DHS ANALYTICAL 

STUDIES 50

Contraception Needed to 

Avoid High-Fertility-Risk Births, 

and Maternal and Child 

Deaths that Would Be Averted

September 2015

This publication was produced for review by the United States Agency for International Development. It was prepared by 

Shea Rutstein and Rebecca Winter of ICF International.

DHS Analytical Studies No. 50 

Contraception Needed to Avoid High-Fertility-Risk Births, 

and Maternal and Child Deaths That Would Be Averted

Shea Rutstein 

Rebecca Winter 

ICF International 

Rockville, Maryland, USA 

September 2015 

Corresponding author: Shea Rutstein, International Health and Development, ICF International, 530 

Gaither Road, Suite 500, Rockville, Maryland, USA; phone: 240-350-3680; fax: 301-407-6501; 

email: Shea.Rutstein@icfi.com 
Acknowledgments: The authors would like to thank Stan Becker and Tom Pullum for careful review and 

expert advice for this report. 

Editor: Diane Stoy

Document Production: Natalie La Roche 

This study was carried out with support provided by the United States Agency for International 

Development (USAID) through The DHS Program (#AID-OAA-C-13-00095). The views expressed are 

those of the authors and do not necessarily reflect the views of USAID or the United States Government. 

The DHS Program assists countries worldwide in the collection and use of data to monitor and evaluate 

population, health, and nutrition programs. For additional information about The DHS Program contact: 

DHS Program, ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA. Phone: +1 

301-407-6500; fax: +1 301-407-6501; email: reports@dhsprogram.com; Internet: www.dhsprogram.com. 

Recommended citation: 

Rutstein, Shea, and Rebecca Winter. 2015. Contraception Needed to Avoid High-Fertility-Risk Births, and 

Maternal and Child Deaths That Would Be Averted. DHS Analytical Studies No. 50. Rockville, Maryland, 

USA: ICF International. 
iii 

Contents 

Tables ......................................................................................................................................................... v

Figures ........................................................................................................................................................ vi

Preface ....................................................................................................................................................... vii

Abstract ........................................................................................................................................................ ix

Executive Summary ..................................................................................................................................... xi

1. Introduction and Rationale ............................................................................................................... 1

1.1. Literature Review ............................................................................................................... 1

2. Methodology and Data ..................................................................................................................... 7

2.1. Data Sources ....................................................................................................................... 7

2.2. Methods .............................................................................................................................. 7

3. Results ............................................................................................................................................ 13

3.1. Percentage of Women Pregnant ........................................................................................ 13

3.2. Fertility-related Risks of Non-pregnant Women .............................................................. 14

3.3. Marital Status of Non-pregnant Women ........................................................................... 31

3.4. Unmet Need for Contraception Based on Fertility Desires by Need for 

Contraception Based on Fertility Risk .............................................................................. 32

3.5. Background Characteristics of Women with a Need for Focused Family Planning 

Efforts ............................................................................................................................... 37

3.6. Family Planning Characteristics for Women with a Need for Focused Family 

Planning Efforts ................................................................................................................ 46

3.7. Child Deaths Averted ........................................................................................................ 55

3.8. Maternal Deaths Averted .................................................................................................. 58

4. Discussion ...................................................................................................................................... 61

5. Conclusions and Policy Implications ............................................................................................. 65

References ................................................................................................................................................... 67

Appendix A ................................................................................................................................................. 69

Appendix B: Country Summaries: Reduced Child and Maternal Mortality through Reduced 

Fertility Risk and Eliminating Unmet Need for Contraception ............................................ 71
iii 
v 

Tables 

Table 1. Distribution of women by pregnancy status at time of survey, 45 DHS country 

surveys 2006-2012 ............................................................................................................ 13 

Table 2. Percent distribution of non-pregnant women by birth interval from last birth to next 

pregnancy, by birth order of next birth, and by age at next birth if became pregnant 

right away, 45 DHS country surveys 2006-2012 .............................................................. 15 

Table 3. Distribution of non-pregnant women by multiple fertility risk categories, 45 DHS 

country surveys 2006-2012 ............................................................................................... 17 

Table 4. Percent distribution of non-pregnant women by need for contraception based on 

fertility risk, 45 DHS country surveys 2006-2012 ............................................................ 19 

Table 5. Percent distribution of all1 non-pregnant women by desires for more children, 

45 DHS country surveys 2006-2012 ................................................................................. 21 

Table 6. Percent distribution of all1 non-pregnant women by desires for more children 

according to risk-based need for contraception, 45 DHS country surveys 2006-2012 ..... 23 

Table 7. Percent distribution of all non-pregnant women by whether using a LAPM 

contraceptive method, 45 DHS country surveys 2006-2012 ............................................ 25 

Table 8. Percent distribution of non-pregnant women by current use of the lactational 

amenorrhea method (LAM), 45 DHS country surveys 2006-2012 ................................... 27 

Table 9. Distribution of non-pregnant women by type of current contraceptive method, 

45 DHS country surveys 2006-2012 ................................................................................. 29 

Table 10. Distribution of non-pregnant women by marital status, 45 DHS country surveys 

2006-2012 ......................................................................................................................... 31 

Table 11. Among non-pregnant married and in-union women, unmet need for contraception 

based on fertility desires by need for contraception based on fertility risk, 45 DHS 

country surveys 2006-2012 ............................................................................................... 33 

Table 12. Percent distribution of non-pregnant married and in-union women by unmet 

combined need for contraception due to either desires or fertility risk and need for 

focused family planning efforts, 45 DHS country surveys 2006-2012 ............................. 36 

Table 13a. Distribution of non-pregnant married and in-union women in need of focused family 

planning efforts by area of residence, 45 DHS country surveys 2006-2012 .................... 38 

Table 13b. Percent distribution of non-pregnant married and in-union women in need of focused 

family planning efforts by level of education, 45 DHS country surveys 2006-2012 ....... 41 

Table 13c. Percent distribution of non-pregnant married and in-union women in need of focused 

family planning efforts by wealth quintile, 45 DHS country surveys 2006-2012 ............ 44 

Table 14. Pattern of use of contraception among married and in-union women with a need for 

focused family planning efforts, 41 DHS country surveys 2006-2012 ............................. 47 

Table 15. Among married and in-union women with a need for focused family planning 

efforts and who visited a health facility in the preceding 12 months, the percent 

who were told of family planning by type of unmet need for contraception, 45 DHS 

country surveys 2006-2012 ............................................................................................... 49 

Table 16. Intentions to use contraception in the future among non-pregnant married and in-union 

women with a combined unmet need for contraception, 45 DHS country surveys 

2006-2012 ......................................................................................................................... 51 

 
vi 

Table 17. Among non-pregnant married women with a combined unmet need for either a 

spacing or a limiting method of contraception but who do not intend to use in the 

future, distribution by summary of reasons for not intending to use, 40 DHS country 

surveys 2006-2012 ............................................................................................................ 54 

Table 18. Infant and under-five child deaths averted due to satisfying risk-based unmet need 

for contraception, 45 DHS country surveys 2006-2012 ................................................... 56 

Table 19. Maternal pregnancy-related deaths averted due to satisfying risk-based unmet needs 

for contraception, 28 DHS country surveys 2006-2012 ................................................... 59 

Table A.1. Among non-pregnant married and in-union women with a combined unmet need for 

either a spacing or a limiting method of contraception but who do not intend to use 

in the future, distribution by reasons for not intending to use, 40 DHS country surveys 

2006-2012 ......................................................................................................................... 70 

Figures 

Figure 1. Combined need for contraception indicator ........................................................................ 9

Figure 2. Percent distribution of non-pregnant married and in-union women in need of focused 

family planning efforts by area of residence within region, 45 DHS country surveys 

2006-2012 ......................................................................................................................... 40 

Figure 3. Percent distribution of non-pregnant married and in-union women in need of focused 

family planning efforts by level of education within region, 45 DHS country surveys 

2006-2012 ......................................................................................................................... 43 

Figure 4. Percent distribution of non-pregnant married and in-union women in need of focused 

family planning efforts by wealth quintile within region, 45 DHS country surveys 

2006-2012 ......................................................................................................................... 46 

Figure 5. Distribution of married and in-union women with an unmet need for contraception 

by intention to use in the future, according to region, 45 DHS country surveys 

2006-2012 ......................................................................................................................... 53 
vii 

Preface 

The Demographic and Health Surveys (DHS) Program is one of the principal sources of international data 

on fertility, family planning, maternal and child health, nutrition, mortality, environmental health, 

HIV/AIDS, malaria, and provision of health services. 

One of the objectives of The DHS Program is to analyze DHS data and provide findings that will be useful 

to policymakers and program managers in low- and middle-income countries. DHS Analytical Studies serve 

this objective by providing in-depth research on a wide range of topics, typically including several countries 

and applying multivariate statistical tools and models. These reports are also intended to illustrate research 

methods and applications of DHS data that may build the capacity of other researchers. 

The topics in the DHS Analytical Studies series are selected by The DHS Program in consultation with the 

U.S. Agency for International Development. 

It is hoped that the DHS Analytical Studies will be useful to researchers, policymakers, and survey 

specialists, particularly those engaged in work in low- and middle-income countries. 

Sunita Kishor 

Director, The DHS Program 

ix 

Abstract 

This report estimates the number of maternal and child deaths that could be averted by satisfying the unmet 

need for contraception based on four high-risk fertility behavior categories, i.e., having a birth at too young 

an age, too old an age, with inadequate spacing, and at high parity. The data come from 45 Demographic 

and Health Surveys conducted between 2006 and 2012 with 691,362 non-pregnant women. Twenty-one 

percent of non-pregnant women have an unmet need for contraception due to their desires or their fertility 

risk, 5 percent for an unmet spacing method, and 16 percent for a limiting method. Another 20 percent are 

using a spacing method but have a need for a long-acting, permanent method of family planning. In total, 

41 percent of women have a need for focused efforts by family planning programs. By satisfying the riskbased unmet need for contraception, over half of infant and under-five deaths could be averted, with 3.2 

million deaths averted out of the 5.6 million deaths projected for 2015. Even more spectacular is the number 

of maternal deaths that could be averted, i.e., 109,000 out of the 155,000 projected, for a reduction of 70 

percent. Only two of five women who need focused efforts and who visited a health facility in the preceding 

year were informed about family planning. It is thus incumbent upon national and private health programs 

and donors to serve the women with unmet needs, to cost-effectively avert maternal and child deaths, and 

to reach the Sustainable Development Targets 3.1 and 3.2. 

xi 

Executive Summary 

Millennium Development Goal (MDG) 4 calls for a reduction in child mortality and MDG 5 for an 

improvement in maternal health to reduce the maternal mortality ratio (MMRatio). Sustainable 

Development Goal (SDG) targets call for reducing neonatal mortality to 12 or fewer deaths per 1,000 live 

births, the under-five mortality to 25 or fewer deaths per 1,000 live births, and the global maternal mortality 

to less than 70 deaths per 100,000 live births. It has been generally accepted that fertility behavior affects 

both the mother’s and the child’s health and survival. Three characteristics and five risks have been 

identified: age of the mother at the birth of her child (too young or too old), parity at birth (too many), and 

the interval between pregnancies and birth (too short or sometimes, too long). 

The conventional measure of unmet need relies on women’s stated preference to space and/or limit births. 

This report calculates an alternate measure of unmet need that considers a woman who falls in a high-risk 

fertility behavior category to be in need of family planning. The report estimates the number of maternal 

and child deaths that could be averted if this alternative risk-based unmet need were satisfied. 

Data and Methods 

This study defines high-risk fertility behaviors as giving birth at less than 18 years of age and at 40 or more 

years of age as the age risk, becoming pregnant again at less than 27 months after a preceding birth as the 

pregnancy spacing risk, and having 4 or more births as the parity risk. 

The data come from 45 Demographic and Health Surveys (DHS) conducted between 2006 and 2012 with 

691,362 non-pregnant women. Data from the United Nations World Population Prospects were also used. 

The number of child deaths that could be averted by satisfying unmet risk-based need and need for a longacting and permanent method of family planning (LAPM) is calculated using both the reduction in the 

number of births and the reduction in the risk of dying due to avoiding births in high-risk fertility behavior 

categories. The probabilities of dying for children in a risk category are drawn from a recent study by 

Rutstein and Winter (2014). 

Reduced age-specific maternal mortality rates (MMRate) are calculated with maternal deaths excluded 

from the numerator if the mother was less than 18 years of age, 40 years or older, or the birth was of order 

4 or higher. The age-specific rates are combined for the MMRatio, weighting by the age-distribution of 

respondent women. 

Results 

Overall, 29 percent of women have a short birth-to-pregnancy interval risk, 43 percent have a high parity 

risk, and 32 percent have a risk because of age. The sum of the percents exceeds 100 because women face 

multiple risks. Among the 69 percent of women who face at least one fertility-related risk, 28 percent of 

women have one risk, 39 percent have double risks, and 2 percent face all three possible risks. 

Two-thirds of non-pregnant fecund women have a need to use contraception based on their fertility risk 

status. Nearly half the non-pregnant women (46 percent) have a need for a limiting method because they 

have had 3 children already or are 40 years of age or over. Among these women, those not currently using 

contraception have an unmet need. 

The overall level of unmet need is estimated by combining unmet need from desires with unmet need from 

fertility risk. Twenty-one percent of non-pregnant women have an unmet need for contraception because 
xii 

of their desires or their risk, 5 percent for an unmet spacing method, and 16 percent for a limiting method. 

Another 20 percent are using a spacing method but have a need for a LAPM. In total, 41 percent of women 

have a need for focused efforts by family planning programs. Only two out of five women who need focused 

efforts and who visited a health facility in the preceding year were informed about family planning or 

contraceptive methods. 

If women were to satisfy their unmet risk-based needs for contraception or were to obtain more effective 

methods of family planning, substantial numbers of under-five deaths and maternal deaths could be averted. 

According to our calculations, over half of infant and under-five deaths could be averted, with 3.2 million 

deaths averted out of the 5.6 million deaths projected for 2015. Even more spectacular is the number of 

maternal deaths that could be averted, 109,000 out of the 155,000, which represents a reduction of 70 

percent. It is unrealistic to assume that risk-based unmet need can be eliminated completely, because of 

conflicts with fertility desires and rejection of use of contraception by some women, their husbands or 

partners, families, or religions. However, satisfying half of the unmet risk-based need would be a highly 

effective, cost-effective intervention. For many women, risk-based needs and desire-based needs coincide, 

and a substantial portion of risk-based unmet needs will be satisfied if women can achieve their preferred 

number and spacing of births. 

Conclusions and Policy Implications 

Avoiding high fertility behavior risk could avert substantial numbers of young child and maternal deaths. 

Many women with unmet needs are not being well-served by health systems. These women need to be 

informed of the fertility risks and their contraceptive choices, and provided with timely, effective, and high 

quality services. It is incumbent upon national health programs, international health donors, and private forprofit and not-for-profit health programs to serve the women with unmet needs for contraception in order 

to cost-effectively avert maternal and child deaths and to reach the Sustainable Development Targets 3.1 

and 3.2. 
1 

1. Introduction and Rationale 

The Millennium Development Goal (MDG) 4 calls for a reduction in child mortality, with a target of 

reducing the under-five mortality rate; MDG 5 calls for an improvement in maternal health, with a target 

of reducing the maternal mortality ratio (MMRatio). The follow-on Sustainable Development Goals (SDG) 

include Targets 3.1 and 3.2, which respectively call for reducing the global maternal mortality to less than 

70 deaths per 100,000 live births and reducing neonatal mortality to 12 or fewer deaths per 1,000 live births 

and under-five mortality to 25 or fewer deaths per 1,000 live births. It has been generally accepted that 

fertility behavior affects both the mother’s and the child’s health and survival. Three characteristics and 

five risks have been identified: age of the mother at the birth of her child (too young or too old), parity at 

birth (too many), and the interval between pregnancies and birth (too short or sometimes, too long). A 

recent study (Rutstein and Winter 2014) with data from Demographic and Health Surveys (DHS) in 45 

countries estimated the values and prevalence of these risks, both individually and in combination. While 

the conventional measure of unmet need relies on women’s stated preference to space and/or limit births, 

this report calculates an alternate measure of unmet need that considers a woman who falls in a high-fertility 

risk category to be in need of family planning, regardless of her stated desire for spacing or limiting the 

number of births. Carrying forward the findings of Rutstein and Winter (2014), this report estimates the 

number of maternal and child deaths that could be averted if this alternative risk-based unmet need were 

satisfied. 

Chapter 1 provides a brief overview of the literature on the effects of women’s fertility risks on child and 

maternal survival, and the potential for family planning to avert child and maternal deaths. Chapter 2 

describes the data and the methodology of the study, and defines all variables. Chapter 3 has four sections 

that describe results. First, the study describes the population of non-pregnant women in 45 countries, with 

data from DHS surveys conducted between 2006 and 2012. The study presents the distribution of these 

women across fertility risk categories, across categories of fertility-risk-based need, women’s desire for 

children, and current contraceptive use. Second, among non-pregnant currently married or in union women, 

the study examines the levels of the conventional desire-based need and the fertility-risk-based need as well 

as levels of a combined measure of desire- and risk- based need. Third, the study focuses specifically on 

the population of women in need of focused family planning efforts: those with either a risk- or desirebased unmet need. Finally, the study estimates the number of deaths in 2015 to children under-five and the 

number of pregnancy-related deaths to women in the 45 study countries that could be averted if women 

would have only those births with optimal birth spacing (36 months or more between births), age at birth 

(18 to 39 years), and parity (less than 4). These potential reductions in mortality (i.e., deaths averted) are 

due to a lower number of births and the lower mortality rates. Chapter 4 provides interpretation of key 

findings, overall conclusions, and policy implications. 

1.1. Literature Review 

As summarized below, the effects of the length of the preceding interval from birth to pregnancy, maternal 

age at the child’s birth, and the child’s birth order on child survival and adverse maternal outcomes are 

well-established.

1.1.1. High fertility risk: The Length of the preceding birth interval 

The effect of short intervals has been shown repeatedly to be one of the most important factors that affect 

the mortality of infants and children under age five years. Early studies identified a U-shaped pattern 

between infant mortality and the length of the preceding birth interval (Hughes, Hunter, and Woodbury 

1923; Woodbury 1925). Subsequent studies demonstrated that after adjusting for a variety of confounding 

factors, the effect of birth interval on the mortality of young children persists (Alam 1995; Alam and David 
2 

1998; Bhalotra and Soest 2006; Conde-Agudelo, Rosas-Bermúdez, and Kafury-Goeta 2006; DaVanzo et 

al. 2008; Koenig et al. 1990; Miller et al. 1992; Mozumder et al. 1998; Zenger 1993). The harmful effects 

of a non-optimal preceding birth interval for the child are concentrated in early infancy (Koenig et al. 1990); 

this suggests that prenatal conditions may explain the effect of birth interval (Boerma and Bicego 1992). 

However, studies have also found that the effect of a short-preceding birth interval on child mortality are 

stronger if the preceding child is still alive; this suggests that sibling completion also plays a role (DaVanzo 

et al. 2008). In recent years, multi-country studies have sought to identify the birth-to-pregnancy interval 

that is optimal for child survival. Rutstein (2005 and 2008) and Rutstein and Winter (2014) found that for 

neonatal mortality and infant mortality, the risk of dying was lowest for children with a preceding birth-tobirth interval of 36-47 months, while for child mortality, risk continued to decrease with increasing length 

of the preceding birth interval. For a more in-depth discussion of the literature on this relationship, see 

previous studies by Rutstein (Rutstein 2005; Rutstein 2008). 

The effects of the length of the preceding birth-to-pregnancy interval on adverse maternal outcomes are 

also well established (Conde-Agudelo and Belizán 2000; Conde-Agudelo, Rosas-Bermúdez, and KafuryGoeta 2007; Conde‐Agudelo et al. 2012). Long preceding birth intervals are associated with an increased 

risk of preeclampsia, while short preceding intervals are associated with increased risk of premature 

membrane rupture, uteroplacental bleeding disorders, and uterine rupture if a vaginal delivery follows a 

Cesarean delivery (Conde-Agudelo, Rosas-Bermúdez, and Kafury-Goeta 2007). The adverse effects 

associated with short intervals could be due to maternal nutritional depletion, since insufficient recovery 

time between pregnancies can worsen the mother’s nutritional status. The adverse outcomes associated with 

a long preceding interval may result in the gradual decline of the mother’s physiological ability to carry a 

pregnancy back to the state that existed before the first pregnancy (i.e., women’s physiological regression) 

(Conde‐Agudelo et al. 2012). 

1.1.2. High fertility risk: Maternal age 

The effects of maternal age on infant and early child survival and health have been studied extensively. 

Children born to very young women and older women have higher levels of mortality (Hobcraft, McDonald, 

and Rutstein 1985; Nortman 1974; Rutstein and Winter 2014). While some authors have used data from 

the United States to provide evidence that this association can be explained by young women’s social 

disadvantage and other confounding factors (Geronimus 1987; Reichman and Pagnini 1997), most studies 

find that the observed maternal-age effect persists after adjusting for socio-demographic factors (Finlay, 

Özaltin, and Canning 2011; Fraser, Brockert, and Ward 1995; Ikamari 2013; Kumar et al. 2013; Rutstein 

and Winter 2014; Van der Klaauw and Wang 2004). This suggests a biological effect. Van der Klaauw and 

Wang (2011) report that the expected U-shaped relationship between maternal age and neonatal, postneonatal, and child (years one to four) mortality persists after adjusting for an array of sociodemographic 

characteristics among children in rural India. In contrast, Ikamari (2013) reports that the risk of neonatal 

and post–neonatal mortality increases incrementally with age, with the lowest risk found in the under 20 

age group, higher risk found in the 20–34 group, and the highest risk in the 35 and older group. However, 

this single contrasting study uses data from Kenya only, whereas the other studies use data from many 

countries. Older maternal age at the child’s birth (age 35–39, and 40 or older) has also been associated with 

stillbirth and preterm birth (Lisonkova et al. 2010). 

Several plausible biological factors could explain the excess mortality observed among young and older 

mothers. The biological influences of aging in older women are believed to influence their reproductive 

health and children’s survival. The bodies of young teenage mothers have not yet reached full physiological 

and reproductive maturity, and this may increase the mother’s risk of complications during pregnancy and 

birth, and the likelihood of inadequate weight gain during pregnancy. Young mothers who are still growing 

may also compete for nutrients with the fetus (Fraser, Brockert, and Ward 1995), while psychological 
3 

immaturity may also affect the child’s care. Some of the observed association could also be explained by 

social factors or collinearity between maternal age and birth order. 

The elevated J-shaped curve of maternal mortality with higher risks among women who are either too young 

or too old has been documented since the early 1970s (Nortman 1974; Stover and Ross 2010). Nortman 

(1974) found the risk of maternal mortality to be lowest among women ages 22-23 years (regardless of 

parity), with slightly elevated risk at young ages and a steep increase in risk at older ages. The risk of both 

hemorrhage and sepsis increased rapidly with increasing age (Nortman 1974). 

1.1.3. High fertility risk: Birth order 

The association between birth order and child mortality is often described as U-shaped, with higher 

mortality levels among first births and high-order births. Two of three recent studies found that the 

association between birth order and child mortality persists after controlling for potential confounders 

(Handa, Koch, and Ng 2010; Rutstein and Winter 2014). In the third study, birth order was not a significant 

determinant of child mortality in adjusted models (Saha and van Soest 2013). See Rutstein and Winter 

(2014) for a more detailed discussion of the literature on maternal age, birth order, and child survival. 

Women are also at higher risk for adverse maternal outcomes during their first birth and high parity births. 

Specifically, the MMRatio tends to be elevated at parity 1, lower for parities 2 and 3, and then steadily 

increases at higher parities (Chen et al. 1974; Cleland et al. 2012; Stover and Ross 2010). At high parity, 

women’s health may be compromised from the cumulative experience of childbirth and lactation, while the 

first birth may be riskier because the woman’s body is undergoing childbirth for the first time (Trussell and 

Pebley 1984). 

1.1.4. Potential deaths averted by contraception 

Beyond the literature that examines the risk associated with specific high-risk fertility behaviors, a variety 

of studies since the 1980s have described and assessed the overall effects of contraceptive use on the health 

and survival of women (Ahmed et al. 2012; Cleland et al. 2012; Fortney 1987; Ross and Blanc 2012; Stover 

and Ross 2010; Trussell and Pebley 1984; Winikoff and Sullivan 1987) and to a lesser extent, children 

(Hobcraft 1987; Trussell and Pebley 1984). These studies have employed different analytic approaches to 

quantifying the potential for increases in contraceptive use to avert maternal and child deaths. 

