Reasons for unmet need for family planning, with attention to the measurement of fertility preferences: protocol for a multi-site cohort study.
BACKGROUND
Unmet need for family planning points to the gap between women's reproductive desire to avoid pregnancy and contraceptive behaviour. An estimated 222 million women in low- and middle-income countries have unmet need for modern contraception. Despite its prevalence, there has been little rigorous research during the past fifteen years on reasons for this widespread failure to implement childbearing desires in contraceptive practice. There is demographic survey data on women's self-reported reasons for non-use, but these data provide limited insight on the full set of possible obstacles to use, and one may doubt the meaningfulness of explanations provided by non-users alone. To rectify this evidence gap, this study will gather extensive information on women's perceptions of contraception (generic and method-specific) and their past contraceptive experience, and it will allow for more complexity in fertility preferences than is standard in demographic surveys.


METHODS
A multi-site cohort study will be conducted in urban Kenya, rural Kenya, and rural Bangladesh. In each setting trained fieldworkers will recruit and interview 2600 women, with participants re-interviewed at 12 and 18 months. Data will be collected using a questionnaire whose development was informed by a review of existing literature and instruments from past studies in both developed and developing countries. Dozens of experts in the field were consulted as the instrument was developed. The questionnaire has three main components: a sub-set of Demographic and Health Survey items measuring socio-demographic characteristics, reproductive history, and sexual activity; additional questions on prospective and retrospective fertility preferences designed to capture ambivalence and uncertainty; and two large blocks of items on (i) generic concerns about contraception and (ii) method-specific attributes. The method-specific items encompass eight modern and traditional methods.


CONCLUSIONS
Policy and programmes intended to reduce unmet need for contraception in developing countries should be informed by clear understanding of the causes of this phenomenon to better reflect the population needs and to more effectively target planning and investments. To this end, this study will field an innovative instrument in Kenya and Bangladesh. The information to be collected will support a rigorous assessment of reasons for unmet need for family planning.
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Kazuyo.Machiyama@lshtm.ac.uk.
Kazuyo
http://orcid.org/0000-0003-4369-3954
K
Machiyama
Institute for Population Research, Ohio State University, Columbus, USA.
John B
JB
Casterline
African Population and Health Research Center, Nairobi, Kenya.
Joyce N
JN
Mumah
icddr,b, Dhaka, Bangladesh.
Fauzia Akhter
FA
Huda
Population Council, Nairobi, Kenya.
Francis
F
Obare
Population Council, Nairobi, Kenya.
George
G
Odwe
African Population and Health Research Center, Nairobi, Kenya.
Caroline W
CW
Kabiru
icddr,b, Dhaka, Bangladesh.
Sharifa
S
Yeasmin
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
John
J
Cleland
D000293:Adolescent; D000328:Adult; D001459:Bangladesh; D003268:Contraception Behavior / Q000208:ethnology / Q000639:trends*; D005191:Family Characteristics; D005193:Family Planning Services / Q000639:trends*; D005260:Female; D005298:Fertility; D006801:Humans; D007630:Kenya; D020380:Needs Assessment; D011157:Population Dynamics; D011247:Pregnancy; D011446:Prospective Studies; D012189:Retrospective Studies; D055815:Young Adult
Bangladesh; Family planning; Fertility; Fertility preferences; Kenya; Measurement; Study protocol; Unmet need for family planning