Unmet need for contraception: issues and challenges.

Unmet need for contraception has been a central indicator for monitoring the progress of family planning programs for 25 years. The purpose of this article is to provide a broad context for the more focused contributions that follow in this special issue. The validity and measurement of the concept of unmet need are discussed. We then present regional trends among married women since 1970. Major reductions in unmet need have been achieved, with the clear exception of sub-Saharan Africa. Less success can be claimed in addressing the needs of sexually active unmarried women, who contribute nearly 20 percent to overall unmet need in developing countries. Prominent reasons for unmet need in settings where contraceptive uptake is low include social resistance and insufficient information concerning methods. As contraceptive use increases, the importance of these reasons wanes, but concerns regarding side effects and health impact remain a barrier, and discontinued users now constitute a large proportion of those with unmet need. Drawing on these reasons, we outline measures to further reduce unmet need.

Policy implications of the next world demographic transition.

Although the world demographic transition from high to low fertility appears to be nearing its completion, observed in perspective, this is the latest in a series of such transitions stretching back into prehistory. A stable new equilibrium is far from inevitable; indeed, it is unlikely. Many countries are experiencing below-replacement-level fertility, and this trend is spreading. Couples are now able to choose their family size, free of the traditional pressures to bear children that was characteristic of most traditional societies. In fact, most societal pressures for the last generation have been distinctly antinatalist, in response to the enormous attention paid by the media to the "population bomb" agenda. This antinatalist attitude is changing, however, and what seems more likely than either a stationary or declining world population is a new growth cycle reflecting a resurgence of fertility as a response to growing material affluence and potential technological mastery of environmental challenges. Societal pressures and policies will play a role in this transition as they did in earlier ones.