The overall effects of contraceptive use on the health and survival of women and children are expected to 

work in two ways: first, through reducing the number of births, and second, through reducing the percentage 

of births that fall in high-risk behavior categories, thus leading to overall reductions in fertility risk. One 

recent study, which examined the effects of the first pathway only, used simulations to estimate the expected 

reduction in maternal deaths in 167 countries if all unmet need for contraception was fulfilled (Ahmed et 

al. 2012). The analysis used MMEIG (WHO) MMRatio estimates, which were held constant, to quantify 

the effect of changes in fertility levels. The study estimated that in 2008, contraceptive use averted 43-44 

percent of maternal deaths. In a separate study, Cleland and colleagues (2012) extended Ahmed and 

colleagues’ results to quantify the effect of changes in the MMRatio from reductions in the percentage of 

births in high-risk behavior categories. They found that in 2008, the reduction in obstetric risk associated 

with contraceptive use averted an additional 3.7 percent of maternal deaths, beyond the reduction from 

lowered fertility. 

Other studies have quantified both pathways through which contraceptive use affects maternal and child 

health. In a study with a methodology similar to the current study, Stover and colleagues (2010) estimated 

the contributions of increasing contraceptive use to reducing maternal mortality between 1990 and 2005. 

In this analysis, the authors used age- and parity-specific estimates of MMRatio to estimate potential 
4 

changes in the overall MMRatio if increasing contraceptive use modified the distribution of births by age 

and parity. They estimated that over one million maternal deaths were averted during this period directly 

due to declines in the fertility rate from increased contraceptive use in developing countries, and that 

additional maternal deaths were averted indirectly, through the reduction in the share of high-risk births 

that resulted from increased contraceptive use (Stover and Ross 2010). 

With a different approach, Ross and Blanc (2012) decomposed the reduction in maternal deaths between 

1990 and 2008 to isolate the effects of increases in the female population, decreases in fertility, and declines 

in the MMRatio. They reported that while the population of women of reproductive age increased by 42 

percent, the number of births remained constant because of lower fertility rates. They estimated that on 

average in developing countries, the contributions of fertility decline and decline in the MMRatio to the 

reduction in maternal deaths were roughly equal. However, in this study, the declines in MMRatio were not 

limited to those that resulted from changes in the fertility-risk profile of childbearing women. Instead, the 

MMRatio declines could also have resulted from general development, improvements in maternal care and 

health system strengthening, or other factors. 

Finally, one of the few studies that has examined the impact of contraceptive use on both maternal and child 

death focused on the reduction in the percentage of births that fall in high-risk behavior categories, and then 

lead to overall reductions in fertility risk (for both the mother and child) (Trussell and Pebley 1984). Using 

published estimates of the association between women’s fertility-risk and maternal, infant, and child 

mortality from other studies, Trussell and Pebley (1984) estimated that if childbearing were limited to 

women aged 20-34, the infant and child mortality rates would fall by roughly 5 percent. Limiting 

childbearing to women aged 20-39 would reduce the MMRatio by roughly 11 percent, and eliminating 

births at parity 4 or higher would reduce infant and child mortality by 8 percent, and the MMRatio by 

4 percent. According to this study, changing the birth spacing patterns to make all non-first births at least 

2 years after the preceding birth would reduce infant mortality by 10 percent and child mortality by 

21 percent. 

While most previous studies have extracted estimates of fertility risk from other sources, the current study 

uses recent DHS survey data to directly calculate estimates of mortality risk and fertility rates. Furthermore, 

while previous studies have most often presented global or regional estimates for the number of deaths 

averted by contraceptive use, this study provides country-specific and regional estimates which we hope 

will be useful for programmatic and planning purposes. The study examines the potential impact of 

eliminating fertility risk-based need on mortality among mothers and children, considering the effects of 

both the reduction in the number of births and the reduction in the percentage of births in high-risk behavior 

categories. 

1.1.5. Risk-based unmet need for contraception 

An earlier study that used high-risk fertility as the basis for calculating unmet need for contraception was 

carried out by Govindasamy et al. (1993). Govindasamy et al. used data from 28 DHS surveys between 

1985 and 1990 to examine the potential mortality reductions which could be achieved through increased 

use of family planning and wider access to maternity care. First, the study examined differentials in the 

coverage and utilization of maternity care. Next, the study explored fertility-related factors that place 

women and their children at high risk. Data on women who fall into high-risk categories were then used to 

calculate a new measure of unmet need for family planning with the goal of avoiding high-risk births. The 

report concluded that the prevention of maternal mortality includes, in part, the prevention of high-risk 

pregnancies with a broadened definition of unmet need for family planning that considers the known 

mortality risks associated with maternal age, parity, and birth spacing. This study carries forward this 

broadened definition of unmet need. 
5 

1.1.6. Definition of high risk fertility behavior 

This study defines high-risk fertility behaviors as births at too young an age, too old an age, becoming 

pregnant too soon after a previous birth, and having too many births. Giving birth at less than 18 years of 

age and at 40 or more years of age constitute the age risk. While women 35-39 years of age have been 

shown to have a higher risk of child mortality, we have conservatively included only women who would 

be 40 or more. Becoming pregnant again at less than 27 months after a preceding birth represents the 

pregnancy spacing risk. Although too long an interval between pregnancies (72 or more months) has also 

been shown to increase mortality and morbidity risks, the avoidance of this risk cannot be accomplished by 

use of contraception and does not affect unmet need for contraception. First births and births of order four 

or higher demonstrate increased risk for mortality and morbidity. However, first births are an unavoidable 

risk if there are to be any children and are not included in calculations of unmet need for contraception. 

7 

2. Methodology and Data 

2.1. Data Sources 

The data for calculating the fertility risk-based unmet need for contraception come from 45 DHS conducted 

between 2006 and 20121

. These nationally representative surveys were also included in the Rutstein and 

Winter (2014) report. The calculations in this report are based on non-pregnant women between the ages 

of 15 and 49 years. For each survey, Table 1 provides the number of women interviewed and their 

pregnancy status at the time of interview. The total number of women in the 45 surveys is 743,420, of whom 

52,058 (7 percent) reported being pregnant at the time of interview, leaving 691,362 for the analysis. In the 

tables below, the number of respondents in each survey are weighted to adjust for variation in sampling 

rates and non-response, which is the standard procedure in DHS final reports. 

In addition, the calculation of the number of averted child and maternal deaths used the United Nations 

World Population Prospects (United Nations, Department of Economics and Social Affairs, Population 

Division 2013). 

2.2. Methods 

2.2.1. Calculation of fertility-behavior-based risks among non-pregnant women

2.2.1.1. The three main fertility risk parameters are considered to be: 

The mother’s age at next birth if she were to become pregnant right after the survey, is calculated by 

adding nine months to the mother’s current age. 

The mother’s birth parity is calculated by adding one to her number of children ever born at the time of 

the survey. Women who would be at risk due to parity include those who have had 3 or more births. Note 

that although having a first birth is riskier than second or third births, it is an unavoidable risk if there are 

to be any children. 

The interval of time between a woman’s last birth prior to the survey and her next pregnancy if she 

were to become pregnant right after the survey. Among women who have had a live birth, those in the highrisk zone have a time interval since last birth of less than 15 months and women in the moderate zone an 

interval of 15 to 26 months. While it has been found that women with long birth intervals are also at 

increased fertility risk, contraception cannot be used to avoid this risk. Women who did not have any live 

births at the time of the survey do not have an interval risk. 

2.2.1.2. Combining risks: 

An indicator of combined risk was created to summarize the total number of risks faced by each woman. 

The indicator uses a maternal age of 40 years or higher, a preceding birth-to-pregnancy interval of less than 

27 months, and a parity of 4 or more as the criteria for higher risk (Table 3). Having a long birth interval 

(72 months or more) is not included in this indicator. 

 

1

 The data sets for several country DHS surveys with fieldwork in 2012 were not available at the time the Rutstein 

and Winter (2014) report was written. Instead, earlier DHS surveys for those countries were used if they took place 

within the period. 
8 

2.2.2. Total and unmet need for contraception 

In this study, the need for contraception is categorized into two types: need for contraception that arises 

from satisfying a woman’s desires to postpone or avoid a birth, and the need for contraception to reduce 

the mortality and morbidity risks of fertility behavior. The former, commonly called need and unmet need 

for contraception, is calculated for DHS main reports. Here, it is termed desire-based need for contraception. 

The need for contraception to reduce mortality risks is termed fertility-risk-based need. The study also 

examines a third measure of unmet need which combines the desire- and fertility-risk-based need. The 

calculation of these three measures is described below. 

Desire-based need for contraception: Desire-based need for contraception is the proportion of two 

numbers. The denominator is the number of women who are currently married or are in a consensual union. 

The numerator is the number of women who are fecund and who do not want another child (need for 

limiting) or want to delay the birth of another child for two or more years (need for spacing). Women who 

are infecund or who want a child within two years are excluded from the numerator. The term need for 

contraception includes all women with a met or unmet need. Met need for contraception includes women 

who have a need and are currently using contraception. Unmet need includes women with a need who are 

not currently using contraception. Met need and unmet need have the same denominator and therefore add 

to total need. Details of the calculation, the definition of fecund, and the treatment of currently married and 

postpartum amenorrheic women are described in Bradley et al. (2012). 

Fertility-risk-based need for contraception: The calculation of fertility-risk-based need for contraception 

in this study is analogous to desire-based need. The denominator is the same as that for desire-based need 

(i.e., all women aged 15-49 years who are currently married or in a consensual union). For the numerator, 

women can be classified into those whose risk categories would indicate a need for not having any more 

births, those who should delay the next conception, and those who need not delay the next conception. The 

first (limiting) category includes women whose next birth would be her fourth or higher parity or who 

would be age 40 or more at the next birth. The second (spacing) category includes women whose next birth 

would be at age less than 18 or whose birth-to-pregnancy interval would be shorter than 27 months. 

Infecund women and women who would not have a fertility-risk based need to limit or space their next 

birth are omitted. As in the definition of desire-based need, unmet fertility-risk based need includes women 

who are not currently using contraception. Pregnant women are not considered to have a current need for 

contraception, and amenorrheic women are treated the same as non-amenorrheic women. 

Combined need for contraception using both definitions: Need for contraception from either desires or 

fertility risk is combined into a single indicator for non-pregnant women who are married or in union; this 

is called combined need. A woman is categorized as having no need if both definitions indicate that there 

is no need for contraception. If there is a need for spacing from both desires and risk, there is combined 

need for spacing. If either desires or risk indicate a need for limiting, women are placed in the combined 

limiting need category. Women with a need for contraception but who are not using have an unmet need 

for either spacing or limiting, according to their category of need. 

Non-pregnant, currently-married women in the combined need category who need a more effective method 

of contraception are in two groups: those who are using contraception for spacing based on their desires but 

have a limiting need based on risk, and those who are using contraception for limiting but are not using a 

long-acting or permanent method (LAPM)2

. Women with an unmet need and women with a need for a more 

effective long-term method constitute the group who require focused family planning efforts. 

 

2

 LAPM methods include female and male sterilization, intrauterine devices (IUD), and contraceptive implants (e.g. 

Norplant, Inplanon, Nexplanon,). 
9 

Figure 1 presents diagrammatically the combinations of desire-based and risk-based need which result in 

the combined need for contraception indicator. Green shading indicates that there was no need for 

contraception at the time of the survey. Also without a need were women who either declared themselves 

infecund or who are inferred to be infecund because they had no pregnancy during five or more years of 

marriage without using contraception (not shown in diagram). Women in the cells shaded in red had an 

unmet need for contraception and women in cells shaded in yellow had a need for a LAPM although they 

were using a method. The area with the red border indicates women in need of focused efforts of family 

planning programs. 

Figure 1. Combined need for contraception indicator 

2.2.3. Child deaths averted 

To calculate the number of child deaths that could be averted in 2015 if women were to satisfy their unmet 

risk-based need for contraception or their need for a LAPM, we consider two elements: the reduction in the 

number of births that would occur and the reduction in the risk of dying after children are born. 

Calculation of the reduction in number of births: 

The reduction in the number of births that would occur is estimated by first calculating two total fertility 

rates (TFR): the standard TFR which includes births to all women, and an alternate, hypothetical TFR that 

assumes that all births to women with risk-based unmet need have been eliminated if they could not be 

shifted into the non-risk category. In the denominator of the alternate TFR, assuming no risk-based unmet 

need, all women contribute women-years of exposure by five-year age groups in the three years preceding 

the survey.3

 In the numerator, starting with the number of births that occurred in the three years preceding 

the survey, births with these characteristics were excluded: 

• Births of order 4 or higher. 

• Births to women age 40 years or more if by shifting those births to age less than 40 the 

resulting birth-to-pregnancy interval would be less than 27 months. 

 

3

 If the survey included individual interviews with ever-married women, then exposure is calculated using “all-women 

factors”. See Guide to DHS Statistics (Rutstein and Rojas 2006). 

Desire-based need

Less than 

18 years 

of age

Last birth 

occurred 

less than 

27 months 

ago

Age 39, 3 

months or 

more

Has had 3 

or more 

births

Less than 

18 years 

of age

Last birth 

occurred 

less than 

27 

months 

ago

Age 39, 3 

months 

or more

Has had 3 

or more 

births

Less than 

18 years 

of age

Last birth 

occurred 

less than 

27 

months 

ago

Age 39, 3 

months 

or more

Has had 3 

or more 

births

Wants within 24 months No need

Unmet 

spacing 

need

Unmet 

spacing 

need

Unmet 

limiting 

need

Unmet 

limiting 

need No need

Met 

spacing 

need

Met 

spacing 

need

Unmet 

need for 

LAPM

Unmet 

need for 

LAPM No need

Met 

spacing 

need

Met 

spacing 

need

Met 

limiting 

need

Met 

limiting 

need

Wants after 24 months or 

unsure if wants

Unmet spacing 

need

Unmet 

spacing 

need

Unmet 

spacing 

need

Unmet 

limiting 

need

Unmet 

limiting 

need

Met spacing 

need

Met 

spacing 

need

Met 

spacing 

need

Unmet 

need for 

LAPM

Unmet 

need for 

LAPM

Met spacing 

need

Met 

spacing 

need

Met 

spacing 

need

Met 

limiting 

need

Met 

limiting 

need

Does not want any more

Unmet limiting 

need

Unmet 

limiting 

need

Unmet 

limiting 

need

Unmet 

limiting 

need

Unmet 

limiting 

need

Unmet need 

for LAPM

Unmet 

need for 

LAPM

Unmet 

need for 

LAPM

Unmet 

need for 

LAPM

Unmet 

need for 

LAPM

Met limiting 

need

Met 

limiting 

need

Met 

limiting 

need

Met 

limiting 

need

Met 

limiting 

need

Not using contraception Using non-LAPM contraception Using LAPM contraceptionAge 18 to 39,3 

months; has 

had 3 or fewer 

births, no birth 

or last birth 

occurred 28 or 

more months 

ago

Risk-based need Age 18 to 39,3 

months; has 

had 3 or fewer 

births, no birth 

or last birth 

occurred 28 or 

more months 

ago

Risk-based need Age 18 to 39,3 

months; has had 

3 or fewer 

births, no birth 

or last birth 

occurred 28 or 

more months 

ago

Risk-based need

Indicates need for 

focused family planning 

efforts

Indicates using a nonLAPM method but needs 

LAPM method

Indicates no need or met 

need for contraception

Indicates unmet need for 

contraception
10 

• Births with a birth-to-pregnancy interval of less than 27 months if by shifting the births to an 

interval of 27 months, mother’s age at birth would be 40 or more. 

It is assumed that births to women under age 18 years can be shifted into age 18 or higher, and are therefore 

not excluded. The age-specific fertility rates and the TFR are then calculated. 

The projected number of births in each country is taken from United Nations, Department of Economic and 

Social Affairs, Population Division (2013). The projected number of births for 2015 is the geometric mean 

of the 2010-14 and 2015-19 periods divided by 54

. 

The reduced number of births is the product of the projected number of births and the ratio of the no riskbased unmet need TFR to the all births TFR.5 

Calculation of the reduction in risk: 

The reduced risk of infant and under-five mortality is obtained from a lifetable calculation for three 

categories: any avoidable fertility risk, no avoidable risk, and first births (unavoidable risk) for children 

born in the five years preceding the survey, adjusted for confounding factors6

. The risks are calculated 

separately for each of the 45 countries and each geographic region. An unweighted combined average rate 

is also calculated. The reduced risk mortality rate (RRMR) is then calculated by 

RRMR=[NARMR*(B-FB)+FBMR*FB]/B 

In this calculation, RRMR is the reduced risk mortality rate, NARMR is the mortality rate for no avoidable 

risk, B is the total number of births, FB is the number of first births, and FBMR is the mortality rate for 

first births. 

Calculation of child deaths averted: 

The number of infant and under-five deaths averted is calculated with the following formulas: 

Current number of infant or under-five deaths: 

Dc=B*MRc 

Where Dc is the number of projected deaths in 2015, B is the projected number of births in 2015, 

using the UN projections as given above, and MRc is the current mortality rate7

. 

Deaths averted due to reduced risk: 

DArr=Dc-B*RRMR 

 

4

 The geometric mean more closely interpolates population growth, which is continuous, than does an arithmetic 

mean which assumes a linear growth. 

5 The TFRs are for the three years preceding each survey. No adjustment has been made for changes that could have 

occurred between the date of the survey and 2015. 

6

 Using the Cox Regression command in IBM SPSS Statistics, version 22, the regression models controlled for 

urban/rural residence, wealth index quintile, type of water supply, type of toilet, whether the household has a 

refrigerator, sex of the child, maternal education, and death of the preceding child. Imputed intervals and multiple 

births are excluded. 

7

 Infant and under-five mortality rates. The term rate is commonly used but they are probabilities of surviving from 

birth to age 12 months and to age 60 months, respectively. 
11 

Where DArr is the number deaths averted due to avoiding fertility-related risks. 

Deaths averted due to reduced fertility: 

DArf=Dc-B*(TFRrr/TFRc)*MRc 

Where DArf is the number of deaths averted through the reduced fertility rate, TFRrr is the reduced 

risk total fertility rate and TFRc is the current fertility rate. 

Deaths averted due to both reduced risk and reduced fertility: 

DAt=Dc-B*(TFRrr/TFRc)*RRMR 

Where DAt is the number of deaths averted due to the joint effects of avoiding high-risk fertility 

behavior. 

2.2.4. Maternal deaths averted 

To calculate the number of maternal deaths that could be averted in 2015 if women were to satisfy their 

risk-based unmet need for contraception or their need for a LAPM, we consider the same two elements 

described above: the reduction in the number of births that would occur and the reduction in the risk of 

pregnancy-related death to the mother. 

Calculation of the reduction in number of births: 

The calculation of the reduction in number of births is the same as described above for child deaths averted. 

Calculation of the reduction in risk: 

For the calculation of reduced maternal mortality rates and ratios, only mother’s age at birth and parity are 

considered since the DHS data do not provide information on the relationship between birth or pregnancy 

spacing and the risks of maternal death.8

The calculation of maternal mortality rates, maternal mortality ratios, and the lifetime risk of maternal death 

follows the standard protocol used to calculate DHS mortality rates for the seven years preceding the survey 

(Rutstein and Rojas 2006). First, reduced age-specific maternal mortality rates are calculated with maternal 

deaths excluded from the numerator if the mother was less than 18 years of age, 40 years or older, or the 

birth was of order 4 or higher9

. The age-specific rates are combined for the total reduced risk maternal 

mortality rate weighting by the age-distribution of respondent women. A reduced risk MMratio is calculated 

with the following formula: 

RRMMRatio=RRMMRate/RRGFR 

Where RRMMRatio is the reduced risk maternal mortality ratio, RRMMRate is the reduced risk 

maternal mortality rate and the RRGFR is the reduced risk general fertility rate for the seven years 

preceding the survey. The RRGFR is calculated as the standard GFR, eliminating births to women 

 

8

 The estimation of maternal mortality is based on the sibling history of the DHS, in which respondents are asked 

about their sisters’ survival after a birth. In this history, no information is obtained on the interval between births. 

9

 These reduced rates are directly calculated avoiding high-risk births. They are not adjusted for confounders since 

there is no information in the DHS to do so (there is no information on the values of residence, wealth, education, etc. 

for the sisters of the respondents in the sibling history of the DHS). 
12 

under age 18 at the time of birth, 40 or over, or birth order 4 or higher. The reduced risk lifetime 

risk of maternal death is calculated by: 

RRLTRMM= 1 – (1-RRMMRatio)RRTFR 

Where RRTFR is the reduced risk total fertility rate for the seven year period prior to the survey, 

eliminating births to women under age 18 at the time of birth, 40 or over, or birth order 4 or higher. 

Calculation of maternal deaths averted: 

The number of maternal deaths averted is estimated similarly to infant and under-five deaths: 

Current number of maternal deaths 

MDc=B*MMRatioc 

Where MDc is the number of projected maternal deaths in 2015, B is the projected number of births 

in 2015, using the UN projections as given above, and MMRatioc is the current maternal mortality 

ratio. 

Maternal deaths averted due to reduced risk for maternal death: 

MDArr=MDc-B*RRMMRatio 

Where MDArr is the number maternal deaths averted due to avoiding fertility-related risks. 

Maternal deaths averted due to reduced fertility: 

MDArf=MDc-B*(RRTFR/TFRc)*MMRatioc 

Where MDArf is the number of deaths averted through the reduced fertility rate, RRTFR is the 

reduced risk total fertility rate and TFRc is the current fertility rate. Note that the TFRs are 

calculated for the 7-year period that precedes the survey. 

Maternal deaths averted due to both reduced maternal mortality risk and reduced fertility: 

MDAt=MDc-B*(TFRrr/TFRc)*RRMMRatio 

Where MDAt is the number of maternal deaths averted due to both effects of avoiding high-risk 

fertility behavior. 
13 

3. Results 

3.1. Percentage of Women Pregnant 

Among the 743,420 women surveyed in the 45 DHS surveys between 2006 and 2012, 8 percent were 

pregnant at the time of the survey. These women were removed from the analysis data set, leaving 691,362 

women who said they were not pregnant or were unsure whether they were pregnant (Table 1). The 

percentage pregnant varies by world region and by country. The regions with the highest percentages 

pregnant were the Middle East/North Africa (11 percent) and West and Central Africa (10 percent). The 

region with the lowest percentage is Eastern Europe/NIS (3 percent). Niger had the highest percentage of 

women pregnant at the time of the survey (15 percent), while Albania had the lowest (2 percent). 

