth, at the centre of family planning services.
Levels of unmet need rise and fall in response to two factors: demand for family planning and contraceptive use. It is important to remember that low levels of unmet need may reflect the fact that women want large families—not that contraception is widely available or used.
Where are we coming from?
In 1994 contraceptive prevalence among currently married women was 48% and unmet need was 15%. By 2005-06 contraceptive prevalence had risen to 60%, while unmet need had fallen to 12%.
In contrast, among never-married sexually active women, contraceptive prevalence remained unchanged at about 50% but unmet need rose from 28% in 1994 to 33% in 2005-06.
Sexually active never-married women comprise only a small share of all women of reproductive age, but they have the highest level of unmet need of all groups.
The evidence
The claim by the VP is backed by the United Nations Population Fund’s 2021 Annual Report.
Unmet need for family planning among all married women is at 10%. This is, however, higher among adolescents at 12.6%.
The report states that despite improved uptake of long-acting reversible methods like implants, the method mix remains skewed towards short-acting methods like oral contraceptives and depot injections.
Uncertain funding situation for contraceptive commodities as a result of global funding cuts, remains another issue of concern.
Despite the country’s high modern contraceptive prevalence rate (65 percent), challenges in ensuring youth-friendly, voluntary, informed choice and access to a range of contraceptive methods for youth remain in the Zimbabwean health care system.
FP2030 is an organisation that focuses on a variety of issues in order to increase access to rights-based, voluntary family planning.
According to FP2030.org, the Ministry of Health’s target on improving access and uptake of voluntary contraceptive services among adolescents was to reduce their unmet need for modern methods of family planning from 12.6% to 8.4% by 2022, which has not been achieved.
Conclusion
The claim by VP Chiwenga that Zimbabwe’s unmet need for all age groups is down to 10% is true. Although it is still higher, at 12.6 for adolescents, it is 10% for all age groups.
