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A new, health-based concept of unmet need for contraception identifies women for whom pregnancy would raise the mortality risk for themselves, their expected child or their previous child because of maternal age, short birth interval or high birth order. When applied to Demographic and Health Survey data for Sri Lanka, the method classifies 4-23% of currently married women as being in need of contraception, depending on whether women who are pregnant, abstaining or using traditional methods are considered as potentially in need. The usual concept of unmet need, based on women's stated fertility preferences, classifies 6-31% as in need. The preference-based approach identifies 50-90% of the women with health-based unmet need, performing better when women using traditional methods and those abstaining from sex are included as potentially in need and when pregnant women are not. The health-based approach identifies 43-65% of those with preference-based unmet need, performing better when pregnant women are included and women using traditional methods are not.
(International Family Planning Perspectives, 22:140-147, 1996)
Deborah S. DeGraff is assistant professor of economics at Bowdoin College, Brunswick, Maine, USA. Victor de Silva is evaluation and research consultant for, and former director of, the Family Planning Association of Sri Lanka, Colombo.