Table 1. Distribution of women by pregnancy status at time of survey, 45 DHS country surveys 

2006-2012 

Country 

Survey 

date 

Total number of 

respondents 

Percentage pregnant Number pregnant 

No or 

unsure Yes Total No or unsure Yes Total 

West and Central Africa 

Benin 2006 17,794 89.1 10.9 100 15,850 1,945 17,794 

Burkina Faso 2010 17,087 89.9 10.1 100 15,357 1,730 17,087 

Cameroon 2011 15,426 90.2 9.8 100 13,914 1,512 15,426 

DR Congo 2007 9,995 88.8 11.2 100 8,872 1,124 9,995 

Ghana 2008 4,916 92.7 7.3 100 4,556 360 4,916 

Liberia 2007 7,092 89.3 10.7 100 6,331 761 7,092 

Mali 2006 14,583 87.2 12.8 100 12,721 1,862 14,583 

Niger 2006 9,223 85.3 14.7 100 7,871 1,352 9,223 

Nigeria 2008 33,385 89.5 10.5 100 29,891 3,494 33,385 

Sao Tome & Principe 2008-09 2,615 91.5 8.5 100 2,394 221 2,615 

Senegal 2010-11 15,688 92.3 7.7 100 14,480 1,208 15,688 

Sierra Leone 2008 7,374 91.9 8.1 100 6,776 598 7,374 

East and Southern Africa 

Burundi 2010 9,389 89.6 10.4 100 8,408 981 9,389 

Ethiopia 2011 16,515 92.7 7.3 100 15,310 1,205 16,515 

Kenya 2008-09 8,444 93.0 7.0 100 7,851 593 8,444 

Lesotho 2009 7,624 95.8 4.2 100 7,303 321 7,624 

Madagascar 2008-09 17,375 91.7 8.3 100 15,938 1,437 17,375 

Malawi 2010 23,020 91.0 9.0 100 20,948 2,072 23,020 

Mozambique 2011 13,745 89.0 11.0 100 12,229 1,516 13,745 

Namibia 2006-07 9,804 94.6 5.4 100 9,277 528 9,804 

Rwanda 2010 13,671 93.0 7.0 100 12,715 956 13,671 

Swaziland 2006-07 4,987 94.4 5.6 100 4,708 279 4,987 

Tanzania 2010 10,139 90.4 9.6 100 9,170 969 10,139 

Uganda 2011 8,674 88.3 11.7 100 7,663 1,011 8,674 

Zambia 2007 7,146 89.3 10.7 100 6,384 762 7,146 

Zimbabwe 2010-11 9,171 91.7 8.3 100 8,413 758 9,171 

Middle East/North Africa 

Egypt 2008 16,527 90.6 9.4 100 14,972 1,555 16,527 

Jordan 2007 10,876 87.9 12.1 100 9,561 1,315 10,876 

Eastern Europe/NIS 

Albania 2008-09 7,584 98.0 2.0 100 7,434 150 7,584 

Armenia 2010 5,922 97.0 3.0 100 5,744 178 5,922 

Azerbaijan 2006 8,444 96.5 3.5 100 8,147 297 8,444 

Ukraine 2007 6,841 97.2 2.8 100 6,650 191 6,841 

(Continued)
14 

Table 1. − Continued 

Country 

Survey 

date 

Total number of 

respondents 

Percentage pregnant Number pregnant 

No or 

unsure Yes Total No or unsure Yes Total 

Asia 

Bangladesh 2011 17,749 94.0 6.0 100 16,681 1,069 17,749 

Cambodia 2010 18,754 95.0 5.0 100 17,821 933 18,754 

India 2005-06 124,385 94.8 5.2 100 117,956 6,429 124,385 

Indonesia 2007 32,895 94.9 5.1 100 31,232 1,664 32,895 

Nepal 2011 12,674 95.1 4.9 100 12,053 621 12,674 

Pakistan 2012-13 13,558 89.2 10.8 100 12,097 1,461 13,558 

Philippines 2008 13,594 94.8 5.2 100 12,889 705 13,594 

Timor-Leste 2009 13,137 93.2 6.8 100 12,238 899 13,137 

Latin America and Caribbean 

Bolivia 2008 16,939 94.5 5.5 100 16,001 938 16,939 

Colombia 2010 53,521 96.7 3.3 100 51,729 1,792 53,521 

Dominican Rep. 2007 27,195 95.6 4.4 100 25,996 1,199 27,195 

Guyana 2009 4,996 95.7 4.3 100 4,782 214 4,996 

Peru 2012 22,947 96.1 3.9 100 22,055 893 22,947 

Unweighted Average

West and Central Africa 155,178 89.8 10.2 100 139,012 16,166 155,178 

East and Southern Africa 159,704 91.8 8.3 100 146,315 13,389 159,704 

Middle East/North Africa 27,403 89.3 10.8 100 24,533 2,870 27,403 

Eastern Europe/NIS 28,791 97.2 2.8 100 27,974 817 28,791 

Asia 246,746 93.9 6.1 100 232,966 13,780 246,746 

Latin America and Caribbean 125,598 95.7 4.3 100 120,562 5,036 125,598 

Total 743,420 92.4 7.6 100 691,362 52,058 743,420 

3.2. Fertility-related Risks of Non-pregnant Women 

Table 2 shows the distribution of non-pregnant women by age at next birth, by birth order of next birth, and 

by birth interval from last birth to next pregnancy if they were to become pregnant within the month after 

the survey. A total of 29 percent of women have a short birth-to-pregnancy interval risk (less than 27 

months), 43 percent have a high parity risk (4 or more births), and 32 percent have a risk because of their 

age (9 percent less than 18 years and 23 percent 40 years old or older). The African and Middle East/North 

African regions have the highest spacing interval risks (33 to 36 percent). The Middle East/North Africa 

region has the greatest parity risk (63 percent). Age at birth related risk does not vary substantially by region 

but is concentrated in the under eighteens in sub-Saharan Africa, and Latin America and the Caribbean. 
15 

Table 2. Percent distribution of non-pregnant women by birth interval from last birth to next pregnancy, 

by birth order of next birth, and by age at next birth if became pregnant right away, 45 DHS country 

surveys 2006-2012 

Country 

Survey 

date 

Number 

of respondents 

Birth interval to next pregnancy Next birth order Age at next birth 

Less 

than 15 

months 

15 to 

26 

months

27 to 

62 

months

63 or 

more 

months

First 

birth First 

Second 

or third

Fourth 

or 

higher 

Less 

than 18 

years 

18 to 

34 

years 

35 to 

39 

years 

40 or 

more 

years 

West and Central Africa 

Benin 2006 15,850 26.3 15.5 16.2 18.5 23.5 23.5 23.5 52.9 8.8 59.2 12.7 19.4 

Burkina Faso 2010 15,357 25.1 16.6 18.8 16.5 22.9 22.9 23.0 54.1 9.6 58.1 12.2 20.1 

Cameroon 2011 13,914 21.5 12.6 14.0 21.4 30.4 30.4 26.4 43.2 11.2 59.7 11.1 18.0 

DR Congo 2007 8,872 25.6 13.5 13.9 17.8 29.2 29.2 23.9 47.0 9.9 59.4 11.2 19.5 

Ghana 2008 4,556 16.8 10.3 15.2 23.4 34.3 34.3 25.8 39.9 9.7 56.5 13.4 20.4 

Liberia 2007 6,331 21.4 12.7 21.1 25.3 19.5 19.5 30.1 50.4 9.4 55.1 13.3 22.2 

Mali 2006 12,721 29.1 15.7 15.8 17.8 21.7 21.7 23.1 55.2 11.4 56.8 11.7 20.1 

Niger 2006 7,871 33.6 17.4 16.0 14.1 19.0 19.0 20.7 60.4 10.1 57.9 12.9 19.1 

Nigeria 2008 29,891 25.0 12.6 13.7 17.8 30.9 30.9 20.4 48.7 9.8 58.1 12.1 19.9 

Sao Tome & Principe 2008-09 2,394 19.6 12.5 21.1 21.2 25.7 25.7 26.5 47.9 9.4 59.0 10.0 21.7 

Senegal 2010-11 14,480 20.7 12.2 15.0 16.1 36.0 36.0 24.2 39.8 9.6 61.5 12.1 16.8 

Sierra Leone 2008 6,776 25.7 13.4 17.4 24.4 19.0 19.0 30.5 50.5 7.3 59.1 15.7 18.0 

East and Southern Africa 

Burundi 2010 8,408 22.6 15.2 13.8 11.2 37.2 37.2 19.5 43.3 13.0 58.3 10.8 17.9 

Ethiopia 2011 15,310 19.6 10.3 17.0 18.0 35.1 35.1 20.9 44.0 13.0 58.4 12.3 16.3 

Kenya 2008-09 7,851 18.1 11.3 17.3 25.5 27.9 27.9 27.8 44.4 10.7 59.1 10.8 19.3 

Lesotho 2009 7,303 14.2 9.6 16.6 27.4 32.2 32.2 38.4 29.4 10.7 59.7 10.6 19.1 

Madagascar 2008-09 15,938 19.5 11.4 18.9 25.4 24.7 24.7 28.3 47.0 10.8 54.8 12.7 21.7 

Malawi 2010 20,948 22.5 16.2 20.8 18.4 22.1 22.1 26.0 52.0 12.1 59.7 11.5 16.7 

Mozambique 2011 12,229 25.6 15.0 16.3 21.5 21.5 21.5 29.7 48.8 11.5 56.4 12.3 19.7 

Namibia 2006-07 9,277 14.6 8.8 16.7 25.6 34.3 34.3 34.9 30.8 10.8 58.9 11.6 18.7 

Rwanda 2010 12,715 15.4 11.1 19.9 15.4 38.1 38.1 22.0 39.9 11.4 58.6 11.2 18.8 

Swaziland 2006-07 4,708 16.2 9.7 17.3 26.9 30.0 30.0 33.8 36.2 11.8 59.0 10.6 18.6 

Tanzania 2010 9,170 22.7 13.3 18.0 20.5 25.5 25.5 26.8 47.7 11.2 56.3 13.0 19.5 

Uganda 2011 7,663 25.7 13.4 16.6 17.7 26.5 26.5 20.6 52.9 12.4 57.5 12.0 18.0 

Zambia 2007 6,384 26.0 15.7 15.2 18.2 24.9 24.9 26.2 48.9 11.6 60.1 11.2 17.0 

Zimbabwe 2010-11 8,413 20.4 10.5 17.8 24.8 26.5 26.5 37.5 36.0 10.4 60.3 12.4 16.9 

Middle East/North Africa 

Egypt 2008 14,972 18.8 11.7 18.2 43.9 7.3 7.3 36.3 56.5 0.4 49.3 16.6 33.7 

Jordan 2007 9,561 24.0 13.2 22.6 32.6 7.7 7.7 23.2 69.1 0.2 45.1 19.8 34.9 

Eastern Europe/NIS 

Albania 2008-09 7,434 4.6 3.2 9.9 46.3 36.1 36.1 35.0 29.0 10.0 42.4 13.9 33.7 

Armenia 2010 5,744 6.3 5.0 8.2 43.3 37.2 37.2 43.6 19.3 5.6 53.5 11.5 29.4 

Azerbaijan 2006 8,147 6.9 4.5 8.4 43.1 37.1 37.1 35.0 27.9 8.0 47.9 13.7 30.5 

Ukraine 2007 6,650 3.8 3.2 9.2 53.7 30.0 30.0 63.8 6.2 5.4 46.5 15.2 32.9 

Asia 

Bangladesh 2011 16,680 12.9 8.1 22.1 48.8 8.1 8.1 45.6 46.3 2.7 58.2 13.5 25.7 

Cambodia 2010 17,821 11.1 7.8 15.8 29.4 35.8 35.8 29.0 35.2 9.9 53.5 10.4 26.2 

India 2005-06 117,956 11.0 7.0 13.3 40.4 28.4 28.4 31.0 40.7 9.2 56.2 13.7 20.9 

Indonesia 2007 31,231 13.6 9.0 22.1 49.2 6.1 6.1 53.3 40.6 0.4 46.1 19.0 34.5 

Nepal 2011 12,053 10.6 6.8 15.5 38.0 29.1 29.1 32.8 38.1 9.9 56.9 12.5 20.6 

Pakistan 2012-13 12,097 23.4 11.7 19.6 34.3 11.1 11.1 25.4 63.5 0.5 52.5 17.8 29.2 

Philippines 2008 12,889 11.6 7.8 14.2 28.7 37.6 37.6 27.8 34.6 10.0 52.5 12.9 24.6 

Timor-Leste 2009 12,238 19.4 10.4 14.4 15.3 40.6 40.6 14.8 44.5 12.1 52.7 12.9 22.3 

Latin America and Caribbean 

Bolivia 2008 16,001 13.2 8.9 16.2 30.5 31.2 31.2 30.2 38.7 9.8 54.5 12.7 23.0 

Colombia 2010 51,729 7.2 5.5 12.7 39.2 35.5 35.5 39.5 25.0 15.0 47.0 11.9 26.1 

Dominican Rep. 2007 25,996 8.8 6.7 15.1 40.3 29.1 29.1 31.6 39.2 9.8 52.3 14.0 24.0 

Guyana 2009 4,782 10.1 6.0 12.4 40.0 31.6 31.6 33.4 35.0 9.5 49.2 14.1 27.2 

Peru 2012 22,055 8.8 7.3 15.6 35.2 33.0 33.0 36.2 30.8 9.4 50.4 14.2 26.1 

Unweighted Averages 

West and Central Africa 139,013 24.2 13.8 16.5 19.5 26.0 26.0 24.8 49.2 9.7 58.4 12.4 19.6 

East and Southern Africa 146,317 20.2 12.3 17.3 21.2 29.0 29.0 28.0 43.0 11.5 58.4 11.6 18.4 

Middle East/North Africa 24,533 21.4 12.5 20.4 38.3 7.5 7.5 29.8 62.8 0.3 47.2 18.2 34.3 

Eastern Europe/NIS 27,975 5.4 4.0 8.9 46.6 35.1 35.1 44.4 20.6 7.3 47.6 13.6 31.6 

Asia 232,965 14.2 8.6 17.1 35.5 24.6 24.6 32.5 42.9 6.8 53.6 14.1 25.5 

Latin America and Caribbean 120,563 9.6 6.9 14.4 37.0 32.1 32.1 34.2 33.7 10.7 50.7 13.4 25.3 

Total 691,366 17.8 10.7 16.1 28.1 27.4 27.4 30.2 42.5 9.2 55.2 12.9 22.6 
16 

Women can be subject to more than one fertility-related risk. Table 3 presents the distribution of nonpregnant women by specific combinations of risk factors and a summary of the number of risk factors to 

which they are exposed. Overall, 13 percent of non-pregnant women have no fertility-related risk and 

another 18 percent face the unavoidable risk of having their first pregnancy (with no other fertility-related 

risk). The other 69 percent of women face at least one fertility-related risk; 28 percent have one risk, 39 

percent have double risks, and 2 percent face all three possible risks. See findings in Rutstein and Winter 

(2014) for a description of how the accumulation of risks raises infant and child mortality. In six countries, 

more than half of non-pregnant women face double or triple avoidable fertility risks: Benin, Burkina Faso, 

Mali, Niger, Uganda, and Zambia. In several other countries, more than 49 percent of non-pregnant women 

face double or triple fertility risks: the Democratic Republic of the Congo, Nigeria, Burundi, Mozambique, 

and Timor-Leste. 
17

Table 3. Distribution of non-pregnant women by multiple fertility risk categories, 45 DHS country surveys 2006-2012 Country 

Survey 

date 

Number of 

respondents 

Extra risk due to fertility pattern Single, double and 3-way risk combinations 

No extra 

risk 

Unavoidable first birth risk 

Single 

spacing 

risk <15 

months 

Single 

spacing 

risk 15-26 

months 

Single 

age risk 

<18 

years 

Single 

age risk 

40+ years

Single 

risk order 

4+ 

Double 

risk 

spacing 

<15, order 

4+ 

Double 

risk 

spacing 

15-26, 

order 4+ 

Double 

risk first 

birth age 

<18 

Double 

risk first 

birth age 

40+ 

Double 

risk order 

4+, age 

40+ 

Double 

risk 

spacing 

<15, age 

<18 

Other 

double 

risk1

3 way risk 

spacing 

15-26, age 

<18, order 

4+ 

3 way risk 

spacing 

15-26, age 

40+, order 

4+ 

No extra 

risk 

Unavoidable 

first birth 

risk 

Any 

single risk

Any 

double 

risk 

Any 3 way 

risk 

West and Central Africa 

Benin 2006 15,850 7.1 14.8 9.3 5.6 0.0 1.2 11.4 15.2 8.5 8.4 0.3 15.0 0.3 0.1 1.5 1.3 7.1 14.8 27.5 47.8 2.8 Burkina Faso 2010 15,357 7.3 13.4 8.7 5.8 0.0 1.0 11.7 14.3 9.1 9.3 0.2 15.4 0.2 0.1 1.9 1.6 7.3 13.4 27.1 48.6 3.6 

Cameroon 2011 13,914 10.1 19.4 8.3 4.9 0.1 2.2 10.0 11.5 6.5 10.4 0.6 13.1 0.6 0.2 1.1 1.0 10.1 19.4 25.5 42.9 2.1 DR Congo 2007 8,872 7.7 19.1 9.6 4.5 0.0 1.5 8.7 13.9 7.1 9.4 0.7 13.8 0.5 0.1 1.6 1.8 7.7 19.1 24.2 45.5 3.5 Ghana 2008 4,556 11.1 24.3 7.1 4.8 0.0 2.6 9.8 8.3 4.5 9.6 0.4 15.1 0.1 0.0 1.3 0.9 11.1 24.3 24.4 38.1 2.1 Liberia 2007 6,331 13.8 10.7 8.7 5.0 0.1 1.7 13.6 10.4 6.1 8.5 0.2 17.2 0.7 0.1 1.6 1.5 13.8 10.7 29.1 43.3 3.1 Mali 2006 12,721 7.1 11.1 8.5 4.9 0.0 1.3 10.3 17.7 8.9 10.1 0.5 14.8 1.0 0.2 1.9 1.5 7.1 11.1 25.0 53.3 3.5 Niger 2006 7,871 5.0 9.8 9.0 4.6 0.1 0.7 11.2 20.8 10.5 8.7 0.5 13.1 1.1 0.2 2.7 2.0 5.0 9.8 25.6 54.9 4.7 Nigeria 2008 29,891 5.8 21.1 8.6 3.9 0.0 1.3 9.9 13.8 7.1 9.2 0.7 14.4 0.4 0.2 2.1 1.4 5.8 21.1 23.8 45.9 3.4 Sao Tome & Principe 2008-09 2,394 12.8 16.7 7.2 4.4 0.0 1.4 11.7 9.7 6.5 8.8 0.2 16.4 0.5 0.2 2.0 1.5 12.8 16.7 24.7 42.3 3.5 Senegal 2010-11 14,480 8.9 25.9 8.3 4.6 0.0 1.8 9.0 11.0 6.0 9.1 1.0 11.5 0.3 0.3 1.1 1.3 8.9 25.9 23.7 39.2 2.3 Sierra Leone 2008 6,776 13.2 12.3 9.3 4.8 0.1 2.1 14.0 13.9 7.3 6.2 0.4 12.5 0.7 0.3 1.8 1.1 13.2 12.3 30.3 41.4 2.8

East and Southern Africa 

Burundi 2010 8,408 4.3 23.8 8.7 5.5 0.0 0.8 7.0 12.0 7.8 12.8 0.6 12.9 0.1 0.0 1.8 1.8 4.3 23.8 22.0 46.3 3.6 Ethiopia 2011 15,310 9.2 21.9 6.6 3.5 0.0 1.2 12.2 11.4 5.8 12.8 0.4 12.3 0.2 0.0 1.3 0.9 9.2 21.9 23.6 43.0 2.3 Kenya 2008-09 7,851 12.9 17.3 7.1 5.1 0.0 2.1 12.7 9.5 5.3 10.2 0.3 15.1 0.4 0.1 1.0 0.7 12.9 17.3 27.0 41.0 1.8 Lesotho 2009 7,303 19.0 21.2 8.9 5.8 0.0 4.2 8.0 4.3 3.0 10.2 0.8 12.8 0.4 0.1 0.6 0.7 19.0 21.2 27.0 31.6 1.2 Madagascar 2008-09 15,938 12.2 14.0 7.4 4.4 0.1 3.1 14.0 9.9 5.5 9.7 1.0 15.0 0.8 0.3 1.3 1.3 12.2 14.0 29.0 42.0 2.8 Malawi 2010 20,948 9.7 10.3 8.7 5.9 0.0 1.1 15.8 11.9 8.9 11.5 0.3 12.6 0.5 0.1 1.4 1.3 9.7 10.3 31.4 45.8 2.8 Mozambique 2011 12,229 10.6 10.4 9.2 6.1 0.1 2.6 11.5 13.7 7.2 10.2 0.8 13.0 1.0 0.2 1.7 1.5 10.6 10.4 29.5 46.3 3.2 Namibia 2006-07 9,277 17.7 23.1 8.1 4.9 0.0 3.7 8.4 5.4 3.0 10.4 0.8 12.5 0.3 0.3 0.8 0.8 17.7 23.1 25.0 32.6 1.6 Rwanda 2010 12,715 8.3 26.1 7.3 4.9 0.0 1.4 11.5 6.9 4.8 11.3 0.6 14.1 0.0 0.0 1.2 1.4 8.3 26.1 25.1 38.0 2.5 Swaziland 2006-07 4,708 16.6 18.0 8.8 5.2 0.0 2.5 10.8 6.2 4.0 11.2 0.8 14.2 0.6 0.0 0.6 0.4 16.6 18.0 27.4 36.9 1.1 Tanzania 2010 9,170 11.0 14.4 8.5 4.8 0.0 1.9 11.3 12.2 7.1 10.6 0.5 14.4 0.5 0.1 1.5 1.3 11.0 14.4 26.5 45.4 2.7 Uganda 2011 7,663 6.5 14.1 8.5 4.2 0.0 1.0 12.9 15.4 7.9 12.0 0.4 13.9 0.4 0.0 1.4 1.3 6.5 14.1 26.5 50.1 2.8 Zambia 2007 6,384 9.6 13.6 8.7 5.4 0.0 1.6 10.3 15.2 8.6 10.8 0.5 11.9 0.7 0.1 1.5 1.5 9.6 13.6 26.0 47.8 3.0 Zimbabwe 2010-11 8,413 16.9 16.2 11.3 6.1 0.0 2.7 10.6 8.0 3.6 9.8 0.5 12.5 0.4 0.1 0.6 0.7 16.9 16.2 30.8 34.9 1.2

Middle East/North Africa 

Egypt 2008 14,972 13.5 5.6 11.1 6.4 0.0 5.0 17.5 7.1 4.7 0.3 1.3 26.1 0.1 0.0 0.5 0.6 13.5 5.6 40.0 39.7 1.2 Jordan 2007 9,561 7.1 6.0 9.7 4.0 0.0 2.3 17.9 12.4 7.9 0.1 1.5 27.9 0.1 0.1 1.7 1.3 7.1 6.0 33.8 50.2 2.9

Eastern Europe/NIS

Albania 2008-09 7,434 15.7 24.8 3.2 2.1 0.0 14.0 8.3 1.3 0.9 10.0 1.2 18.3 0.0 0.0 0.0 0.1 15.7 24.8 27.6 31.8 0.1 Armenia 2010 5,744 19.0 29.3 5.2 4.3 0.0 15.0 5.6 1.0 0.6 5.6 2.2 11.9 0.0 0.1 0.0 0.1 19.0 29.3 30.1 21.5 0.1 Azerbaijan 2006 8,147 15.7 26.2 5.1 3.1 0.0 11.0 8.6 1.7 1.2 7.9 3.0 16.2 0.0 0.1 0.1 0.1 15.7 26.2 27.8 30.1 0.2 Ukraine 2007 6,650 30.2 23.0 3.4 2.8 0.0 27.3 1.6 0.3 0.3 5.4 1.6 3.8 0.0 0.0 0.1 0.0 30.2 23.0 35.1 11.5 0.2

(Continued)
18

Table 3. − ContinuedCountry 

Survey 

date 

Number of 

respondents 

Extra risk due to fertility pattern Single, double and 3-way risk combinations 

No extra 

risk 

Unavoidable first birth risk 

Single 

spacing 

risk <15 

months 

Single 

spacing 

risk 15-26 

months 

Single 

age risk 

<18 

years 

Single 

age risk 

40+ years

Single 

risk order 

4+ 

Double 

risk 

spacing 

<15, order 

4+ 

Double 

risk 

spacing15

-26, order 

4+ 

Double 

risk first 

birth age 

<18 

Double 

risk first 

birth age 

40+ 

Double 

risk order 

4+, age 

40+ 

Double 

risk 

spacing 

<15, age 

<18 

Other 

double 

risk1

3 way risk 

spacing 

15-26, age 

<18, order 

4+ 

3 way risk 

spacing 

15-26, age 

40+, order 

4+ 

No extra 

risk 

Unavoidable 

first birth 

risk 

Any 

single risk

Any 

double 

risk 

Any 3 way 

risk 

Asia 

Bangladesh 2011 16,680 26.8 6.0 7.5 5.2 0.1 5.0 19.3 4.3 2.6 1.6 0.5 19.8 0.9 0.1 0.2 0.2 26.8 6.0 37.1 29.8 0.3 Cambodia 2010 17,821 12.9 23.9 6.8 4.7 0.0 4.5 9.5 3.7 2.5 9.8 2.1 18.4 0.1 0.1 0.5 0.6 12.9 23.9 25.4 36.7 1.1 India 2005-06 117,956 15.6 18.7 6.4 3.8 0.0 4.8 18.1 4.3 2.9 9.0 0.7 15.1 0.2 0.0 0.2 0.2 15.6 18.7 33.2 32.2 0.3 Indonesia 2007 31,231 28.4 4.9 8.7 5.5 0.0 10.4 10.9 4.0 2.7 0.3 1.0 21.5 0.1 0.2 0.8 0.7 28.4 4.9 35.5 29.8 1.4 Nepal 2011 12,053 18.4 18.6 6.8 4.0 0.0 3.4 15.8 3.5 2.4 9.8 0.7 15.9 0.1 0.0 0.2 0.3 18.4 18.6 30.0 32.4 0.6 Pakistan 2012-13 12,097 8.4 9.5 10.2 4.3 0.0 2.4 19.2 12.2 6.5 0.4 1.2 23.9 0.1 0.0 0.9 0.8 8.4 9.5 36.1 44.3 1.7 Philippines 2008 12,889 12.4 25.7 5.9 3.8 0.0 5.2 9.6 4.7 3.2 9.8 2.1 15.6 0.2 0.2 0.7 0.7 12.4 25.7 24.6 35.9 1.4 Timor-Leste 2009 12,238 3.9 27.1 6.1 2.9 0.0 1.7 9.3 10.8 5.5 12.0 1.5 14.7 0.1 0.1 2.3 1.9 3.9 27.1 20.0 44.7 4.3

