Measuring Unmet Need: Wives, Husbands or Couples?

Context: The definition of unmet need has changed over time, and estimates of unmet need can be calculated using wives', husbands'and couples' reports. All of these estimates may have implications for program planning. Methods: Data from recent Demographic and Health Surveys (DHS) in Bangladesh, the Dominican Republic and Zambia are used to examine a new definition of unmet need - one that considers only responses regarding prospective fertility desires and intentions to use contraceptives. Unmet need is determined for wives, for husbands and for couples. A minimum estimate of unmet need for couples is produced when both partners have unmet need; a maximum occurs if either spouse having unmet need defines couple unmet need. Results: Differences between spouses in contraceptive and fertility intentions are substantial in all three countries. There is greater dissimilarity between husbands and wives regarding intention to practice contraception than there is regarding childbearing intentions. In Zambia, 55% of wives who were not practicing contraception report intending to use contraceptives within 12 months, compared with 36% of comparable husbands. In Bangladesh, the corresponding figures are 46% for wives and 42% for husbands; in the Dominican Republic, the proportions are 49% and 41%, respectively. When unmet need calculated using wives'reports is compared with results using the minimum estimate, couples' unmet need is overestimated by 106% in Bangladesh, by 96% in the Dominican Republic and by 246% in Zambia. On the other hand, estimates based on wives' reports were closer to the maximum estimate for couples. Conclusions: Unmet need calculated for married women differs considerably from unmet need calculated for husbands and couples. Large discrepancies in these measures maybe an indicator of spousal disagreement or lack of communication about reproductive goals or contraceptive use - issues that programs will have to address if they seek to raise contraceptive prevalence rates.