Family Planning as a dimension of poverty

Family planning means that people are able to voluntarily choose the number of children they have, and the spacing of pregnancies, through reliable methods of birth control. It includes access to information, contraception and services to ensure people – particularly women – are able to make informed choices freely.

While family planning has benefits across the population, it is of critical importance to women. The inability to freely choose the number and spacing of children is critically linked to poverty and undermines gender equality and women’s empowerment (UNFPA, 2020:1). This is reflected in the SDGs. SDG 3 – ‘ensure healthy lives and promote well-being for all at all ages’ – sets the target of ‘universal access to sexual and reproductive health-care services, including for family planning’ by 2030 (SDG Target 3.7), while SDG 5 – ‘achieve gender equality and empower all women and girls’ – recognises that women must be able to freely make informed decisions about sexual relations, contraceptive use and reproductive health care if the overall goal of achieving gender equality and empowering all women is to be achieved. The right to choose the number and spacing of children and to information is enshrined in Article 16 of the Convention on the Elimination of All Forms of Discrimination Against Women.

What the research reveals about family planning

The economic and social benefits of family planning and access to contraception are well documented. Evidence of the positive impacts of family planning for women’s health has been developed through decades of research (see Maine, 1981). Access to voluntary family planning and contraception improves women’s participation in education and the labour force (Starbird et al., 2016). Finlay and Lee (2018) have identified a causal link between improvements in reproductive health, including access to family planning, and women’s economic empowerment. Quality family planning services benefit ‘maternal and infant survival, nutrition, educational attainment, the status of girls and women at home and in society, human immunodeficiency virus (HIV) prevention, and environmental conservation efforts’ (Allen, 2007: 1). According to the United Nations Population Fund (UNFPA, 2020: 1) ‘achieving universal access to quality sexual and reproductive health services is estimated to yield returns of $120 for every dollar invested’. Starbird et al. (2016: 1) argue that ‘investing in family planning is a good decision at every level’, and describe it as a development ‘best buy’.

While family planning has been demonstrated to benefit both individuals and societies, UNFPA estimates that access to these services remains inadequate. Globally, an estimated 232 million women who want to avoid pregnancy are not using family planning methods. Darroch et al. (2011) found that one in four sexually active women who want to avoid pregnancy have an unmet need for modern contraception, which accounted for 82 percent of unintended pregnancies in low-income countries. A lack of knowledge about contraception, social opposition to contraception and health concerns over the side effects of using contraception are all factors in understanding the drivers of unmet need (Casterline and Sinding, 2000: 3).

Deprivation in family planning is most commonly measured through ‘unmet need’, which refers to the proportion of women who want to prevent or delay childbearing but are not using any method of contraception (UNDESA, 2019). A more specific measure is the non-use of contraception among women stating a desire to avoid pregnancy (Cleland et al., 2014). The two concepts are intrinsically linked but differentiated by the specificity of inclusions and exclusions. Where family planning includes a broad range of features such as the procurement of contraceptives, education and family planning counselling, the unmet need for contraception looks solely at the methods used or not used to avoid or delay pregnancy. Unmet need for contraception is often utilised to ascertain more detail about the type, frequency and accessibility of contraceptive materials and their use or non-use.

In assessing unmet need, it is important to avoid assumptions about where need is, particularly assumptions arising from social, cultural or religious attitudes that may not reflect practice. Early research that utilised the World Fertility Surveys interviewed only married women of reproductive age on their fertility preferences and their met or unmet need (Westoff, 1978). While marriage as a criterion for inclusion continues in some quarters, clearly this excludes important groups of women with unmet need and creates vulnerability. Studies indicate that women categorised as having low-susceptibility status can account for 10–25 percent of unmet need for family planning (Pritchett, 1994; Westoff and Bankole, 1995).

What the IMMP reveals about family planning

During the participatory research that underpins the IDM, several difficulties associated with reproductive health were raised by female participants, including menstruation, access to and affordability of family planning and pre-natal services, and concerns about the quality and side effects of contraception. These issues underpin the questions in the survey covering past and current pregnancy, contraception use and menstruation. The family planning dimension measures unmet need for contraception.

The IMMP individual survey makes a distinction between modern and traditional forms of contraception. Only modern forms of contraception are considered to meet the need to prevent pregnancy. A modern method of contraception is defined as having ‘a sound basis in reproductive biology, a precise protocol for correct use and existing data showing the method has been tested in an appropriately designed study to assess efficacy under various conditions. (Festin et al, 2018: 4). Methods such as sterilisation, IUDs, injectables (depo-provera), implants, condoms, birth control pill, diaphragm and vaginal ring are considered modern forms of contraception in the IMMP survey.

What the IMMP Family Planning dimension measures

The family planning dimension of the IMMP has one theme: unmet need for contraception.

Theme 1: Unmet need for contraception

The unmet need for contraception theme is made up of a single indicator of the same title and five variables. The variables ascertain whether women and men who are sexually active and want to delay or avoid having children are using any modern or traditional (less effective) methods of contraception, and if they are not using contraception, why not. These variables ask the respondent if: they personally used contraception; their partner used contraception; they used a modern method; they used a traditional method; they did not use contraception, their reasons for not using it.