Latin America and Caribbean 

Bolivia 2008 16,001 14.8 20.9 6.4 4.2 0.0 4.0 11.6 5.5 3.7 9.3 1.0 16.2 0.4 0.3 0.8 0.8 14.8 20.9 26.3 36.3 1.7 Colombia 2010 51,729 20.0 19.1 4.7 3.7 0.0 10.5 8.3 1.8 1.4 14.6 1.8 13.1 0.3 0.3 0.2 0.2 20.0 19.1 27.1 33.3 0.5 Dominican Rep. 2007 25,996 16.1 18.8 5.1 3.7 0.0 6.2 16.7 3.2 2.7 9.2 1.1 16.3 0.4 0.1 0.2 0.2 16.1 18.8 31.6 33.1 0.3 Guyana 2009 4,782 16.7 20.4 5.5 3.2 0.0 7.6 11.5 3.7 2.4 9.2 2.0 16.7 0.3 0.3 0.5 0.2 16.7 20.4 27.8 34.5 0.6 Peru 2012 22,055 18.8 22.4 5.1 4.1 0.0 7.6 8.9 2.9 2.4 9.1 1.6 15.5 0.2 0.4 0.5 0.6 18.8 22.4 25.7 31.9 1.2

Unweighted Averages

West and Central Africa 139,013 9.2 16.6 8.6 4.8 0.0 1.6 10.9 13.4 7.3 9.0 0.5 14.4 0.5 0.2 1.7 1.4 9.2 16.6 25.9 45.3 3.1 East and Southern Africa 146,317 11.8 17.5 8.4 5.1 0.0 2.1 11.2 10.1 5.9 11.0 0.6 13.4 0.5 0.1 1.2 1.1 11.8 17.5 26.9 41.6 2.3 Middle East/North Africa 24,533 10.3 5.8 10.4 5.2 0.0 3.7 17.7 9.8 6.3 0.2 1.4 27.0 0.1 0.1 1.1 1.0 10.3 5.8 36.9 45.0 2.1 Eastern Europe/NIS 27,975 20.2 25.8 4.2 3.1 0.0 16.8 6.0 1.1 0.8 7.2 2.0 12.6 0.0 0.1 0.1 0.1 20.2 25.8 30.2 23.7 0.1 Asia 232,965 15.9 16.8 7.3 4.3 0.0 4.7 14.0 5.9 3.5 6.6 1.2 18.1 0.2 0.1 0.7 0.7 15.9 16.8 30.2 35.7 1.4 Latin America and Caribbean 120,563 17.3 20.3 5.4 3.8 0.0 7.2 11.4 3.4 2.5 10.3 1.5 15.6 0.3 0.3 0.4 0.4 17.3 20.3 27.7 33.8 0.9 

Total 691,366 13.1 17.6 7.6 4.6 0.0 4.4 11.5 8.7 5.0 8.8 0.9 15.3 0.4 0.1 1.1 0.9 13.1 17.6 28.1 39.2 2.0 1 Includes double risks: order 4+ and age <18; spacing 15-26 and age <18; spacing <15 and age 40+; spacing 15-26 and age 40+ 
19 

3.2.1. Need for contraception based on fertility-related risks 

Table 4 reveals that two-thirds of non-pregnant fecund women have a need to use contraception based on 

their fertility risk status. The table shows the distribution of non-pregnant women across three categories 

(with the percentages in each row adding to 100). The column “no need for contraception” includes women 

between the ages of 18 and 39 who have had less than 3 births and whose last birth (if any) occurred 27 or 

more months ago. The column “spacing method need” includes women under age 18 and/or whose last 

birth occurred less than 27 months ago. The column “need for a long-acting or permanent method (LAPM)” 

includes women who are age 40 or over and/or who have had 3 or more births. This table indicates that 

overall slightly more than one in five non-pregnant women have a need for a spacing method due to being 

less than 18 years of age or having had a birth within the last 27 months. Nearly half the non-pregnant 

women (46 percent) have a need for a limiting method due to having had 3 children already or being 40 

years of age or over. 

The need for a spacing method is highest in the two sub-Saharan African regions, and the need for a limiting 

method is highest in the Middle East/North Africa region (Note: the Middle East/North Africa region is 

based on only two country surveys). In eight countries in East and Southern Africa, at least 25 percent of 

non-pregnant women have a spacing need. In eleven countries, the limiting need exceeds 50 percent, 5 in 

West and Central Africa, 2 in East and Southern Africa, in both countries in Middle East/North Africa, and 

2 in Asia. 

Table 4. Percent distribution of non-pregnant women by need for contraception 

based on fertility risk, 45 DHS country surveys 2006-2012 

Country 

Survey 

date 

Number of 

respondents 

Need for contraception based 

on fertility risk 

No need for 

contraception Spacing 

method need 

Need for 

LAPM 

West and Central Africa 

Benin 2006 15,850 27.1 23.1 49.8 

Burkina Faso 2010 15,357 23.2 24.0 52.7 

Cameroon 2011 13,914 32.2 24.4 43.4 

DR Congo 2007 8,872 34.5 21.9 43.6 

Ghana 2008 4,556 36.4 21.6 41.9 

Liberia 2007 6,331 26.2 23.1 50.7 

Mali 2006 12,721 22.5 24.6 52.9 

Niger 2006 7,871 18.9 23.4 57.8 

Nigeria 2008 29,891 29.3 22.1 48.7 

Sao Tome & Principe 2008-09 2,394 31.2 19.8 49.0 

Senegal 2010-11 14,480 36.7 22.5 40.8 

Sierra Leone 2008 6,776 28.8 20.7 50.5 

East and Southern Africa 

Burundi 2010 8,408 30.2 26.9 42.9 

Ethiopia 2011 15,310 33.0 23.2 43.9 

Kenya 2008-09 7,851 31.7 22.6 45.7 

Lesotho 2009 7,303 40.1 25.3 34.6 

Madagascar 2008-09 15,938 27.6 22.6 49.9 

Malawi 2010 20,948 21.4 26.4 52.2 

Mozambique 2011 12,229 25.8 26.3 47.9 

Namibia 2006-07 9,277 41.8 23.4 34.8 

Rwanda 2010 12,715 35.2 23.5 41.3 

Swaziland 2006-07 4,708 36.1 25.8 38.1 

Tanzania 2010 9,170 27.1 24.6 48.3 

Uganda 2011 7,663 22.4 25.0 52.6 

Zambia 2007 6,384 24.5 25.6 49.9 

Zimbabwe 2010-11 8,413 34.0 27.8 38.3 

(Continued)
20 

Table 4. − Continued 

Country 

Survey 

date 

Number of 

respondents 

Need for contraception based 

on fertility risk 

No need for 

contraception 

Spacing 

method need 

Need for 

LAPM 

Middle East/North Africa 

Egypt 2008 14,972 21.4 18.0 60.6 

Jordan 2007 9,561 14.5 13.9 71.7 

Eastern Europe/NIS 

Albania 2008-09 7,434 42.2 15.2 42.6 

Armenia 2010 5,744 52.9 15.1 32.0 

Azerbaijan 2006 8,147 44.7 16.0 39.3 

Ukraine 2007 6,650 56.1 11.6 32.3 

Asia 

Bangladesh 2011 16,680 34.8 15.8 49.4 

Cambodia 2010 17,821 40.5 20.8 38.7 

India 2005-06 117,956 36.9 19.3 43.7 

Indonesia 2007 31,231 34.4 14.6 51.0 

Nepal 2011 12,053 39.1 20.6 40.2 

Pakistan 2012-13 12,097 18.9 14.9 66.3 

Philippines 2008 12,889 39.2 19.7 41.1 

Timor-Leste 2009 12,238 32.4 20.8 46.8 

Latin America and Caribbean 

Bolivia 2010 51,729 40.7 23.4 35.9 

Colombia 2008 16,001 38.4 20.3 41.3 

Dominican Rep. 2007 25,996 36.4 18.4 45.2 

Guyana 2009 4,782 38.1 18.1 43.8 

Peru 2012 22,055 44.0 18.5 37.5 

Unweighted Averages 

West and Central Africa 139,013 28.9 22.6 48.5 

East and Southern Africa 146,317 30.8 24.9 44.3 

Middle East/North Africa 24,533 18.0 16.0 66.2 

Eastern Europe/NIS 27,975 49.0 14.5 36.6 

Asia 232,965 34.5 18.3 47.2 

Latin America and Caribbean 68,834 39.2 18.8 42.0 

Total 691,366 33.0 21.2 45.8 

Note: Need for contraception based on fertility risk is categorized as follows: 

- No need for contraception includes women between the ages of 18 and 39 who have had less than 

3 births and whose last birth (if any) occurred 27 or more months ago. Also includes women who 

have declared themselves to be infecund or who have had a hysterectomy. 

- Spacing method need includes women under age 18 and/or whose last birth occurred less than 27 

months ago. 

- Need for LAPM includes women age 40 or over and/or have had 3 or more births. 

LAPM: Long Acting and Permanent Methods--intrauterine devices (IUDs), implants, female and male 

sterilization 
21 

3.2.2. Fertility desires of non-pregnant women 

Many non-pregnant women face a fertility-related risk, but also want to either delay or avoid a/another birth 

as do women without a fertility-related risk. An examination of non-pregnant women’s desires for future 

fertility is provided in Table 5. Just over half of non-pregnant women want to have a future birth, and about 

one in three do not. If sterilized women or women with sterilized husbands are included, the percentage 

reaches 38 percent who do not want a future birth. The remaining 11 percent were either undecided (5 

percent), infecund (3 percent), had missing responses, or were not asked due to never having had sex or not 

being currently in a marital union (3 percent)10. By region, West and Central Africa have the highest 

percentage of non-pregnant women who want a future birth (68 percent) and the Middle East/North Africa 

the lowest (34 percent). By individual country, the highest percentage of women who want a/another birth 

is in Niger (84 percent) and the lowest is in Egypt and Bangladesh (28 and 29 percent, respectively). Table 

5 also shows that although slightly more than half of non-pregnant women want a future birth, only one in 

seven want that birth within 2 years of the survey. Only in Pakistan, Egypt and India do more than half of 

those who want a future birth want that birth to occur within two years. 

Table 5. Percent distribution of all1 non-pregnant women by desires for more children, 45 DHS 

country surveys 2006-2012 

Country 

Survey 

date 

Number 

of 

respondents 

Desire for more children 

Have another 

Undecided Wants no 

more 

Sterilized 

(respondent or 

partner) 

Declared 

infecund Missing 

Not 

asked1 Total 

Wants 

within 2 

years 

Wants 

after 2+ 

years 

Wants, 

unsure 

timing 

West and Central Africa 

Benin 2006 15,850 21.0 34.9 11.9 2.5 23.1 0.3 5.7 0.5 0.0 100.0 

Burkina Faso 2010 15,357 18.0 37.2 5.5 1.5 20.9 0.2 2.7 0.2 13.8 100.0 

Cameroon 2011 13,914 22.5 32.4 17.9 2.4 20.9 0.4 3.1 0.4 0.0 100.0 

DR Congo 2007 8,872 20.8 25.2 21.6 5.0 16.9 0.6 9.6 0.3 0.0 100.0 

Ghana 2008 4,556 15.1 29.5 21.9 6.5 24.4 1.1 1.3 0.2 0.0 100.0 

Liberia 2007 6,331 17.6 33.0 11.5 9.7 24.5 0.5 2.1 1.1 0.0 100.0 

Mali 2006 12,721 28.0 24.2 22.0 2.5 17.8 0.3 4.6 0.6 0.0 100.0 

Niger 2006 7,871 33.9 35.4 14.5 1.8 9.3 0.3 4.4 0.4 0.0 100.0 

Nigeria 2008 29,891 23.0 22.7 21.7 12.3 16.4 0.3 2.9 0.6 0.0 100.0 

Sao Tome & 

Principe 2008-09 2,394 8.7 35.8 6.7 5.6 38.8 1.0 2.7 0.7 0.0 100.0 

Senegal 2010-11 14,480 21.6 24.9 33.4 2.1 15.5 0.2 2.3 0.0 0.0 100.0 

Sierra Leone 2008 6,776 24.6 21.4 11.5 9.4 26.9 0.0 4.3 1.9 0.0 100.0 

East and Southern Africa 

Burundi 2010 8,408 9.9 33.6 26.7 2.3 24.8 0.4 2.2 0.2 0.0 100.0 

Ethiopia 2011 15,310 13.1 38.6 11.0 3.9 30.9 0.4 1.9 0.2 0.0 100.0 

Kenya 2008-09 7,851 10.7 28.8 13.7 3.3 38.3 3.4 1.6 0.1 0.0 100.0 

Lesotho 2009 7,303 12.1 26.9 3.7 0.0 52.6 1.8 0.3 0.0 2.6 100.0 

Madagascar 2008-09 15,938 15.4 32.4 9.5 2.8 37.4 1.0 1.5 0.1 0.0 100.0 

Malawi 2010 20,948 11.4 35.3 8.1 2.6 32.6 8.3 1.5 0.1 0.0 100.0 

Mozambique 2011 12,229 25.9 25.2 8.8 6.0 28.5 0.2 5.5 0.0 0.0 100.0 

Namibia 2006-07 9,277 9.1 22.7 13.5 6.8 40.0 5.4 1.6 0.7 0.0 100.0 

Rwanda 2010 12,715 5.4 19.4 5.3 1.1 35.2 0.5 0.8 0.1 32.2 100.0 

Swaziland 2006-07 4,708 7.4 19.7 14.0 1.8 52.0 3.2 1.8 0.1 0.0 100.0 

Tanzania 2010 9,170 17.7 31.9 5.7 1.1 23.2 2.8 2.0 0.2 15.3 100.0 

Uganda 2011 7,663 13.0 39.3 8.0 3.1 32.0 2.5 1.9 0.1 0.0 100.0 

Zambia 2007 6,384 12.4 31.8 15.3 7.9 29.3 1.6 1.7 0.2 0.0 100.0 

Zimbabwe 2010-11 8,413 15.7 32.8 7.2 6.3 35.8 1.0 1.2 0.0 0.0 100.0 

Middle East/North Africa 

Egypt* 2008 14,972 14.3 12.7 0.5 2.1 59.4 1.1 2.5 0.0 7.5 100.0 

Jordan* 2007 9,561 18.4 21.4 1.0 2.2 45.7 4.1 1.8 0.0 5.3 100.0 

(Continued)

 

10 Table 5 is for all non-pregnant women. However, in a few countries, never married and not currently married 

women were not asked the questions. 
22 

Table 5. − Continued

Country 

Survey 

date 

Number 

of 

respondents 

Desire for more children 

Have another 

Undecided Wants no 

more 

Sterilized 

(respondent or 

partner) 

Declared 

infecund Missing 

Not 

asked1

 Total 

Wants 

within 2 

years 

Wants 

after 2+ 

years 

Wants, 

unsure 

timing 

Eastern Europe/NIS 

Albania 2008-09 7,434 6.9 9.2 25.2 4.6 49.5 2.2 2.4 0.0 0.0 100.0 

Armenia 2010 5,744 6.4 8.0 20.1 16.9 40.9 0.2 7.4 0.1 0.0 100.0 

Azerbaijan 2006 8,147 6.3 3.2 29.1 5.8 50.6 0.3 4.2 0.5 0.0 100.0 

Ukraine 2007 6,650 6.8 7.5 21.2 10.1 47.5 0.5 5.9 0.5 0.0 100.0 

Asia 

Bangladesh* 2011 16,680 10.8 17.4 0.5 1.1 54.9 6.2 2.3 6.8 0.0 100.0 

Cambodia 2010 17,821 7.6 16.6 20.0 11.0 37.9 1.6 5.2 0.0 0.0 100.0 

India 2005-06 117,956 9.8 7.7 1.0 0.7 24.5 32.0 3.2 0.1 20.9 100.0 

Indonesia* 2007 31,231 13.5 21.3 3.0 3.3 47.9 3.4 1.2 0.2 6.1 100.0 

Nepal 2011 12,053 6.7 13.2 13.9 6.4 38.8 18.8 2.3 0.0 0.0 100.0 

Pakistan* 2012-13 12,097 23.7 14.8 1.2 2.6 41.3 9.5 1.5 0.2 5.1 100.0 

Philippines 2008 12,889 9.3 26.6 12.3 6.9 37.4 6.3 1.2 0.0 0.0 100.0 

Timor-Leste 2009 12,238 5.3 19.1 4.0 43.4 25.5 0.5 2.2 0.0 0.0 100.0 

Latin America and Caribbean 

Bolivia 2008 16,001 8.3 32.0 2.8 1.4 47.9 4.6 2.9 0.0 0.0 100.0 

Colombia 2010 51,729 8.7 32.6 3.0 2.0 26.5 25.2 2.0 0.0 0.0 100.0 

Dominican 

Rep. 2007 25,996 12.0 30.9 4.1 1.0 14.5 35.5 1.7 0.3 0.0 100.0 

Guyana 2009 4,782 12.0 25.5 9.9 5.3 41.5 3.9 1.6 0.4 0.0 100.0 

Peru 2012 22,055 9.1 40.2 0.7 0.7 39.6 6.6 3.1 0.0 0.0 100.0 

Unweighted Averages 

West and Central Africa 139,013 21.2 29.7 16.7 5.1 21.3 0.4 3.8 0.6 1.2 100.0 

East and Southern Africa 146,317 12.8 29.9 10.8 3.5 35.2 2.3 1.8 0.2 3.6 100.0 

Middle East/North Africa 24,533 16.4 17.1 0.8 2.2 52.6 2.6 2.2 - 6.4 100.0 

Eastern Europe/NIS 27,975 6.6 7.0 23.9 9.4 47.1 0.8 5.0 0.3 - 100.0 

Asia 232,965 10.8 17.1 7.0 9.4 38.5 9.8 2.4 0.9 4.0 100.0 

Latin America and 

Caribbean 120,563 10.0 32.2 4.1 2.1 34.0 15.2 2.3 0.1 - 100.0 

Total 691,366 14.0 25.2 11.6 5.3 33.8 4.4 2.8 0.4 2.4 100.0 

* Ever-married samples 

1Not asked of women who were not currently married or who never had sexual relations, depending on survey. 

3.2.3. Fertility desires versus risk-based need for contraception 

Women have varying desires for future births and varying fertility-based needs to delay or avoid a future 

birth. Table 6 shows the interaction of the two concepts. Among non-pregnant women with no risk-based 

need, less than one in four want another birth within two years. Two out of three non-pregnant women with 

a risk-based need to space their births also want to delay the next birth or are unsure about the timing of the 

next birth. About two of three non-pregnant women with a risk-based need to limit their births either express 

that they do not want a future birth or are using sterilization as a method. Only 11 percent want another 

child in the near future. However, not all non-pregnant women’s desires coincide with their risk-based need 

to limit births. For three countries (Mali, Niger, and Nigeria), less than one third of non-pregnant women 

with a risk-based limiting need want no more children or are using sterilization, and in seven other countries 

in West and Central Africa, fewer than half of these women want no more children. The only other country 

with such a low percentage is Tanzania. 
23

Table 6. Percent distribution of all1 non-pregnant women by desires for more children according to risk-based need for contraception, 

45 DHS country surveys 2006-2012 

Country 

Survey 

date 

Need for contraception based on fertility risk 

Number 

of 

respondents 

No risk-based need for contraception Risk-based need for a spacing method Risk-based need for a long acting or permanent method (LAPM) 

Wants 

within 2 

years 

Wants 

after 2+ 

years 

Wants, 

unsure 

timing

Undecided

Wants 

no 

more 

Sterilized 

(respondent or 

partner)

Declared 

infecund 

Not 

asked or 

missing1

Number 

of 

respondents 

Wants 

within 2 

years 

Wants 

after 2+ 

years 

Wants, 

unsure 

timing 

Undecided 

Wants 

no 

more 

Sterilized 

(respondent or 

partner)

Not 

asked or 

missing1

Number 

of 

respondents 

Wants 

within 2 

years 

Wants 

after 2+ 

years 

Wants, 

unsure 

timing

Undecided

Wants 

no 

more 

Sterilized 

(respondent or 

partner)

Not 

asked or 

missing1

West and Central Africa 

Benin 2006 4,299 28.7 25.7 19.6 1.7 2.5 0.1 21.2 0.4 3,659 13.5 60.0 21.2 2.0 2.5 0.0 0.7 7,892 20.3 28.3 3.3 3.2 43.8 0.5 0.5Burkina Faso 2010 3,566 31.3 15.2 15.2 0.5 1.3 0.0 11.5 24.9 3,691 9.0 51.2 4.9 0.3 0.9 0.0 33.6 8,100 16.3 40.4 1.5 2.6 38.7 0.3 0.3 Cameroon 2011 4,475 29.0 30.0 28.6 0.7 1.9 0.0 9.5 0.2 3,403 13.9 51.7 29.4 1.4 3.2 0.0 0.3 6,036 22.6 23.4 3.4 4.2 45.0 0.9 0.5 DR Congo 2007 3,052 21.2 8.7 34.9 3.9 2.7 0.2 27.8 0.6 1,961 13.6 44.2 30.9 6.2 5.1 0.0 0.1 3,858 24.3 28.6 6.3 5.2 34.1 1.3 0.2 

Ghana 2008 1,655 22.8 25.3 39.0 6.8 2.4 0.0 3.5 0.2 987 3.0 53.3 30.5 8.0 5.1 0.0 0.1 1,914 14.6 20.8 2.6 5.5 53.4 2.7 0.3 

Liberia 2007 1,665 27.9 30.8 17.8 12.1 2.9 0.1 8.0 0.5 1,460 8.6 50.4 21.4 14.0 4.0 0.0 1.6 3,206 16.4 26.2 3.7 6.5 45.0 0.8 1.2 

Mali 2006 2,855 36.5 4.3 35.7 1.6 1.3 0.0 20.3 0.3 3,121 18.6 32.1 43.6 2.6 2.3 0.0 0.7 6,745 28.8 28.9 6.2 2.9 31.9 0.5 0.7 Niger 2006 1,467 37.6 4.8 30.5 1.3 1.3 0.3 23.7 0.4 1,836 28.0 44.9 24.5 1.6 0.8 0.0 0.2 4,567 35.1 41.4 5.3 2.0 15.2 0.4 0.5 Nigeria 2008 8,747 23.1 10.5 41.7 13.1 1.2 0.0 9.9 0.5 6,594 20.8 35.2 31.6 10.7 1.1 0.0 0.6 14,551 23.9 24.5 5.3 12.6 32.5 0.6 0.6 Sao Tome & Principe 2008-09 750 18.2 44.9 12.6 7.1 7.6 0.1 8.8 0.8 477 2.6 63.6 8.1 8.8 14.9 0.0 1.9 1,167 5.1 18.6 2.3 3.3 68.6 1.9 0.2 

Senegal 2010-11 5,335 27.4 7.0 57.1 1.3 1.0 0.0 6.2 0.0 3,247 12.0 42.8 41.4 1.6 2.3 0.0 0.0 5,898 21.6 31.3 7.6 3.1 36.0 0.4 0.0 Sierra Leone 2008 1,949 37.6 13.8 18.5 8.8 4.6 0.0 15.0 1.7 1,395 18.5 39.5 23.4 11.4 5.5 0.0 1.6 3,432 19.8 18.3 2.7 8.8 48.2 0.1 2.1

