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Rothschild, Drake, and Brown Provide Commentary on Unmet Need Measurement

Posted: 2/22/2021 (CSDE Research)

In a recently published commentary for Studies in Family Planning, CSDE Trainee Claire Rothschild (Epidemiology, PhD), CSDE Regional Affiliate Win Brown (Bill & Melinda Gates Foundation), and CSDE Affiliate Alison Drake (Global Health) make the case for including observations from method discontinuation measures to update current approaches to measuring unmet need for contraception. While unmet need for contraception is commonly used to assess programmatic needs, it inadequately captures the complexity of fertility and contraceptive preferences, including women’s satisfaction with their contraceptive method. In their 2019 commentary, Sarah Rominski and Rob Stephenson propose reclassifying dissatisfied current users as having an unmet need for contraception. As revising the current definition based on their proposal would require significant investment to update survey and monitoring systems, understanding the potential impact on current estimates of unmet need is critical. The authors estimate the impact of this approach in a Kenyan cohort of modern contraceptive users. They find the prevalence of method dissatisfaction ranges from 6.6% (95% confidence interval [CI] 5.6–7.8%) to 18.9% (95% CI 17.1–20.9%); if applied nationally, this results in a large (approximately 25–70%) increase in Kenya’s current estimate of unmet need for any contraception. The findings suggest a large impact on unmet need estimates for equivalent populations. Overall, the authors advocate for better measurements of method satisfaction and acceptability, with metrics developed that are robust to socioeconomic gradients and validated in low‐ and middle‐income settings to ensure women’s contraceptive needs are captured equitably. To read the article, click here