East and Southern Africa 

Burundi 2010 2,529 14.9 18.5 54.3 2.1 2.9 0.0 7.2 0.1 2,268 5.4 55.3 34.8 1.6 2.7 0.0 0.2 3,611 9.1 30.6 2.2 2.9 54.0 0.9 0.3 Ethiopia 2011 5,045 17.9 43.2 18.0 3.4 11.3 0.2 5.9 0.1 3,548 6.2 56.7 18.2 4.8 13.9 0.0 0.1 6,717 13.2 25.5 1.9 3.8 54.6 0.7 0.3 

Kenya 2008-09 2,481 19.8 36.5 21.7 3.2 13.6 0.1 5.0 0.2 1,789 5.2 51.5 25.4 4.3 13.6 0.0 0.0 3,581 7.2 12.2 2.4 2.9 67.9 7.4 0.1 Lesotho 2009 2,946 22.5 36.4 5.8 0.0 31.0 0.4 0.7 3.1 1,847 3.3 42.1 5.2 0.0 45.1 0.1 4.2 2,510 6.3 4.5 0.2 0.0 83.6 4.6 0.8 Madagascar 2008-09 4,388 29.6 35.9 15.2 2.7 10.8 0.2 5.5 0.0 3,596 8.0 61.9 18.7 3.0 8.3 0.0 0.1 7,953 10.8 17.1 2.2 2.7 65.3 1.9 0.1 Malawi 2010 4,461 26.3 39.1 14.5 2.2 10.1 0.8 6.9 0.1 5,530 7.5 58.5 16.6 4.3 12.8 0.1 0.1 10,956 7.3 22.1 1.2 1.9 51.8 15.5 0.2 Mozambique 2011 3,156 40.2 18.1 10.3 3.4 6.7 0.0 21.4 0.0 3,231 20.0 44.7 18.1 7.7 9.5 0.0 0.0 5,843 21.4 18.2 2.8 6.4 50.8 0.4 0.0 Namibia 2006-07 3,885 13.0 30.9 19.9 7.3 23.0 1.0 3.9 0.9 2,160 4.1 30.4 19.1 9.7 35.7 0.2 0.6 3,231 7.9 7.7 2.1 4.1 63.3 14.3 0.6 

Rwanda 2010 4,471 8.5 12.8 9.7 0.6 5.2 0.0 2.3 61.0 2,990 2.4 38.4 6.4 0.6 7.1 0.0 45.0 5,253 4.4 14.1 0.9 1.9 76.7 1.3 0.8 Swaziland 2006-07 1,697 13.1 27.8 20.6 2.3 30.8 0.3 5.0 0.1 1,213 2.0 30.3 24.3 2.3 40.9 0.1 0.1 1,797 5.6 4.8 0.9 1.1 79.6 7.9 0.1 Tanzania 2010 2,489 30.2 20.4 12.6 0.6 3.9 0.1 7.4 24.8 2,250 8.1 45.0 6.5 0.7 4.8 0.0 34.9 4,431 15.5 31.8 1.5 1.6 43.5 5.7 0.5 Uganda 2011 1,719 25.4 43.3 15.2 2.4 4.8 0.2 8.7 0.0 1,921 8.0 65.7 16.2 4.3 5.7 0.0 0.2 4,024 10.2 25.0 1.0 2.8 56.2 4.7 0.1 Zambia 2007 1,564 23.1 26.1 28.5 8.3 6.8 0.3 6.8 0.2 1,635 6.7 47.7 26.9 10.9 7.3 0.2 0.2 3,184 10.0 26.4 2.9 6.1 51.6 2.9 0.1Zimbabwe 2010-11 2,855 29.9 31.9 12.7 6.2 15.5 0.1 3.6 0.0 2,337 6.7 60.7 9.2 8.1 15.3 0.0 0.0 3,222 9.5 13.4 0.9 5.2 68.6 2.4 0.0

Middle East/North Africa 

Egypt* 2008 3,213 40.7 8.1 0.6 2.9 27.8 0.1 11.5 8.4 2,688 16.5 52.5 1.2 3.3 25.1 0.0 1.4 9,070 4.2 2.6 0.2 1.4 80.8 1.8 9.0 Jordan* 2007 1,378 52.8 10.4 1.2 1.2 9.7 0.0 12.2 12.6 1,326 21.8 65.9 0.9 2.4 8.1 0.0 0.8 6,857 10.9 15.1 1.0 2.3 60.3 5.7 4.7

Eastern Europe/NIS 

Albania 2008-09 3,136 12.7 12.3 40.6 5.8 22.5 0.3 5.8 0.0 1,142 4.0 24.0 51.5 8.1 12.3 0.1 0.0 3,155 2.1 0.9 0.5 2.1 89.8 4.7 0 Armenia 2010 3,048 8.4 5.6 30.3 22.0 19.6 0.0 13.9 0.1 856 7.6 31.5 23.6 23.6 13.5 0.0 0.1 1,841 2.3 1.0 1.7 5.4 88.7 0.6 0.2 Azerbaijan 2006 3,652 9.0 2.2 46.7 7.1 25.2 0.0 9.4 0.5 1,301 9.5 12.8 44.5 10.8 21.1 0.0 1.4 3,193 1.8 0.5 2.8 2.2 91.8 0.7 0.2 Ukraine 2007 3,731 10.3 8.3 29.2 13.0 27.6 0.4 10.4 0.7 768 4.4 24.4 37.9 16.2 16.6 0.3 0.2 2,150 1.6 0.2 1.5 2.8 92.9 0.8 0.2

(Continued)
24

Table 6. − ContinuedCountry 

Survey 

date 

Need for contraception based on fertility risk 

Number 

of 

respondents 

No risk-based need for contraception Risk-based need for a spacing method Risk-based need for a long acting or permanent method (LAPM) 

Wants 

within 2 

years 

Wants 

after 2+ 

years 

Wants, 

unsure 

timing

Undecided

Wants 

no 

more 

Sterilized 

(respondent or 

partner)

Declared 

infecund 

Not 

asked or 

missing1

Number 

of 

respondents 

Wants 

within 2 

years 

Wants 

after 2+ 

years 

Wants, 

unsure 

timing 

Undecided 

Wants 

no 

more 

Sterilized 

(respondent or 

partner)

Not 

asked or 

missing1

Number 

of 

respondents 

Wants 

within 2 

years 

Wants 

after 2+ 

years 

Wants, 

unsure 

timing

Undecided

Wants 

no 

more 

Sterilized 

(respondent or 

partner)

Not 

asked or 

missing1

Asia 

Bangladesh* 2011 5,811 23.3 23.4 0.8 1.4 36.0 2.0 6.5 6.6 2,560 8.1 53.3 0.8 2.0 33.7 0.8 1.3 8,310 2.9 2.2 0.1 0.5 74.7 10.8 8.8 Cambodia 2010 7,228 11.7 15.6 33.8 15.1 10.5 0.4 12.8 0.0 3,694 3.4 39.5 26.6 16.2 14.0 0.2 0.0 6,899 5.5 5.5 2.0 3.9 79.3 3.7 0.1 India 2005-06 43,537 17.7 4.7 1.2 0.8 14.2 18.0 8.7 34.7 22,814 10.6 25.4 2.2 0.9 14.3 5.3 41.2 51,605 2.8 2.4 0.4 0.5 37.8 55.6 0.4 

Indonesia* 2007 10,742 28.9 28.3 4.7 2.7 25.5 0.5 3.6 5.8 4,553 4.1 58.4 3.7 5.2 25.8 0.3 2.5 15,937 5.8 6.0 1.6 3.3 69.4 6.1 7.7 Nepal 2011 4,713 12.3 16.1 20.9 8.8 27.7 8.3 5.9 0.0 2,491 5.0 30.1 26.5 13.1 24.3 1.0 0.0 4,848 2.1 1.6 0.6 0.7 57.0 38.1 0.0Pakistan* 2012-13 2,281 66.3 5.7 1.7 1.8 8.3 0.8 8.2 7.2 1,800 29.3 54.2 2.3 4.0 8.6 0.1 1.5 8,016 10.4 8.6 0.8 2.5 58.0 14.1 5.6 

Philippines 2008 5,046 16.3 38.6 20.3 8.3 12.9 0.6 3.1 0.0 2,544 2.1 47.3 19.2 11.4 19.3 0.7 0.0 5,299 6.2 5.2 1.3 3.4 69.4 14.5 0.0 Timor-Leste 2009 3,960 5.0 5.3 7.7 70.0 5.0 0.1 6.9 0.0 2,554 4.1 29.1 5.1 58.4 3.2 0.0 0.0 5,723 6.1 24.2 0.8 18.3 49.6 1.1 0.0

Latin America and Caribbean 

Bolivia 2008 6,143 14.2 50.1 4.0 1.7 22.0 0.4 7.6 0.0 3,264 2.1 53.7 4.9 2.7 36.3 0.2 0.0 6,594 5.8 4.4 0.6 0.6 77.9 10.8 0.0 Colombia 2010 21,059 15.9 41.8 3.3 2.5 19.9 11.8 4.8 0.0 12,099 1.8 64.1 6.6 2.9 19.6 5.0 0.0 18,571 5.1 1.7 0.4 0.9 38.4 53.5 0.0 Dominican Rep. 2007 9,447 24.8 45.4 6.7 1.1 9.3 7.5 4.7 0.3 4,789 5.3 70.3 8.0 1.6 11.8 2.6 0.4 11,760 4.3 3.3 0.4 0.6 19.8 71.4 0.3 Guyana 2009 1,834 22.2 34.6 15.7 6.2 16.5 0.4 4.1 0.4 866 4.6 56.3 16.5 7.9 14.6 0.0 0.1 2,082 6.2 4.6 2.0 3.3 74.8 8.6 0.6 Peru 2012 9,697 13.9 56.5 1.0 1.0 20.0 0.6 7.0 0.0 4,090 1.7 70.8 0.7 0.8 25.3 0.6 0.0 8,268 7.2 6.0 0.5 0.3 69.6 16.5 0.0

Unweighted Averages 

West and Central Africa 39,815 28.4 18.4 29.3 4.9 2.6 0.1 13.8 2.5 31,831 13.5 47.4 25.9 5.7 4.0 - 3.5 67,366 20.7 27.6 4.2 5.0 41.0 0.9 0.6 East and Southern Africa 43,686 22.5 30.1 18.5 3.2 12.6 0.3 6.5 6.5 36,315 6.7 49.2 17.5 4.5 15.9 0.1 6.1 66,313 9.9 18.1 1.7 3.1 62.0 5.0 0.3 Middle East/North Africa 4,591 46.8 9.3 0.9 2.1 18.8 0.1 11.9 10.5 4,014 19.2 59.2 1.1 2.9 16.6 - 1.1 15,927 7.6 8.9 0.6 1.9 70.6 3.8 6.9 Eastern Europe/NIS 13,567 10.1 7.1 36.7 12.0 23.7 0.2 9.9 0.3 4,067 6.4 23.2 39.4 14.7 15.9 0.1 0.4 10,339 2.0 0.7 1.6 3.1 90.8 1.7 0.2 Asia 83,318 22.7 17.2 11.4 13.6 17.5 3.8 7.0 6.8 43,010 8.3 42.2 10.8 13.9 17.9 1.1 5.8 106,637 5.2 7.0 1.0 4.1 61.9 18.0 2.8 Latin America and Caribbean 48,180 18.2 45.7 6.1 2.5 17.5 4.1 5.6 0.1 25,108 3.1 63.0 7.3 3.2 21.5 1.7 0.1 47,275 5.7 4.0 0.8 1.1 56.1 32.2 0.2 

Total 233,157 23.6 23.4 19.6 6.2 12.6 1.3 9.0 4.4 144,345 8.9 47.1 18.6 7.2 13.7 0.4 4.0 313,857 10.7 15.1 2.1 3.5 58.7 8.9 1.1 * Ever-married samples 1Not asked of women who were not currently married or who never had sexual relations, depending on survey. 

Note: Need for contraception based on fertility risk is categorized as follows: No need for contraception includes women between the ages of 18 and 39 who have had less than 3 births and whose last birth (if any) occurred 27 or more months ago. Also includes women who have declared themselves to be infecund or who have had a hysterectomy. Spacing method need includes women under age 18 and/or whose last birth occurred less than 27 months ago. Need for LAPM includes women age 40 or over and/or have had 3 or more births. LAPM: Long Acting and Permanent Methods--intrauterine devices (IUDs), implants, female and male sterilization 
25 

3.2.4. Use of contraception 

Long-acting and permanent methods (LAPM) are appropriate for women who do not want a future birth or 

who have a risk-based need to avoid a future birth. These methods provide the greatest protection from a 

future birth. Long-acting and permanent methods include the intrauterine device (IUD) and the progestogen 

implant, as well as female and male sterilization. The use of LAPM and other methods by non-pregnant 

women is shown in Table 7. Only 8 percent of non-pregnant women use LAPM, while 26 percent use a 

non-LAPM and two-thirds use no method. The use of LAPM is particularly low in the sub-Saharan African 

regions. The Middle East/North Africa countries Egypt and Jordan have high rates of use of LAPM, 39 and 

28 percent, respectively. Other countries with high rates are India (33 percent), Colombia (33 percent) and 

the Dominican Republic (38 percent). 

Table 7. Percent distribution of all non-pregnant women by whether using a LAPM 

contraceptive method, 45 DHS country surveys 2006-2012 

Country 

Survey 

date 

Number of 

respondents 

Whether using a long acting or 

permanent method 

Not using 

any method 

Using LAPM: 

IUD, 

sterilization, 

implant 

Using nonLAPM 

West and Central Africa 

Benin 2006 15,850 80.7 1.4 17.9 

Burkina Faso 2010 15,357 83.0 3.6 13.4 

Cameroon 2011 13,914 73.7 1.2 25.1 

DR Congo 2007 8,872 77.4 0.8 21.8 

Ghana 2008 4,556 79.1 2.0 18.9 

Liberia 2007 6,331 85.1 0.7 14.2 

Mali 2006 12,721 91.4 0.5 8.1 

Niger 2006 7,871 88.3 0.4 11.3 

Nigeria 2008 29,891 82.8 1.2 16.0 

Sao Tome & Principe 2008-09 2,394 66.4 1.3 32.3 

Senegal 2010-11 14,480 89.6 1.6 8.8 

Sierra Leone 2008 6,776 88.9 0.4 10.7 

East and Southern Africa 

Burundi 2010 8,408 85.0 2.7 12.3 

Ethiopia 2011 15,310 78.9 3.1 18.0 

Kenya 2008-09 7,851 65.5 5.9 28.5 

Lesotho 2009 7,303 62.5 3.2 34.4 

Madagascar 2008-09 15,938 65.5 2.6 31.9 

Malawi 2010 20,948 61.1 9.7 29.2 

Mozambique 2011 12,229 86.1 0.4 13.5 

Namibia 2006-07 9,277 50.8 6.1 43.1 

Rwanda 2010 12,715 69.2 4.6 26.1 

Swaziland 2006-07 4,708 59.9 4.2 36.0 

Tanzania 2010 9,170 68.2 5.3 26.5 

Uganda 2011 7,663 73.3 5.1 21.7 

Zambia 2007 6,384 66.5 2.0 31.5 

Zimbabwe 2010-11 8,413 55.0 3.5 41.5 

Middle East/North Africa 

Egypt* 2008 14,972 37.9 38.7 23.4 

Jordan* 2007 9,561 38.0 28.4 33.6 

Eastern Europe/NIS 

Albania 2008-09 7,434 51.1 2.8 46.1 

Armenia 2010 5,744 65.1 6.3 28.6 

Azerbaijan 2006 8,147 66.9 6.3 26.9 

Ukraine 2007 6,650 47.6 13.0 39.4 

(Continued)
26 

Table 7. − Continued

Country 

Survey 

date 

Number of 

respondents 

Whether using a long acting or 

permanent method 

Not using 

any method 

Using LAPM: 

IUD, 

sterilization, 

implant 

Using nonLAPM 

Asia 

Bangladesh* 2011 16,680 39.0 8.1 53.0 

Cambodia 2010 17,821 66.9 3.9 29.1 

India 2005-06 117,956 53.8 33.4 12.9 

Indonesia* 2007 31,231 39.0 11.0 50.0 

Nepal 2011 12,053 59.9 20.8 19.4 

Pakistan* 2012-13 12,097 62.1 12.1 25.8 

Philippines 2008 12,889 65.7 8.8 25.5 

Timor-Leste 2009 12,238 85.4 1.9 12.6 

Latin America and Caribbean 

Bolivia 2008 16,001 56.1 10.6 33.3 

Colombia 2010 51,729 40.9 33.4 25.7 

Dominican Rep. 2007 25,996 43.5 37.6 18.9 

Guyana 2009 4,782 63.8 9.0 27.1 

Peru 2012 22,055 47.8 8.9 43.3 

Unweighted Averages 

West and Central Africa 139,013 82.2 1.3 16.5 

East and Southern Africa 146,317 67.7 4.2 28.2 

Middle East/North Africa 24,533 38.0 33.6 28.5 

Eastern Europe/NIS 27,975 57.7 7.1 35.3 

Asia 232,965 59.0 12.5 28.5 

Latin America and Caribbean 120,563 50.4 19.9 29.7 

Total 691,366 65.9 8.2 25.9 

* Ever-married samples 

The spacing method with the shortest duration of use is the lactational amenorrheic method (LAM), which 

can be used for a maximum of 6 months after the birth of a living child. To be successfully used, a woman 

must be postpartum amenorrheic, breastfeeding her child exclusively or predominantly, and be within six 

months of giving birth. Table 8 shows that among non-pregnant women, almost none say they use LAM, 

with even fewer using and meeting the LAM criteria. Only in Niger and Zambia do more than 4 percent of 

non-pregnant women use LAM. 
27 

Table 8. Percent distribution of non-pregnant women by current use of the 

lactational amenorrhea method (LAM), 45 DHS country surveys 2006-2012 

Country 

Survey 

date 

Number of 

respondents* 

Not using 

LAM 

Using LAM 

correctly 

Using LAM 

incorrectly 

West and Central Africa 

Benin 2006 15,850 99.8 0.1 0.1 

Burkina Faso 2010 15,357 99.9 0.0 0.0 

Cameroon 2011 13,914 99.8 0.0 0.2 

DR Congo 2007 8,872 100.0 0.0 0.0 

Ghana 2008 4,556 100.0 0.0 0.0 

Liberia 2007 6,331 100.0 0.0 0.0 

Mali 2006 12,721 99.5 0.2 0.3 

Niger 2006 7,871 95.2 1.0 3.7 

Nigeria 2008 29,891 98.7 0.1 1.1 

Sao Tome & Principe 2008-09 2,394 100 0.1 0.3 

Senegal 2010-11 14,480 99.9 0.0 0.1 

Sierra Leone 2008 6,776 99.3 0.1 0.6 

East and Southern Africa 

Burundi 2010 8,408 100.0 0.0 0.0 

Ethiopia 2011 15,310 100.0 0.0 0.0 

Kenya 2008-09 7,851 99.6 0.2 0.3 

Lesotho 2009 7,303 100.0 0.0 0.0 

Madagascar 2008-09 15,938 99.2 0.5 0.4 

Malawi 2010 20,948 100.0 0.0 0.0 

Mozambique 2011 12,229 99.9 0.0 0.1 

Namibia 2006-07 9,277 100.0 0.0 0.0 

Rwanda 2010 12,715 99.7 0.1 0.2 

Swaziland 2006-07 4,708 99.2 0.0 0.8 

Tanzania 2010 9,170 98.9 0.1 1.0 

Uganda 2011 7,663 99.9 0.0 0.1 

Zambia 2007 6,384 95.4 0.9 3.8 

Zimbabwe 2010-11 8,413 99.9 0.0 0.1 

Middle East/North Africa 

Egypt* 2008 14,972 100.0 0.0 0.0 

Jordan* 2007 9,561 98.5 0.6 0.9 

Eastern Europe/NIS 

Albania 2008-09 7,434 99.7 0.1 0.1 

Armenia 2010 5,744 99.5 0.1 0.4 

Azerbaijan 2006 8,147 99.3 0.2 0.6 

Ukraine 2007 6,650 100.0 0.0 0.0 

Asia 

Bangladesh* 2011 16,680 100.0 0.0 0.0 

Cambodia 2010 17,821 100.0 0.0 0.0 

India 2005-06 117,956 100.0 0.0 0.0 

Indonesia* 2007 31,231 100.0 0.0 0.0 

Nepal 2011 12,053 100.0 0.0 0.0 

Pakistan* 2012-13 12,097 98.4 0.3 1.4 

Philippines 2008 12,889 99.8 0.1 0.2 

Timor-Leste 2009 12,238 100.0 0.0 0.0 

Latin America and Caribbean 

Bolivia 2008 16,001 99.5 0.2 0.3 

Colombia 2010 51,729 99.9 0.0 0.1 

Dominican Rep. 2007 25,996 99.7 0.0 0.3 

Guyana 2009 4,782 99.9 0.0 0.1 

Peru 2012 22,055 99.9 0.1 0.0 

Unweighted Averages 

West and Central Africa 139,013 99.3 0.1 0.5 

East and Southern Africa 146,317 99.4 0.1 0.5 

Middle East/North Africa 24,533 99.3 0.3 0.5 

Eastern Europe/NIS 27,975 99.6 0.1 0.3 

Asia 232,965 99.8 0.1 0.2 

Latin America and Caribbean 120,563 99.8 0.1 0.2 

Total 691,366 99.5 0.1 0.4 

* Ever-married samples 
28 

Table 9 illustrates the range of contraceptive methods used by non-pregnant women. The most commonly 

used method is contraceptive injections (7 percent), followed by pill (6 percent), condom (5 percent) and 

female sterilization (4 percent). A traditional method, withdrawal, also has almost 4 percent using and has 

particularly high use in the Eastern Europe/NIS region. 
29

Table 9. Distribution of non-pregnant women by type of current contraceptive method, 45 DHS country surveys 2006-2012Country 

Survey 

date 

Number of 

respondents 

Not 

using Pill IUD Injections

Diaphragm Condom

Female 

sterilization 

Male 

sterilization Implant 

Lactational 

Amenorrheic 

Method 

(LAM) 

Female 

condom 

Foam or 

jelly 

Other 

modern 

method 

Periodic 

abstinence

Abstinence 

(not 

postpartum) Withdrawal

Other method 

(including 

countryspecific 

method) 

West and Central Africa 

Benin 2006 15,850 80.7 1.5 0.6 1.7 0.0 2.9 0.3 0.0 0.5 0.2 0.0 0.0 0.0 8.1 0.0 3.2 0.3Burkina Faso 2010 15,357 83.0 3.1 0.3 5.6 0.0 3.4 0.2 0.0 3.2 0.1 0.0 0.0 0.0 1.0 0.0 0.1 0.1Cameroon 2011 13,914 73.7 1.8 0.2 2.6 0.0 12.0 0.4 0.0 0.6 0.2 0.2 0.0 0.0 6.5 0.0 1.4 0.5DR Congo 2007 8,872 77.4 0.9 0.2 0.4 0.0 5.4 0.6 0.0 0.0 0.0 0.0 0.0 0.0 11.7 0.0 2.6 0.8Ghana 2008 4,556 79.1 3.9 0.2 4.5 0.0 3.8 1.1 0.0 0.7 0.0 0.2 0.0 0.0 4.3 0.0 1.4 0.6Liberia 2007 6,331 85.1 4.3 0.2 4.2 0.0 3.9 0.5 0.0 0.0 0.0 0.0 0.0 0.0 1.4 0.0 0.3 0.0Mali 2006 12,721 91.4 3.0 0.1 2.6 0.0 0.5 0.3 0.0 0.1 0.5 0.0 0.0 0.0 0.8 0.0 0.1 0.6Niger 2006 7,871 88.3 3.2 0.1 1.6 0.0 0.1 0.3 0.0 0.0 4.8 0.0 0.0 0.0 0.1 0.0 0.0 1.5Nigeria 2008 29,891 82.8 1.7 0.8 2.2 0.0 5.3 0.3 0.0 0.0 1.3 0.0 0.0 0.0 2.3 0.0 2.0 1.2Sao Tome & Principe 2008-09 2,394 66.4 11.5 0.3 9.0 0.0 7.7 1.0 0.0 0.0 0.4 0.0 0.0 0.0 2.2 0.0 0.9 0.5Senegal 2010-11 14,480 89.6 3.2 0.5 4.0 0.0 0.7 0.2 0.0 1.0 0.1 0.0 0.0 0.0 0.3 0.0 0.2 0.4Sierra Leone 2008 6,776 88.9 3.2 0.4 3.4 0.0 1.2 0.0 0.0 0.0 0.7 0.0 0.0 0.0 0.6 0.0 0.2 1.4

East and Southern Africa 

Burundi 2010 8,408 85.0 1.6 1.9 7.1 0.0 0.9 0.4 0.0 0.4 0.0 0.0 0.0 0.0 1.2 0.0 1.5 0.0 Ethiopia 2011 15,310 78.9 1.6 0.2 15.1 0.0 0.3 0.4 0.0 2.5 0.0 0.0 0.0 0.0 0.7 0.0 0.2 0.0Kenya 2008-09 7,851 65.5 5.1 1.1 15.9 0.0 2.8 3.4 0.0 1.4 0.4 0.0 0.0 0.0 3.5 0.0 0.5 0.5Lesotho 2009 7,303 62.5 8.1 1.3 14.0 0.0 10.9 1.8 0.0 0.1 0.0 0.2 0.0 0.0 0.1 0.0 0.5 0.5Madagascar 2008-09 15,938 65.5 5.2 0.3 15.4 0.0 1.0 1.0 0.1 1.3 0.8 0.0 0.0 0.0 8.6 0.0 0.7 0.2Malawi 2010 20,948 61.1 2.1 0.2 21.1 0.0 2.9 8.3 0.0 1.2 0.0 0.1 0.0 0.0 0.7 0.0 1.4 1.0Mozambique 2011 12,229 86.1 4.8 0.2 4.8 0.0 3.3 0.2 0.0 0.0 0.1 0.1 0.0 0.0 0.1 0.0 0.1 0.1Namibia 2006-07 9,277 50.8 5.7 0.6 18.1 0.1 17.9 5.3 0.2 0.1 0.0 0.3 0.0 0.0 0.3 0.0 0.1 0.6Rwanda 2010 12,715 69.2 4.2 0.3 15.7 0.0 2.0 0.5 0.0 3.9 0.3 0.0 0.0 0.0 1.7 0.0 1.9 0.4Swaziland 2006-07 4,708 59.9 6.2 0.9 12.7 0.0 14.4 3.1 0.1 0.1 0.8 0.1 0.0 0.0 0.2 0.0 1.2 0.3Tanzania 2010 9,170 68.2 5.7 0.5 9.4 0.0 4.7 2.8 0.0 2.0 1.1 0.0 0.0 0.0 2.9 0.0 2.1 0.8Uganda 2011 7,663 73.3 2.4 0.4 12.1 0.0 3.7 2.5 0.1 2.1 0.1 0.0 0.0 0.0 1.2 0.0 1.7 0.4Zambia 2007 6,384 66.5 8.3 0.1 6.9 0.0 5.7 1.6 0.0 0.3 4.6 0.1 0.0 0.0 1.0 0.0 4.0 1.0Zimbabwe 2010-11 8,413 55.0 29.8 0.2 6.6 0.0 3.8 1.0 0.0 2.4 0.1 0.3 0.0 0.0 0.1 0.0 0.7 0.1

Middle East/North Africa 

Egypt* 2008 14,972 37.9 12.2 37.1 7.6 0.0 0.7 1.1 0.0 0.5 0.0 0.0 0.0 0.0 0.5 0.0 0.2 2.0Jordan* 2007 9,561 38.0 9.1 24.1 0.8 0.0 5.7 4.1 0.0 0.1 1.5 0.0 0.0 0.0 4.5 0.0 11.7 0.3

Eastern Europe/NIS 0.0 

Albania 2008-09 7,434 51.1 1.2 0.6 0.5 0.0 3.3 2.1 0.0 0.0 0.3 0.0 0.0 0.0 0.6 0.0 40.3 0.0 

Armenia 2010 5,744 65.1 1.0 6.1 0.0 0.0 9.4 0.2 0.0 0.0 0.5 0.0 0.1 0.0 1.5 0.0 15.4 0.8Azerbaijan 2006 8,147 66.9 0.7 6.0 0.0 0.0 1.4 0.3 0.0 0.0 0.7 0.0 0.1 0.0 2.6 0.0 21.0 0.2

Ukraine 2007 6,650 47.6 3.9 12.5 0.0 0.0 21.9 0.5 0.0 0.0 0.0 0.0 0.6 0.0 4.9 0.0 7.0 1.1

Asia 

Bangladesh* 2011 16,680 39.0 27.2 0.7 11.2 0.0 5.5 4.9 1.2 1.1 0.0 0.0 0.0 0.0 6.9 0.0 1.9 0.4 Cambodia 2010 17,821 66.9 10.0 2.0 6.8 0.0 1.8 1.6 0.0 0.3 0.0 0.0 0.0 0.0 2.5 0.0 7.6 0.2India 2005-06 117,956 53.8 2.4 1.4 0.1 0.0 4.1 31.2 0.8 0.0 0.0 0.0 0.3 0.0 3.9 0.0 2.0 0.0Indonesia* 2007 31,231 39.0 13.1 4.9 31.6 1.3 3.1 0.2 1.5 0.0 0.0 0.0 0.0 0.0 2.1 0.2 0.1 2.8Nepal 2011 12,053 59.9 3.3 1.0 7.3 0.0 3.5 12.5 6.3 0.9 0.0 0.0 0.0 0.0 0.9 0.0 4.3 0.0Pakistan* 2012-13 12,097 62.1 1.7 2.5 2.9 0.0 9.4 9.3 0.3 0.1 1.6 0.0 0.0 0.1 0.7 0.0 9.1 0.1Philippines 2008 12,889 65.7 10.5 2.5 1.7 0.0 1.7 6.3 0.0 0.0 0.2 0.0 0.0 0.0 4.3 0.0 6.7 0.3Timor-Leste 2009 12,238 85.4 1.1 0.9 10.3 0.0 0.2 0.5 0.0 0.6 0.0 0.0 0.0 0.0 0.4 0.0 0.2 0.5

(Continued)
30

Table 9. − ContinuedCountry 

Survey 

date 

Number of 

respondents 

Not 

using Pill IUD Injections

Diaphragm Condom

Female 

sterilization 

Male 

sterilization Implant 

Lactational 

Amenorrheic 

Method 

(LAM) 

Female 

condom 

Foam or 

jelly 

Other 

modern 

method 

Periodic 

abstinence

Abstinence 

(not 

postpartum) Withdrawal

Other method 

(including 

countryspecific 

method) 

Latin America and Caribbean 

Bolivia 2008 16,001 56.1 2.6 5.9 7.8 0.0 3.8 4.5 0.1 0.0 0.5 0.0 0.1 0.0 14.9 0.0 3.4 0.2 Colombia 2010 51,729 40.9 6.3 5.4 7.7 0.0 7.4 23.4 1.8 2.8 0.1 0.0 0.1 0.0 1.5 0.0 2.4 0.2Dominican Rep. 2007 25,996 43.5 9.9 1.7 3.3 0.0 3.1 35.5 0.0 0.4 0.3 0.0 0.0 0.0 0.9 0.0 1.1 0.1Guyana 2009 4,782 63.8 6.2 5.0 3.4 0.0 15.1 3.9 0.0 0.1 0.1 0.0 0.0 0.0 0.6 0.0 1.0 0.6Peru 2012 22,055 47.8 5.8 2.3 11.8 0.0 9.2 6.3 0.3 0.1 0.1 0.0 0.2 0.0 10.6 0.0 4.9 0.6

Unweighted Averages 

West and Central Africa 139,013 82.2 3.4 0.3 3.5 0.0 3.9 0.4 0.0 0.5 0.7 0.0 0.0 0.0 3.3 0.0 1.0 0.7East and Southern Africa 146,317 67.7 6.5 0.6 12.5 0.0 5.3 2.3 0.0 1.3 0.6 0.1 0.0 0.0 1.6 0.0 1.2 0.4Middle East/North Africa 24,533 38.0 10.7 30.6 4.2 0.0 3.2 2.6 0.0 0.3 0.8 0.0 0.0 0.0 2.5 0.0 6.0 1.2Eastern Europe/NIS 27,975 57.7 1.7 6.3 0.1 0.0 9.0 0.8 0.0 0.0 0.4 0.0 0.2 0.0 2.4 0.0 20.9 0.5

Asia 232,965 59.0 8.7 2.0 9.0 0.2 3.7 8.3 1.3 0.4 0.2 0.0 0.0 0.0 2.7 0.0 4.0 0.5

Latin America and Caribbean 120,563 50.4 6.2 4.1 6.8 0.0 7.7 14.7 0.4 0.7 0.2 0.0 0.1 0.0 5.7 0.0 2.6 0.3

Total 691,366 65.9 5.8 3.0 7.4 0.0 5.1 4.1 0.3 0.7 0.5 0.0 0.0 0.0 2.8 0.0 3.8 0.5 * Ever-married samples 
31 

3.3. Marital Status of Non-pregnant Women 

Women who are not currently in a marital union (formally or informally married) are presumed to not have 

regular sexual relations, and they are less likely to be in need of a contraceptive method for fertility risk. 

The distribution of non-pregnant women by marital status is shown in Table 10. In this table for the five 

ever-married samples, the percentages never in union were calculated by using data from the household 

schedule of the DHS, assuming that women never in union are all not pregnant. Table 10 shows that 62 

percent of non-pregnant women are either currently formally married or are living with a partner. West and 

Central Africa and Asia are the regions with the highest percentage of women in a marital union, 67 and 69 

percent, respectively. Two countries, Mali and Niger, have more than 80 percent of non-pregnant women 

in a marital union and three others, Bangladesh, Indonesia and Nepal, have between 70 and 79 percent in a 

marital union. In four countries, less than half of non-pregnant women are in a marital union, Namibia (34 

percent), Swaziland (40 percent), Dominican Republic and Swaziland (both 48 percent). 

Table 10. Distribution of non-pregnant women by marital status, 45 DHS country surveys 

2006-2012 

Country 

Survey 

date 

Number of 

respondents

Current marital status 

Never in 

union Married 

Living 

with 

partner Widowed Divorced 

No longer 

living 

together/ 

separated 

West and Central Africa 

Benin 2006 15,850 22.0 66.4 6.5 2.3 0.7 2.1 

Burkina Faso 2010 15,357 19.3 73.6 3.7 1.9 0.3 1.1 

Cameroon 2011 13,914 30.3 46.5 14.0 3.2 1.4 4.6 

DR Congo 2007 8,872 27.0 54.4 8.4 2.2 2.0 6.0 

Ghana 2008 4,556 34.4 43.9 12.1 2.2 3.4 4.1 

Liberia 2007 6,331 27.3 40.1 22.1 2.9 1.3 6.4 

Mali 2006 12,721 13.5 76.9 5.8 1.6 0.9 1.2 

Niger 2006 7,871 11.6 83.6 0.2 1.7 2.5 0.4 

Nigeria 2008 29,891 27.8 66.1 1.4 2.5 0.9 1.2 

Sao Tome & Principe 2008-09 2,394 24.9 3.9 59.2 0.4 0.1 11.5 

Senegal 2010-11 14,480 31.4 62.7 0.7 1.2 3.4 0.6 

Sierra Leone 2008 6,776 19.9 63.9 9.7 2.8 0.5 3.1 

East and Southern Africa 

Burundi 2010 8,408 36.9 37.3 16.1 4.8 0.5 4.3 

Ethiopia 2011 15,310 29.2 55.4 4.0 3.5 5.7 2.1 

Kenya 2008-09 7,851 33.0 52.1 4.0 4.6 1.4 5.0 

Lesotho 2009 7,303 35.2 51.1 0.8 7.8 0.9 4.3 

Madagascar 2008-09 15,938 19.4 58.8 8.6 2.1 1.5 9.5 

Malawi 2010 20,948 21.4 56.8 8.2 3.9 5.3 4.5 

Mozambique 2011 12,229 19.6 42.8 22.9 4.1 2.3 8.2 

Namibia 2006-07 9,277 58.8 19.6 14.4 2.6 1.1 3.3 

Rwanda 2010 12,715 40.9 33.8 13.9 5.8 4.7 0.8 

Swaziland 2006-07 4,708 50.5 31.4 8.9 5.8 0.4 2.9 

Tanzania 2010 9,170 26.8 56.0 5.0 3.1 5.5 3.6 

Uganda 2011 7,663 26.9 34.0 24.8 4.2 0.7 9.3 

Zambia 2007 6,384 28.0 57.9 0.7 4.7 6.6 2.0 

Zimbabwe 2010-11 8,413 25.8 56.7 2.7 6.6 3.9 4.3 

Middle East/North Africa 

Egypt* 2008 17,379 32.9 62.1 0.0 3.0 1.5 0.5 

Jordan* 2007 13,262 45.8 51.3 0.0 1.3 1.5 0.2 

Eastern Europe/NIS 

Albania 2008-09 7,434 31.7 64.0 1.2 1.6 1.3 0.2 

Armenia 2010 5,744 33.3 59.5 0.5 2.6 3.8 0.3 

Azerbaijan 2006 8,147 32.0 60.8 0.2 2.8 3.5 0.6 

Ukraine 2007 6,650 23.2 54.5 4.7 3.5 11.8 2.3 

(Continued)
32 

Table 10. − Continued

Country 

Survey 

date 

Number of 

respondents

Current marital status 

Never in 

union Married 

Living 

with 

partner Widowed Divorced 

No longer 

living 

together/ 

separated 

Asia 

Bangladesh* 2011 17,154 15.5 78.8 0.0 3.1 1.1 1.4 

Cambodia 2010 17,821 32.4 59.5 0.6 3.2 4.0 0.3 

India 2005-06 117,956 21.6 73.5 0.0 3.4 0.3 1.2 

Indonesia* 2007 35,519 24.4 70.9 0.0 2.3 2.4 0.0 

Nepal 2011 12,053 22.5 74.6 0.0 2.1 0.1 0.7 

Pakistan* 2012-13 14,524 35.9 60.9 0.0 2.1 0.6 0.6 

Philippines 2008 12,889 35.0 50.1 10.0 1.7 0.1 3.1 

Timor-Leste 2009 12,238 38.2 55.3 2.0 2.6 0.7 1.2 

Latin America and Caribbean 

Bolivia 2008 16,001 33.1 37.5 20.9 1.4 0.8 6.3 

Colombia 2010 51,729 36.8 18.1 30.2 1.5 0.4 13.1 

Dominican Rep. 2007 25,996 24.9 14.8 40.6 1.2 17.0 1.5 

Guyana 2009 4,782 31.6 33.8 23.7 1.7 1.4 7.9 

Peru 2012 22,055 33.5 24.9 30.8 0.5 0.4 9.9 

Unweighted Averages 

West and Central Africa 139,013 24.1 56.8 12.0 2.1 1.5 3.5 

East and Southern Africa 146,317 32.3 46.0 9.6 4.5 2.9 4.6 

Middle East/North Africa 30,641 39.3 56.7 - 2.2 1.5 0.3 

Eastern Europe/NIS 27,975 30.1 59.7 1.7 2.6 5.1 0.9 

Asia 240,154 28.2 65.5 1.6 2.6 1.2 1.1 

Latin America and Caribbean 120,563 32.0 25.8 29.2 1.3 4.0 7.7 

Total 704,663 29.5 51.8 9.9 2.9 2.5 3.5 

* Ever-married samples: 

Current marital status is calculated from the household declaration and never-in-union women are assumed to be not pregnant at the 

time of the survey. Therefore the number of respondents for these surveys will not match those of other tables. 

 

3.4. Unmet Need for Contraception Based on Fertility Desires by Need for Contraception Based 

on Fertility Risk 

For many non-pregnant women currently in a marital union, their desires for a future birth are aligned with 

their need for contraception due to fertility risk. Table 11 shows the coincidence of unmet need based on 

desires with the total need based on fertility risk. Among the women with no risk-based need (first column 

panel), about half have either no unmet need based on desires or are infecund or menopausal. Only 

11 percent of the women with a risk-based need also have an unmet need based on desires, while 39 percent 

are using contraception and therefore meeting their needs. 

Among the non-pregnant married women with a risk-based need for spacing (second column panel), about 

one in four have an unmet desire-based need, 44 percent are using contraception to meet their desire-based 

need, and 30 percent either have no unmet desire-based need, are infecund, or menopausal. 

Similarly, among those with a risk-based need for limiting (third column panel), 23 percent have an desirebased need that is unmet, 39 percent are using contraception to meet their desire-based need, and 30 percent 

either have no unmet desire-based need, are infecund, or menopausal. 
33

Table 11. Among non-pregnant married and in-union women, unmet need for contraception based on fertility desires by need for contraception based on fertility risk, 45 DHS country surveys 2006-2012 Country 

Survey 

date 

Need for contraception based on fertility risk1

No need for contraception Spacing method need Need for LAPM 

Number of 

respondents 

Unmet need for contraception based on desires 

Number of 

respondents

Unmet need for contraception based on desires 

Number of 

respondents

Unmet need for contraception based on desires 

Unmet 

need for 

spacing 

Unmet 

need for 

limiting 

Using 

for 

spacing

Using 

for 

limiting

No 

unmet 

need 

Infecund, 

menopausal 

Unmet 

need for 

spacing

Unmet 

need for 

limiting

Using 

for 

spacing 

Using 

for 

limiting 

No 

unmet 

need 

Infecund, 

menopausal 

Unmet 

need for 

spacing

Unmet 

need for 

limiting

Using 

for 

spacing

Using 

for 

limiting

No 

unmet 

need 

Infecund, 

menopausal 

West and Central Africa 

Benin 2006 1,857 6.7 2.0 10.0 3.8 47.3 30.2 2,283 30.4 0.7 21.9 1.2 43.5 2.2 7,407 15.8 20.6 9.3 10.9 37.2 5.9 Burkina Faso 2010 1,869 10.3 0.5 19.2 1.4 35.5 32.8 2,228 30.9 0.4 16.3 0.7 50.9 0.7 7,774 17.7 11.1 9.6 8.7 35.8 16.8Cameroon 2011 1,686 7.1 0.4 25.7 2.3 31.3 33.1 1,550 25.6 1.4 25.2 1.2 46.1 0.5 5,181 14.1 13.7 12.2 14.9 28.5 16.3DR Congo 2007 1,140 4.9 2.0 11.4 7.2 11.0 63.6 1,074 30.5 1.3 24.5 1.2 37.2 5.3 3,357 16.8 7.5 14.8 11.4 27.6 21.8Ghana 2008 490 15.4 1.2 23.9 2.1 33.0 24.5 439 45.0 4.2 21.5 2.6 25.5 1.2 1,622 17.0 19.8 8.7 18.6 17.7 18.1Liberia 2007 701 20.1 1.6 13.0 1.4 27.7 36.3 558 45.3 2.3 5.8 0.2 44.0 1.9 2,676 20.2 17.3 6.8 7.6 21.8 25.7Mali 2006 2,007 17.4 0.9 8.1 1.4 48.4 23.7 2,003 33.9 1.4 9.0 0.7 52.8 2.0 6,509 19.1 17.4 5.2 4.6 47.4 6.1Niger 2006 861 5.6 0.1 4.2 1.4 38.7 50.0 1,373 16.9 0.1 12.6 0.1 65.7 4.6 4,361 13.6 4.4 12.8 2.6 51.8 14.7Nigeria 2008 2,784 9.2 1.0 10.3 1.5 39.0 38.8 3,893 21.5 0.4 15.1 0.5 59.4 2.9 13,521 14.2 8.2 8.8 9.7 37.9 21.0Sao Tome & Principe 2008-09 271 22.5 3.1 30.6 7.0 18.3 18.5 237 27.5 8.2 39.9 7.1 13.9 3.4 1,002 11.7 23.2 13.6 31.0 7.7 12.6Senegal 2010-11 1,934 11.6 0.6 7.2 0.5 44.5 35.6 1,798 38.0 1.3 15.4 0.3 44.5 0.6 5,455 21.2 13.3 8.8 8.2 29.3 19.2Sierra Leone 2008 1,102 8.9 2.1 6.1 1.4 29.8 51.3 796 28.0 3.9 4.7 0.3 55.7 6.6 3,092 15.5 16.9 4.4 6.3 27.0 29.4

East and Southern Africa 

Burundi 2010 451 8.3 0.4 13.8 1.0 41.0 35.5 1,028 28.4 0.2 29.2 0.8 39.8 1.5 3,013 19.3 15.0 12.3 14.5 25.4 13.4 Ethiopia 2011 1,722 9.4 1.9 34.6 8.4 18.3 27.4 1,549 24.4 2.2 28.5 5.0 37.8 2.1 5,835 15.4 14.2 11.1 17.8 24.4 17.1Kenya 2008-09 783 6.7 3.7 37.9 14.8 22.7 14.2 706 21.3 4.8 40.2 9.3 22.7 1.7 2,914 8.9 17.7 9.7 41.1 11.9 10.8Lesotho 2009 1,156 6.7 4.4 31.1 20.8 24.2 12.4 842 20.0 11.2 27.6 23.8 16.3 0.8 1,787 4.5 19.8 4.5 44.3 4.4 22.2Madagascar 2008-09 2,376 10.4 1.7 37.5 8.7 20.1 21.5 1,703 21.6 1.6 34.5 4.4 36.5 1.4 6,667 6.8 13.7 12.1 33.6 18.9 14.9Malawi 2010 1,918 12.9 3.7 27.0 9.3 29.5 17.6 2,723 18.2 3.2 42.4 8.3 26.5 1.3 8,970 9.6 14.7 16.6 40.1 11.0 8.0Mozambique 2011 1,649 7.2 1.7 7.8 2.8 34.1 46.3 1,690 24.3 2.9 11.9 1.4 58.0 1.4 4,706 13.7 15.2 6.0 8.6 37.0 19.4Namibia 2006-07 756 6.4 5.3 34.3 26.3 17.9 9.6 456 11.0 8.1 34.7 31.2 14.1 0.9 1,945 7.1 13.2 9.7 49.0 8.9 11.8Rwanda 2010 835 6.9 0.5 43.9 9.6 21.9 17.0 1,183 13.6 0.8 54.5 6.6 23.9 0.5 4,058 7.5 13.8 13.6 45.2 8.9 10.9Swaziland 2006-07 430 9.1 6.1 26.5 23.7 20.9 13.6 267 11.4 14.3 29.4 30.5 11.6 2.9 1,198 3.2 19.6 5.9 50.0 7.0 14.3Tanzania 2010 956 4.0 0.2 28.2 2.4 25.8 39.4 1,008 24.5 1.3 36.1 2.9 34.9 0.3 3,629 13.4 9.2 19.2 22.6 20.2 15.5Uganda 2011 518 8.0 1.9 21.3 3.2 33.5 32.1 763 32.0 1.4 29.9 3.2 32.8 0.5 3,229 17.0 17.8 14.2 24.4 16.5 10.0Zambia 2007 489 7.9 1.5 22.9 6.0 35.9 25.7 688 21.0 0.7 49.5 4.3 24.0 0.4 2,564 12.3 13.0 25.0 25.1 15.6 9.1Zimbabwe 2010-11 1,213 4.3 2.4 40.3 14.5 26.3 12.3 1,294 9.4 1.4 64.3 12.1 12.0 0.8 2,492 4.6 9.3 22.6 45.0 8.3 10.2

Middle East/North Africa 

Egypt 2008 2,943 2.1 2.1 15.4 27.4 29.8 23.2 2,651 8.3 2.9 48.0 19.7 19.7 1.1 8,250 1.2 8.4 3.7 71.8 3.4 11.2 Jordan 2007 1,204 2.7 3.2 20.6 7.7 36.2 29.6 1,315 11.8 1.3 58.6 5.5 21.4 0.9 6,523 2.8 9.2 19.9 52.6 7.5 7.4

Eastern Europe/NIS 

Albania 2008-09 1,471 5.2 6.3 28.8 37.2 10.4 12.1 405 16.1 4.8 48.2 19.3 10.7 0.8 2,976 0.7 11.8 2.7 72.0 1.2 11.5 

Armenia 2010 1,367 4.1 4.3 22.5 32.4 9.1 27.7 527 18.1 2.2 45.1 17.6 16.7 0.1 1,555 1.3 14.5 3.6 54.9 1.2 24.5Azerbaijan 2006 1,610 2.7 8.8 11.0 41.1 16.6 19.6 644 10.4 11.4 27.4 24.4 24.1 0.8 2,720 1.1 29.1 1.7 54.3 1.9 11.7

Ukraine 2007 2,003 3.9 2.6 37.7 34.4 4.7 16.5 365 12.1 3.8 44.8 25.4 13.0 0.3 1,564 0.8 12.4 3.6 63.1 1.2 18.8

Asia 

Bangladesh 2011 5,438 5.0 4.2 27.8 34.6 14.1 14.2 2,529 12.3 4.1 39.0 23.1 20.6 0.9 7,600 1.5 11.6 2.4 66.3 3.5 14.7 Cambodia 2010 2,663 6.9 3.4 35.1 21.0 15.0 18.5 1,988 14.8 4.6 40.1 12.3 27.4 0.4 6,056 2.4 16.4 7.2 48.0 6.5 19.1India 2005-06 25,424 4.3 3.0 7.5 44.3 17.7 23.2 12,896 20.8 6.6 16.0 20.2 35.0 0.7 48,351 1.8 8.3 1.0 70.5 5.6 12.5Indonesia 2007 10,127 4.1 2.0 39.8 24.2 15.8 14.0 4,442 8.3 2.5 54.7 20.5 12.6 0.9 14,704 2.1 7.1 8.8 53.4 3.6 24.5Nepal 2011 2,930 12.2 17.4 10.2 34.4 13.1 12.7 1,410 27.2 13.1 14.4 17.7 26.7 0.9 4,647 1.6 19.8 0.4 64.5 5.2 8.5Pakistan 2012-13 2,116 5.3 1.8 9.0 7.3 46.8 29.7 1,777 23.8 2.3 29.9 5.3 37.9 0.7 7,585 5.6 16.8 6.2 41.3 10.6 19.3Philippines 2008 1,867 8.1 5.1 29.7 19.8 19.6 17.7 1,156 22.1 9.6 34.6 19.8 13.5 0.5 4,721 3.6 17.6 6.0 51.6 5.6 15.7Timor-Leste 2009 712 17.9 0.8 14.0 4.5 18.4 44.2 1,048 40.9 1.6 17.0 0.7 38.1 1.7 5,254 18.5 14.8 13.4 14.2 18.4 20.9

(Continued)
34

Table 11. − ContinuedCountry 

Survey 

date 

Need for contraception based on fertility risk1

No need for contraception Spacing method need Need for LAPM 

Number of 

respondents 

Unmet need for contraception based on desires 

Number of 

respondents

Unmet need for contraception based on desires 

Number of 

respondents

Unmet need for contraception based on desires 

Unmet 

need for 

spacing 

Unmet 

need for 

limiting 

Using 

for 

spacing

Using 

for 

limiting

No 

unmet 

need 

Infecund, 

menopausal 

Unmet 

need for 

spacing

Unmet 

need for 

limiting

Using 

for 

spacing 

Using 

for 

limiting 

No 

unmet 

need 

Infecund, 

menopausal 

Unmet 

need for 

spacing

Unmet 

need for 

limiting

Using 

for 

spacing

Using 

for 

limiting

No 

unmet 

need 

Infecund, 

menopausal 

Latin America and Caribbean 

Bolivia 2008 2,276 3.0 3.5 39.7 27.9 8.1 17.9 1,399 13.8 9.4 32.3 29.9 14.2 0.5 5,669 2.0 16.4 7.1 59.1 3.5 11.9 Colombia 2010 8,636 2.4 1.8 33.2 43.3 10.3 8.9 3,232 6.4 2.8 41.4 40.9 6.8 0.4 13,120 0.6 4.9 3.6 83.9 2.1 4.7 Dominican Rep. 2007 3,612 8.2 2.2 33.3 25.4 19.3 11.4 1,793 14.3 2.7 54.8 17.9 10.1 0.2 8,997 1.6 4.9 3.3 83.5 2.3 4.3 Guyana 2009 810 13.1 8.0 22.5 17.3 19.1 20.0 310 21.6 10.3 34.5 13.0 19.5 1.1 1,629 3.9 26.1 4.3 43.0 4.8 17.8 Peru 2012 3,873 2.4 1.9 44.1 29.7 6.8 15.1 1,720 4.8 3.1 47.8 33.6 7.7 0.2 6,684 0.6 5.2 8.6 72.8 2.7 8.7 

Unweighted Averages 

West and Central Africa 16,702 11.6 1.3 14.1 2.6 33.7 36.5 18,232 31.1 2.1 17.7 1.3 44.9 2.7 61,957 16.4 14.5 0.7 11.2 30.8 17.3 East and Southern Africa 15,252 7.7 2.5 29.1 10.8 26.6 23.2 15,900 20.1 3.9 36.6 10.3 27.9 1.2 53,007 10.2 14.7 0.4 33.0 15.6 13.4 Middle East/North Africa 4,147 2.4 2.7 18.0 17.6 33.0 26.4 3,966 10.1 2.1 53.3 12.6 20.6 1.0 14,773 2.0 8.8 1.2 62.2 5.5 9.3 Eastern Europe/NIS 6,451 4.0 5.5 25.0 36.3 10.2 19.0 1,941 14.2 5.6 41.4 21.7 16.1 0.5 8,815 1.0 17.0 0.5 61.1 1.4 16.6 Asia 51,277 8.0 4.7 21.6 23.8 20.1 21.8 27,246 21.3 5.6 30.7 15.0 26.5 0.8 98,918 4.6 14.1 0.5 51.2 7.4 16.9 Latin America and Caribbean 19,207 5.8 3.5 34.6 28.7 12.7 14.7 8,454 12.2 5.7 42.2 27.1 11.7 0.5 36,099 1.7 11.5 0.3 68.5 3.1 9.5 

Total 113,036 8.0 3.0 23.5 15.5 24.6 25.3 75,739 21.4 4.0 32.3 11.7 29.0 1.4 273,569 8.8 14.1 0.5 38.1 15.1 14.7 

1 Need for contraception based on fertility risk is categorized as follows: The column “No need for contraception” includes women between the ages of 18 and 39 who have had less than 3 births and whose last birth (if any) occurred 27 or more months ago. 

The column “Spacing method need” includes women under age 18 and/or whose last birth occurred less than 27 months ago, and the column “Need for a LAPM” includes women who are age 40 or over and/or who have had 3 or more births.
35 

3.4.1. Combining unmet needs by desire and risk 

The overall level of unmet need, which is estimated by combining unmet need from desires with unmet 

need from fertility risk, is shown in Table 12. The unweighted average for the 45 DHS surveys between 

2006 and 2012 indicates that 21 percent of non-pregnant women have an unmet need for contraception due 

to their desires or risk, 5 percent for an unmet spacing method, and 16 percent for a limiting method. 

Another 20 percent are using a spacing method but have a need for a LAPM. The other 59 percent of women 

have either no unmet need or are using the appropriate type of contraceptive method, indicating that 41 

percent of women have a need for focused efforts by family planning programs. 

By both desires and risk, unmet need is highest in West and Central Africa (28 percent) and lowest in the 

Middle East/North Africa. However, the need for focused efforts (if we assume women to be in need of 

focused efforts if they have either a desire- or risk-based unmet need, or a need for a more effective method) 

is high in all the regions, at between 33 and 45 percent of married women. In nine of the forty-five countries, 

the combined unmet need exceeds 30 percent of married women, 18 countries have a combined unmet need 

between 20 and 29 percent, 13 countries are between 10 and 29 percent, and 5 countries have a combined 

unmet need below 10 percent. For focused family planning efforts, there are only six countries in which 

less than 30 percent of married women need these efforts, and there are six countries where more than half 

of women need focused efforts. 
36 

Table 12. Percent distribution of non-pregnant married and in-union women by unmet combined need 

for contraception due to either desires or fertility risk and need for focused family planning efforts, 45 

DHS country surveys 2006-2012 

Country Survey date 

Number of 

respondents

No unmet 

need: 

no need or 

using appropriately 

Unmet need 

for a 

spacing 

method 

Unmet need 

for a limiting 

method 

Need for a more 

effective 

method: 

spacing method 

needs limiting 

Need for 

focused 

family 

planning 

efforts1

West and Central Africa 

Benin 2006 11,547 57.0 7.1 23.8 11.9 42.8 

Burkina Faso 2010 11,871 63.3 7.4 19.0 10.1 36.5 

Cameroon 2011 8,417 60.7 6.1 17.4 15.5 39.0 

DR Congo 2007 5,572 63.0 6.9 15.3 14.7 36.9 

Ghana 2008 2,550 50.3 10.7 24.3 14.6 49.6 

Liberia 2007 3,935 54.4 10.0 26.1 9.0 45.1 

Mali 2006 10,520 61.3 9.8 23.0 5.6 38.4 

Niger 2006 6,595 73.8 4.3 11.9 9.9 26.1 

Nigeria 2008 20,198 68.0 5.4 15.2 11.2 31.8 

Sao Tome & Principe 2008-09 1,509 38.3 8.3 25.1 28.2 61.6 

Senegal 2010-11 9,188 60.5 9.9 20.8 8.8 39.5 

Sierra Leone 2008 4,990 65.4 6.4 21.2 6.5 34.1 

East and Southern Africa

Burundi 2010 4,493 53.8 7.3 23.1 15.7 46.1 

Ethiopia 2011 9,106 58.2 5.9 19.7 16.1 41.7 

Kenya 2008-09 4,404 50.3 4.6 19.0 26.1 49.7 

Lesotho 2009 3,784 58.6 6.5 15.3 19.2 41.0 

Madagascar 2008-09 10,747 55.1 5.7 13.3 25.8 44.8 

Malawi 2010 13,611 51.8 5.5 17.1 25.6 48.2 

Mozambique 2011 8,045 67.3 6.6 17.9 8.2 32.7 

Namibia 2006-07 3,157 57.4 3.1 14.9 24.3 42.3 

Rwanda 2008 7,743 55.8 5.2 15.6 23.4 44.2 

Swaziland 2006-07 1,895 50.3 3.7 17.8 28.1 49.6 

Tanzania 2010 5,593 58.0 5.1 14.9 22.0 42.0 

Uganda 2011 4,510 45.8 6.3 25.4 22.4 54.1 

Zambia 2007 3,741 45.4 4.9 17.7 32.0 54.6 

Zimbabwe 2010-11 4,999 57.8 3.5 7.9 30.9 42.3 

Middle East/North Africa

Egypt 2008 13,844 73.2 2.0 6.7 17.9 26.6 

Jordan 2007 9,042 56.3 2.1 9.3 31.8 43.2 

Eastern Europe/NIS 

Albania 2008-09 4,852 44.8 2.9 10.0 42.3 55.2 

Armenia 2010 3,449 64.5 4.4 9.2 21.9 35.5 

Azerbaijan 2006 4,974 51.1 2.2 20.8 25.4 48.4 

Ukraine 2007 3,932 71.6 3.1 6.9 18.2 28.2 

Asia 

Bangladesh 2011 15,567 60.9 3.7 8.5 26.8 39.0 

Cambodia 2010 10,708 55.9 4.5 12.3 26.9 43.7 

India 2005-06 86,671 79.8 4.3 7.4 8.1 19.8 

Indonesia 2007 29,272 67.7 2.7 5.7 23.6 32.0 

Nepal 2011 8,987 61.1 8.2 18.8 11.9 38.9 

Pakistan 2012-13 11,478 60.0 4.7 15.5 19.7 39.9 

Philippines 2010 6,075 48.4 3.6 14.5 33.5 51.6 

Timor-Leste 2009 7,014 48.3 7.9 25.2 18.6 51.7 

Latin America and Caribbean

Bolivia 2008 9,344 54.3 2.8 13.4 29.4 45.6 

Colombia 2010 24,988 82.1 1.7 3.9 12.1 17.7 

Dominican Rep. 2007 14,402 83.7 3.8 5.0 7.4 16.2 

Guyana 2009 2,749 54.5 6.3 21.3 17.8 45.4 

Peru 2012 12,276 60.4 1.4 4.3 32.8 38.5 

(Continued)
37 

Table 12. − Continued

Country Survey date 

Number of 

respondents

No unmet 

need: 

no need or 

using appropriately 

Unmet need 

for a spacing 

method 

Unmet need 

for a limiting 

method 

Need for a 

more effective 

method: 

spacing 

method needs 

limiting 

Need for 

focused 

family 

planning 

efforts1

Unweighted Averages 

West and Central Africa 96,892 59.7 7.7 20.3 12.2 40.1 

East and Southern Africa 85,828 54.7 5.3 17.1 22.8 45.2 

Middle East/North Africa 22,886 64.8 2.1 8.0 24.9 34.9 

Eastern Europe/NIS 17,207 58.0 3.2 11.7 27.0 41.8 

Asia 175,772 60.3 5.0 13.5 21.1 39.6 

Latin America and Caribbean 63,759 67.0 3.2 9.6 19.9 32.7 

Total 462,344 59.1 5.3 15.6 19.8 40.7 

1

 Includes unmet need for spacing, unmet need for limiting and need for a more effective method 

Note: Due to rounding, may not sum to 100.0 exactly 

3.5. Background Characteristics of Women with a Need for Focused Family Planning Efforts 

Tables 13a, b, and c respectively present the urban-rural residence, level of women’s education, and 

economic status of women with a need for focused family planning efforts to satisfy combined unmet needs 

for spacing, limiting, and more effective methods. By residence, almost two of three women in need of 

focused efforts live in rural areas, and there is not a large difference between whether the need is for spacing 

or limiting (Table 13a and Figure 2). The regional and country patterns of need by residence generally 

follow the patterns observed for all the countries in total. 
38

Table 13a. Distribution of non-pregnant married and in-union women in need of focused family planning efforts by area of residence, 45 DHS country surveys 2006-2012 Country 

Survey 

date 

Unmet need for a 

spacing method 

Unmet need for a 

limiting method 

Need for a more effective 

method: spacing method 

needs limiting 

Total in need of focused family 

planning efforts 

Number of 

respondents Urban Rural 

Number of 

respondents Urban Rural 

Number of 

respondents Urban Rural 

Number of 

respondents Urban Rural 

West and Central Africa 

Benin 2006 818 38.6 61.4 2,744 34.5 65.5 1,379 45.5 54.5 4,941 38.2 61.8 Burkina Faso 2010 880 23.9 76.1 2,261 16.6 83.4 1,197 35.4 64.6 4,338 23.3 76.7 Cameroon 2011 516 53.3 46.7 1,468 42.8 57.2 1,306 61.7 38.3 3,290 52.0 48.0 DR Congo 2007 383 44.9 55.1 853 41.3 58.7 821 49.2 50.8 2,057 45.1 54.9 Ghana 2008 273 39.7 60.3 620 38.1 61.9 374 47.3 52.7 1,266 41.1 58.9 Liberia 2007 393 41.1 58.9 1,027 30.3 69.7 355 51.8 48.2 1,776 37.0 63.0 Mali 2006 1,028 50.6 49.4 2,423 24.8 75.2 591 46.7 53.3 4,043 34.6 65.4 Niger 2006 281 24.7 75.3 787 21.2 78.8 652 27.4 72.6 1,719 24.1 75.9 Nigeria 2008 1,093 30.6 69.4 3,079 29.6 70.4 2,257 53.6 46.4 6,430 38.2 61.8 Sao Tome & Principe 2008-09 126 61.8 38.2 378 58.5 41.5 426 42.1 57.9 930 51.4 48.6 Senegal 2010-11 908 51.6 48.4 1,913 37.7 62.3 808 64.4 35.6 3,629 47.1 52.9 Sierra Leone 2008 321 33.7 66.3 1,056 26.9 73.1 325 53.0 47.0 1,702 33.2 66.8 

East and Southern Africa

Burundi 2010 329 7.9 92.1 1,039 5.8 94.2 707 12.3 87.7 2,075 8.3 91.7 Ethiopia 2011 539 12.2 87.8 1,794 10.7 89.3 1,469 24.8 75.2 3,803 16.4 83.6 Kenya 2008-09 203 25.5 74.5 838 16.4 83.6 1,149 15.1 84.9 2,190 16.6 83.4 Lesotho 2009 246 19.3 80.7 579 20.8 79.2 728 28.4 71.6 1,553 24.1 75.9 Madagascar 2008-09 615 21.1 78.9 1,434 11.6 88.4 2,771 15.8 84.2 4,820 15.3 84.7 Malawi 2010 744 17.8 82.2 2,332 17.3 82.7 3,485 15.4 84.6 6,561 16.3 83.7 Mozambique 2011 529 33.6 66.4 1,443 31.0 69.0 657 51.6 48.4 2,628 36.7 63.3 Namibia 2006-07 99 46.5 53.5 471 34.4 65.6 766 50.8 49.2 1,336 44.7 55.3 Rwanda 2010 219 19.1 80.9 879 9.2 90.8 2,036 11.7 88.3 3,134 11.5 88.5 Swaziland 2006-07 70 21.3 78.7 338 22.1 77.9 533 23.2 76.8 941 22.6 77.4 Tanzania 2010 285 23.5 76.5 832 17.9 82.1 1,229 25.7 74.3 2,347 22.7 77.3 Uganda 2011 286 20.7 79.3 1,146 8.9 91.1 1,012 20.3 79.7 2,443 15.0 85.0 Zambia 2007 183 33.4 66.6 661 29.3 70.7 1,197 34.4 65.6 2,042 32.7 67.3 Zimbabwe 2010-11 173 37.0 63.0 394 26.3 73.7 1,544 27.7 72.3 2,111 28.2 71.8 

Middle East/North Africa 

Egypt 2008 281 30.1 69.9 930 29.6 70.4 2,478 36.4 63.6 3,689 34.2 65.8 Jordan 2007 188 76.0 24.0 841 83.5 16.5 2,877 85.5 14.5 3,906 84.6 15.4 

Eastern Europe/NIS 

Albania 2008-09 142 36.9 63.1 485 31.0 69.0 2,053 42.3 57.7 2,680 40.0 60.0 Armenia 2010 151 49.0 51.0 316 50.6 49.4 754 55.8 44.2 1,222 53.6 46.4 Azerbaijan 2006 111 50.8 49.2 1,035 53.5 46.5 1,265 49.3 50.7 2,412 51.2 48.8 Ukraine 2007 123 60.9 39.1 272 59.8 40.2 716 68.8 31.2 1,111 65.7 34.3 

(Continued)
39

Table 13a. − ContinuedCountry 

Survey 

date 

Unmet need for a 

spacing method 

Unmet need for a 

limiting method 

Need for a more effective 

method: spacing method 

needs limiting 

Total in need of focused family 

planning efforts 

Number of 

respondents Urban Rural 

Number of 

respondents Urban Rural 

Number of 

respondents Urban Rural 

Number of 

respondents Urban Rural 

Asia 

Bangladesh 2011 583 21.6 78.4 1,321 21.2 78.8 4,171 22.9 77.1 6,075 22.4 77.6 Cambodia 2010 478 13.5 86.5 1,321 12.8 87.2 2,878 15.6 84.4 4,677 14.6 85.4 India 2005-06 3,769 23.0 77.0 6,451 23.0 77.0 7,048 34.6 65.4 17,268 27.7 72.3 Indonesia 2007 787 44.6 55.4 1,677 37.4 62.6 6,916 40.7 59.3 9,379 40.5 59.5 Nepal 2011 740 9.1 90.9 1,691 9.8 90.2 1,069 14.9 85.1 3,500 11.2 88.8 Pakistan 2012-13 536 32.2 67.8 1,777 27.4 72.6 2,260 41.3 58.7 4,573 34.8 65.2 Philippines 2008 405 50.4 49.6 1,206 47.9 52.1 1,813 49.3 50.7 3,425 48.9 51.1 Timor-Leste 2009 556 23.4 76.6 1,768 24.1 75.9 1,303 30.4 69.6 3,627 26.3 73.7 

Latin America and Caribbean 

Bolivia 2008 261 62.5 37.5 1,255 43.0 57.0 2,751 54.4 45.6 4,267 51.6 48.4 

Colombia 2010 414 73.6 26.4 966 68.3 31.7 3,027 63.9 36.1 4,407 65.8 34.2 Dominican Rep. 2007 553 76.3 23.7 714 66.2 33.8 1,070 69.9 30.1 2,337 70.3 29.7 Guyana 2009 173 21.6 78.4 584 23.5 76.5 490 20.3 79.7 1,247 22.0 78.0 Peru 2012 173 67.5 32.5 522 58.2 41.8 4,023 60.7 39.3 4,719 60.7 39.3 

Unweighted Averages 

West and Central Africa 7,020 41.2 58.8 18,609 33.5 66.5 10,491 48.2 51.8 36,121 38.8 61.2 East and Southern Africa 4,520 24.2 75.8 14,180 18.7 81.3 19,283 25.5 74.5 37,984 22.2 77.8 Middle East/North Africa 469 53.1 47.0 1,771 56.6 43.5 5,355 61.0 39.1 7,595 59.4 40.6 Eastern Europe/NIS 527 49.4 50.6 2,108 48.7 51.3 4,788 54.1 46.0 7,425 52.6 47.4 Asia 7,854 27.2 72.8 17,212 25.5 74.6 27,458 31.2 68.8 52,524 28.3 71.7 Latin America and Caribbean 1,574 60.3 39.7 4,041 51.8 48.2 11,361 53.8 46.2 16,977 54.1 45.9 

Total 21,964 36.8 63.2 57,921 31.9 68.1 78,736 39.8 60.2 158,626 35.6 64.4 Note: Women with an unmet need (either desire- or fertility-risk based) and women with a need for a more effective method constitute the group who require focused family planning 

efforts. 
40 

Figure 2. Percent distribution of non-pregnant married and in-union women in need of focused 

family planning efforts by area of residence within region, 45 DHS country surveys 2006-2012 

By education, over half of the women with a need for focused family planning efforts have less than a 

primary complete education; only 10 percent have completed secondary school and 8 percent have higher 

education (Table 13b). The needs for spacing and for limiting vary by level of education, with fewer lesseducated women with a need for spacing and more with a need for limiting. For example, 41 percent of 

women with less than a primary school education have a need for limiting while 56 percent have a need for 

spacing. The opposite is true for women with secondary or higher education: 21 percent of these women 

have a spacing need and 15 percent have a limiting need (Table 13b and Figure 3). 

0

10

20

30

40

50

60

70

80

90

West and Central Africa East and Southern Africa Middle East/North Africa Eastern Europe/NIS Asia Latin America and

Caribbean

Percent of women in need of focused FP efforts

Urban Rural
41

Table 13b. Percent distribution of non-pregnant married and in-union women in need of focused family planning efforts by level of 

education, 45 DHS country surveys 2006-2012 

Country 

Survey 

date 

Unmet need for a spacing method Unmet need for a limiting method 

Need for a more effective method: 

Spacing method needs limiting Total 

Number 

of 

respondents No edu- cation 

Incomplete 

primary 

Complete 

primary 

Incomplete 

secondary 

Complete 

secondary Higher

Number 

of 

respondents No edu- cation 

Incomplete 

primary

Complete 

primary

Incomplete 

secondary

Complete 

secondary Higher

Number 

of 

respondents No edu- cation 

Incomplete 

primary 

Complete 

primary

Incomplete 

secondary 

Complete 

secondary Higher

Number 

of 

respondents No edu- cation 

Incomplete 

primary

Complete 

primary

Incomplete 

secondary 

Complete 

secondary Higher

West and Central Africa 

Benin 2006 818 63.3 21.3 3.0 10.6 0.6 1.3 2,744 77.9 15.1 1.7 4.8 0.2 0.2 1,379 62.7 20.3 2.8 12.6 0.9 0.6 4,941 71.3 17.6 2.2 8.0 0.5 0.5 

Burkina Faso 2010 880 73.5 13.7 4.2 7.1 0.8 0.7 2,261 88.8 6.6 2.0 2.1 0.1 0.4 1,197 69.8 13.2 4.1 11.3 0.7 0.9 4,338 80.5 9.9 3.0 5.7 0.4 0.6Cameroon 2011 516 16.7 20.5 14.5 42.5 1.5 4.2 1,468 32.5 28.9 15.3 20.4 0.9 1.9 1,306 6.3 14.7 29.8 40.9 2.6 5.7 3,290 19.6 22.0 20.9 32.0 1.7 3.8DR Congo 2007 383 16.9 31.8 8.9 36.0 4.4 1.9 853 24.6 30.4 8.1 31.2 5.3 0.3 821 15.6 30.0 9.7 34.3 9.2 1.2 2,057 19.6 30.5 8.9 33.4 6.7 1.0Ghana 2008 273 19.1 19.0 7.4 42.7 7.5 4.2 620 36.7 21.3 4.6 32.2 3.9 1.3 374 20.5 20.5 8.3 43.4 6.1 1.2 1,266 28.1 20.6 6.3 37.7 5.3 1.9Liberia 2007 393 28.3 36.3 8.3 18.3 6.2 2.6 1,027 55.0 25.1 4.9 9.5 4.3 1.0 355 42.6 25.1 4.6 17.5 8.1 1.9 1,776 46.6 27.6 5.6 13.1 5.5 1.5Mali 2006 1,028 63.4 12.5 1.6 20.2 0.9 1.4 2,423 87.1 7.2 1.4 3.8 0.2 0.3 591 67.9 16.5 2.2 12.1 0.6 0.7 4,043 78.3 9.9 1.6 9.2 0.4 0.7Niger 2006 281 80.9 10.4 1.5 6.6 0.3 0.2 787 87.2 8.2 0.9 3.4 0.3 0.0 652 79.6 11.1 2.1 5.9 0.6 0.7 1,719 83.3 9.6 1.5 4.9 0.4 0.3Nigeria 2008 1,093 39.3 5.1 12.2 16.4 19.6 7.4 3,079 47.5 7.9 19.4 9.9 10.9 4.3 2,257 13.4 5.8 24.2 15.9 26.8 13.9 6,430 34.1 6.7 19.9 13.1 18.0 8.2Sao Tome & Principe 2008-09 126 4.0 38.4 11.2 46.4 0.0 0.0 378 9.5 56.9 10.9 21.9 0.9 0.0 426 4.1 63.6 11.8 19.8 0.3 0.4 930 6.3 57.4 11.3 24.3 0.5 0.2Senegal 2010-11 908 57.6 23.7 4.4 12.9 0.2 1.2 1,913 76.3 14.6 2.8 5.2 0.7 0.5 808 52.0 26.2 7.5 11.6 0.9 1.8 3,629 66.2 19.5 4.2 8.5 0.6 1.0Sierra Leone 2008 321 67.5 9.9 2.2 14.5 2.2 3.6 1,056 77.9 9.6 2.2 8.2 0.8 1.3 325 61.6 10.0 4.6 18.7 2.0 3.2 1,702 72.8 9.7 2.7 11.4 1.3 2.1

East and Southern Africa

Burundi 2010 329 49.2 31.2 12.0 5.6 0.5 1.5 1,039 61.7 22.4 12.4 3.4 0.0 0.1 707 45.7 25.0 19.4 8.9 0.5 0.6 2,075 54.2 24.7 14.7 5.6 0.2 0.5 

Ethiopia 2011 539 51.9 38.1 2.9 3.4 1.4 2.4 1,794 75.8 21.3 1.7 0.6 0.3 0.3 1,469 64.4 26.9 2.4 2.3 1.1 2.9 3,803 68.0 25.8 2.1 1.7 0.8 1.6Kenya 2008-09 203 6.7 30.2 32.7 9.7 16.3 4.5 838 13.0 39.1 29.7 8.6 7.7 1.9 1,149 4.6 31.9 31.4 10.3 16.9 4.9 2,190 8.0 34.5 30.9 9.6 13.3 3.8Lesotho 2009 246 0.3 23.7 28.6 36.5 8.1 2.8 579 1.8 35.1 33.3 24.8 3.5 1.4 728 1.3 30.6 28.1 28.8 4.7 6.5 1,553 1.3 31.2 30.1 28.5 4.8 4.0Madagascar 2008-09 615 17.7 41.8 6.9 27.7 3.1 2.8 1,434 23.3 50.6 4.9 18.7 1.0 1.5 2,771 13.0 48.6 6.2 27.2 2.4 2.6 4,820 16.7 48.3 5.9 24.7 2.1 2.3Malawi 2010 744 7.5 57.5 10.1 15.3 7.9 1.6 2,332 24.1 57.5 8.6 7.0 2.2 0.6 3,485 18.0 61.7 8.5 8.0 3.1 0.6 6,561 19.0 59.8 8.7 8.5 3.3 0.7Mozambique 2011 529 22.4 40.8 12.0 21.8 2.4 0.7 1,443 37.6 49.3 5.0 6.0 1.2 0.8 657 22.5 47.0 9.4 15.4 4.2 1.6 2,628 30.8 47.0 7.5 11.5 2.2 1.0Namibia 2006-07 99 8.1 25.0 6.1 42.3 11.8 6.6 471 20.5 29.9 10.2 27.4 6.4 5.5 766 11.4 27.2 6.4 37.5 8.5 9.0 1,336 14.3 28.0 7.7 34.3 8.0 7.6Rwanda 2010 219 18.6 56.5 15.2 4.9 3.6 1.2 879 28.0 54.4 11.8 4.4 0.7 0.6 2,036 20.0 55.0 15.0 7.7 1.5 0.8 3,134 22.1 55.0 14.1 6.6 1.4 0.8Swaziland 2006-07 70 7.3 19.4 19.6 43.5 6.7 3.5 338 17.4 25.3 17.1 28.5 8.7 3.0 533 7.4 22.7 13.9 35.6 12.3 8.0 941 11.0 23.4 15.5 33.6 10.6 5.9Tanzania 2010 285 28.3 11.9 49.9 9.6 0.4 0.0 832 27.9 14.0 54.7 3.2 0.1 0.0 1,229 18.1 11.8 61.6 6.1 2.1 0.4 2,347 22.8 12.6 57.7 5.5 1.2 0.2Uganda 2011 286 4.9 48.8 16.1 20.6 2.8 6.9 1,146 20.1 56.0 12.0 10.1 0.3 1.5 1,012 11.0 48.9 11.9 22.7 1.0 4.4 2,443 14.6 52.2 12.4 16.6 0.9 3.4Zambia 2007 183 11.3 38.7 23.2 17.2 7.0 2.6 661 15.7 46.7 21.1 13.6 1.1 1.8 1,197 13.9 40.9 21.5 16.9 3.0 3.9 2,042 14.2 42.6 21.5 15.9 2.8 3.1Zimbabwe 2010-11 173 0.0 10.9 13.9 72.3 0.7 2.2 394 4.6 18.5 22.4 49.1 1.0 4.4 1,544 3.5 16.3 22.4 54.3 0.3 3.2 2,111 3.4 16.2 21.7 54.8 0.5 3.4

Middle East/North Africa 

Egypt 2008 281 18.1 5.0 2.0 11.2 45.7 18.1 930 42.8 9.9 4.1 10.8 26.4 5.9 2,478 40.1 10.8 5.8 10.6 26.2 6.5 3,689 39.1 10.2 5.1 10.7 27.7 7.2 Jordan 2007 188 1.3 2.9 1.2 43.6 16.0 35.1 841 6.5 5.7 5.0 45.7 13.7 23.4 2,877 2.9 3.1 2.9 43.5 18.2 29.5 3,906 3.6 3.6 3.2 44.0 17.1 28.4

Eastern Europe/NIS 

Albania 2008-09 142 1.0 1.7 62.2 4.4 13.3 17.4 485 0.2 2.8 63.3 4.2 22.7 6.8 2,053 0.3 2.3 54.2 4.4 31.0 7.9 2,680 0.3 2.3 56.2 4.4 28.6 8.2 

Armenia 2010 151 0.0 0.0 0.0 4.2 46.6 49.2 316 0.0 0.0 0.0 6.0 50.0 44.0 754 0.0 0.0 0.0 4.2 40.2 55.6 1,222 0.0 0.0 0.0 4.7 43.5 51.8Azerbaijan 2006 111 0.3 1.3 1.1 71.1 14.1 12.1 1,035 1.1 0.6 0.8 45.3 41.7 10.5 1,265 1.0 0.3 0.2 37.1 51.3 10.0 2,412 1.0 0.5 0.5 42.2 45.5 10.3Ukraine 2007 123 0.0 0.0 0.0 30.2 6.0 63.7 272 0.0 0.0 0.3 36.6 9.0 54.1 716 0.1 0.0 0.2 29.6 7.9 62.1 1,111 0.1 0.0 0.2 31.4 8.0 60.3

Asia 

Bangladesh 2011 583 7.9 10.9 10.9 53.2 6.3 10.7 1,321 31.5 19.9 10.5 28.3 4.1 5.6 4,171 39.0 23.8 11.5 18.4 3.1 4.1 6,075 34.4 21.7 11.3 23.9 3.6 5.1 Cambodia 2010 478 13.8 44.7 10.7 27.1 1.9 1.7 1,321 22.4 56.1 5.0 14.2 1.6 0.6 2,878 19.8 53.2 6.4 17.9 1.5 1.1 4,677 19.9 53.2 6.5 17.8 1.6 1.0India 2005-06 3,769 36.8 6.2 9.1 36.7 5.5 5.6 6,451 59.8 6.8 6.3 20.6 2.7 3.8 7,048 48.9 8.3 6.8 25.6 3.5 7.0 17,268 50.3 7.3 7.1 26.2 3.6 5.5Indonesia 2007 787 2.2 8.7 30.8 27.1 25.4 5.8 1,677 10.9 22.4 30.5 17.4 14.4 4.3 6,916 7.3 20.9 33.8 17.5 14.8 5.6 9,379 7.5 20.2 33.0 18.3 15.6 5.4Nepal 2011 740 20.6 14.1 5.6 33.8 16.9 9.0 1691.0 47.0 15.8 7.1 18.7 7.1 4.2 1069.0 59.7 15.3 3.9 12.6 4.4 4 3,500 45.3 15.3 5.8 20.0 8.4 5.2Pakistan 2012-13 536 43.0 8.1 12.0 11.6 13.0 12.3 1,777 68.6 6.8 7.0 6.7 6.4 4.6 2,260 50.3 6.7 12.9 9.2 10.9 9.9 4,573 56.6 6.9 10.5 8.5 9.4 8.1Philippines 2008 405 1.1 9.1 9.6 13.3 32.1 34.8 1,206 2.6 13.5 15.8 16.2 26.3 25.5 1,813 0.8 10.5 17.0 16.7 30.4 24.7 3,425 1.4 11.4 15.7 16.1 29.1 26.2

Timor-Leste 2009 556 23.7 10.1 9.7 27.2 24.5 4.9 1,768 41.5 15.0 11.8 16.1 13.9 1.7 1,303 29.9 17.5 14.8 19.3 16.1 2.5 3,627 34.6 15.1 12.6 19.0 16.3 2.5

(Continued)
42

Table 13b. − ContinuedCountry 

Survey 

date 

Unmet need for a spacing method Unmet need for a limiting method 

Need for a more effective method: 

Spacing method needs limiting Total 

Number 

of 

respondents No edu- cation 

Incomplete 

primary 

Complete 

primary 

Incomplete 

secondary 

Complete 

secondary Higher

Number 

of 

respondents No edu- cation 

Incomplete 

primary

Complete 

primary

Incomplete 

secondary

Complete 

secondary Higher

Number 

of 

respondents No edu- cation 

Incomplete 

primary 

Complete 

primary

Incomplete 

secondary 

Complete 

secondary Higher

Number 

of 

respondents No edu- cation 

Incomplete 

primary 

Complete 

primary

Incomplete 

secondary 

Complete 

secondary Higher

Latin America and Caribbean 

Bolivia 2008 261 2.2 34.1 8.7 18.6 20.2 16.2 1,255 11.7 61.6 5.1 9.4 7.0 5.0 2,751 7.1 56.6 5.9 10.6 10.8 9.0 4,267 8.2 56.7 5.8 10.7 10.2 8.3 Colombia 2010 414 3.2 7.1 11.1 31.3 26.1 21.1 966 5.8 19.4 18.2 21.5 22.2 12.9 3,027 3.6 23.7 19.9 22.7 19.3 10.8 4,407 4.0 21.2 18.7 23.2 20.6 12.2

Dominican Rep. 2007 553 1.0 22.4 9.2 30.7 15.5 21.3 714 7.7 40.4 7.2 23.2 10.1 11.4 1,070 5.2 43.2 9.6 20.4 10.1 11.4 2,337 5.0 37.4 8.8 23.7 11.4 13.8

Guyana 2009 173 0.8 7.1 6.3 36.8 36.1 13.0 584 3.0 17.3 12.8 41.2 21.1 4.7 490 1.7 16.3 13.4 45.6 18.7 4.4 1,247 2.2 15.5 12.1 42.3 22.2 5.7

Peru 2012 173 0.2 12.0 13.4 18.1 41.3 14.9 522 5.5 29.3 14.9 15.2 18.4 16.7 4,023 5.1 29.8 14.7 15.3 20.3 14.7 4,719 5.0 29.1 14.7 15.4 20.9 15.0

Unweighted Averages 

West and Central Africa 7,020 44.2 20.2 6.6 22.9 3.7 2.4 18,609 58.4 19.3 6.2 12.7 2.4 1.0 10,491 41.3 21.4 9.3 20.3 4.9 2.7 36,121 50.6 20.1 7.3 16.8 3.4 1.8 East and Southern Africa 4,520 16.7 33.9 17.8 23.6 5.2 2.8 14,180 26.5 37.2 17.5 14.7 2.4 1.7 19,283 18.2 35.3 18.4 20.1 4.4 3.5 37,984 21.5 35.8 17.9 18.4 3.7 2.7Middle East/North Africa 469 9.7 4.0 1.6 27.4 30.9 26.6 1,771 24.7 7.8 4.6 28.3 20.1 14.7 5,355 21.5 7.0 4.4 27.1 22.2 18.0 7,595 21.4 6.9 4.2 27.4 22.4 17.8Eastern Europe/NIS 527 0.3 0.8 15.8 27.5 20.0 35.6 2,108 0.3 0.9 16.1 23.0 30.9 28.9 4,788 0.4 0.7 13.7 18.8 32.6 33.9 7,425 0.4 0.7 14.2 20.7 31.4 32.7

Asia 7,854 18.6 14.0 12.3 28.8 15.7 10.6 17,212 35.5 19.5 11.8 17.3 9.6 6.3 27,458 32.0 19.5 13.4 17.2 10.6 7.4 52,524 31.3 18.9 12.8 18.7 11.0 7.4

Latin America and Caribbean 1,574 1.5 16.5 9.7 27.1 27.8 17.3 4,041 6.7 33.6 11.6 22.1 15.8 10.1 11,361 4.5 33.9 12.7 22.9 15.8 10.1 16,977 4.9 32.0 12.0 23.1 17.1 11.0 

Total 21,964 20.9 20.5 12.0 25.2 11.6 9.7 57,921 32.0 24.3 12.1 16.8 8.5 6.2 78,736 23.9 24.3 13.4 20.2 10.2 8.1 158,626 27.2 23.8 12.6 19.1 9.7 7.6 Note: Women with an unmet need (either desire- or fertility-risk based) and women with a need for a more effective method constitute the group who require focused family planning efforts. 
43 

Figure 3. Percent distribution of non-pregnant married and in-union women in need of focused 

family planning efforts by level of education within region, 45 DHS country surveys 2006-2012 

The distribution of women in need of focused family planning efforts by their wealth quintile is surprisingly 

uniform, between 19 and 20 percent in each quintile (Table 13c and Figure 4). The distribution of women 

in need of a spacing method is also close to uniform. More women with a combined limiting need are in 

the lower quintiles than in the higher quintiles but the opposite is true for women users with a need for a 

LAPM. The distribution by quintile within region is shown in Figure 4. Focused efforts needed are quite 

uniform in the Eastern Europe/NIS and Asia regions, are increasing somewhat with wealth in the subSaharan Africa regions, and are decreasing with wealth in the Middle East/North Africa and Latin America 

and Caribbean regions. A possible explanation for these different patterns is that long periods of postpartum 

abstinence and higher levels of infecundity occur among the poor than the wealthy in sub-Saharan Africa. 

In addition, use of contraception is higher among the wealthy than among the poor in the Middle East/North 

Africa and Latin America and Caribbean regions.

0

10

20

30

40

50

60

West and Central Africa East and Southern Africa Middle East/North Africa Eastern Europe/NIS Asia Latin America and

Caribbean

Percent of women in need of focused FP efforts

No education Primary incomplete Completed primary Incomplete secondary Secondary completed Higher
44

Table 13c. Percent distribution of non-pregnant married and in-union women in need of focused family planning efforts by wealth quintile, 45 DHS country surveys 2006-2012 Country 

Survey 

date 

Unmet need for a spacing method Unmet need for a limiting method 

Need for a more effective method: 

Spacing method needs limiting Total 

Number of 

respondents Poorest Poorer Middle Richer Richest 

Number of 

respondents Poorest Poorer Middle Richer Richest 

Number of 

respondents Poorest Poorer Middle Richer Richest 

Number of 

respondents Poorest Poorer Middle Richer Richest

West and Central Africa 

Benin 2006 818 18.0 16.4 21.0 25.9 18.7 2,744 19.8 21.7 21.5 19.8 17.2 1,379 11.3 15.5 17.4 23.6 32.2 4,941 17.1 19.1 20.3 21.9 21.6 Burkina Faso 2010 880 15.0 21.2 22.6 19.5 21.7 2,261 20.8 21.8 22.2 21.2 13.9 1,197 11.3 14.0 15.6 24.5 34.6 4,338 17.0 19.6 20.5 21.8 21.2Cameroon 2011 516 15.2 15.4 19.3 26.1 24.0 1,468 25.0 21.6 21.1 18.4 13.9 1,306 3.2 15.3 21.3 29.2 31.0 3,290 14.8 18.1 20.9 23.9 22.3DR Congo 2007 383 22.0 19.5 25.0 17.9 15.6 853 18.6 24.2 22.0 20.9 14.4 821 13.6 17.1 17.8 20.9 30.6 2,057 17.3 20.5 20.9 20.3 21.1Ghana 2008 273 16.4 23.5 22.0 22.7 15.5 620 23.9 24.6 18.9 19.0 13.6 374 14.0 18.5 17.1 22.4 28.1 1,266 19.3 22.6 19.0 20.8 18.3Liberia 2007 393 17.6 16.4 23.5 20.8 21.6 1,027 18.6 25.7 21.8 20.5 13.4 355 7.9 12.5 29.7 25.7 24.3 1,776 16.2 21.0 23.7 21.6 17.4Mali 2006 1,028 12.9 13.3 16.0 17.3 40.5 2,423 21.3 21.8 21.7 19.1 16.2 591 10.5 13.8 13.8 23.3 38.6 4,043 17.6 18.5 19.1 19.2 25.6Niger 2006 281 18.3 16.0 16.5 20.6 28.6 787 19.7 21.2 19.9 17.0 22.1 652 20.3 15.5 13.7 20.3 30.2 1,719 19.7 18.2 17.0 18.8 26.3Nigeria 2008 1,093 20.5 19.6 18.0 21.6 20.4 3,079 20.6 22.7 20.5 20.0 16.2 2,257 5.5 8.8 15.6 25.9 44.2 6,430 15.3 17.3 18.3 22.3 26.8Sao Tome & Principe 2008-09 16 22.1 14.8 21.6 25.5 0.0 21 21.3 21.4 18.8 17.8 0.0 17 20.2 18.1 23.1 21.9 0.0 18 20.9 19.0 21.1 20.7 0.0Senegal 2010-11 908 16.6 15.8 18.0 25.2 24.4 1,913 22.7 22.6 21.5 19.0 14.2 808 9.2 12.3 23.3 25.0 30.2 3,629 18.2 18.6 21.0 21.9 20.3Sierra Leone 2008 321 19.7 18.7 19.6 19.4 22.6 1,056 20.5 22.1 22.5 20.6 14.4 325 12.3 10.6 13.3 26.1 37.6 1,702 18.8 19.2 20.2 21.4 20.4

East and Southern Africa 

Burundi 2010 329 26.7 20.3 19.3 14.9 18.7 1,039 17.6 26.8 19.7 20.1 15.7 707 14.7 17.2 21.6 20.3 26.2 2,075 18.1 22.5 20.3 19.3 19.8 Ethiopia 2011 539 27.3 22.8 18.4 19.5 12.1 1,794 24.6 21.1 23.1 19.8 11.4 1,469 11.0 16.9 20.0 24.5 27.6 3,803 19.7 19.7 21.3 21.6 17.8Kenya 2008-09 203 16.5 23.1 15.9 20.2 24.3 838 29.3 23.2 16.7 13.3 17.6 1,149 11.0 21.0 25.5 26.1 16.5 2,190 18.5 22.0 21.2 20.6 17.6Lesotho 2009 246 21.8 23.0 16.8 21.6 16.8 579 27.5 21.1 16.2 21.1 14.1 728 14.5 15.3 19.6 23.8 26.8 1,553 20.5 18.7 17.9 22.4 20.5Madagascar 2008-09 615 20.1 19.6 14.7 17.2 28.4 1,434 23.2 21.9 19.2 18.5 17.1 2,771 11.3 15.4 22.2 25.0 26.1 4,820 16.0 17.9 20.4 22.1 23.7Malawi 2010 744 16.9 20.4 21.2 21.3 20.2 2,332 19.1 21.1 20.9 19.7 19.2 3,485 16.6 20.3 21.1 23.1 18.8 6,561 17.5 20.6 21.1 21.7 19.1Mozambique 2011 529 16.5 19.1 20.6 19.8 24.0 1,443 19.8 20.7 18.7 20.4 20.4 657 5.2 10.6 14.9 25.4 43.9 2,628 15.5 17.9 18.1 21.5 27.0Namibia 2006-07 99 31.0 8.2 22.1 17.7 21.1 471 27.2 18.8 25.0 17.1 11.9 766 13.9 16.2 20.4 27.4 22.1 1,336 19.9 16.5 22.1 23.1 18.5Rwanda 2010 219 31.9 19.7 16.6 10.3 21.4 879 25.1 23.6 18.4 18.7 14.2 2,036 16.8 19.4 20.7 23.8 19.3 3,134 20.2 20.6 19.8 21.4 18.0Swaziland 2006-07 70 25.7 7.1 15.3 30.8 21.0 338 22.8 19.6 19.1 20.1 18.4 533 15.0 18.2 23.4 20.5 22.9 941 18.6 17.9 21.2 21.1 21.2Tanzania 2010 285 19.7 20.9 21.0 20.1 18.3 832 24.4 22.6 25.3 17.2 10.5 1,229 15.1 17.9 19.7 24.1 23.3 2,347 19.0 19.9 21.8 21.2 18.2Uganda 2011 286 21.3 19.8 17.4 15.6 26.0 1,146 25.6 23.2 19.5 19.4 12.3 1,012 10.8 16.5 19.7 23.2 29.7 2,443 19.0 20.0 19.3 20.5 21.1Zambia 2007 183 19.3 24.1 22.1 20.9 13.6 661 20.9 24.5 22.9 19.7 11.9 1,197 25.2 17.7 17.0 21.4 18.7 2,042 23.3 20.5 19.4 20.8 16.0Zimbabwe 2010-11 173 20.4 19.8 18.3 25.6 15.9 394 26.0 25.3 15.6 18.6 14.5 1,544 20.9 20.5 20.2 21.7 16.7 2,111 21.8 21.3 19.2 21.4 16.2

Middle East/North Africa 

Egypt 2008 281 20.9 20.4 23.1 21.4 14.1 930 26.2 22.6 20.1 17.1 14.0 2,478 25.2 21.7 20.6 17.6 14.8 3,689 25.2 21.9 20.7 17.7 14.6 Jordan 2007 188 29.8 31.1 22.5 9.3 7.3 841 21.7 19.7 20.2 16.1 22.2 2,877 17.9 19.9 22.8 21.3 18.1 3,906 19.3 20.4 22.2 19.6 18.4

Eastern Europe/NIS 

Albania 2008-09 142 22.9 16.5 24.3 18.4 18.0 485 24.8 23.1 22.9 17.5 11.8 2,053 20.0 20.2 22.0 18.5 19.3 2,680 21.0 20.5 22.3 18.3 17.8 

Armenia 2010 151 20.2 29.4 16.8 21.5 12.1 316 22.3 28.6 23.0 9.3 16.8 754 24.4 20.1 13.5 19.9 22.1 1,222 23.4 23.5 16.4 17.4 19.5Azerbaijan 2006 111 17.2 28.6 22.8 14.5 16.9 1,035 17.6 21.7 23.1 23.2 14.4 1,265 24.6 20.1 18.8 17.2 19.2 2,412 21.3 21.2 20.8 19.7 17.1

Ukraine 2007 123 14.7 23.9 28.5 18.0 14.9 272 16.9 19.9 20.8 19.9 22.5 716 14.2 21.1 18.2 17.5 29.0 1,111 14.9 21.1 20.0 18.1 25.9

Asia 

Bangladesh 2011 583 13.4 17.2 21.4 26.7 21.3 1,321 19.4 16.7 19.1 23.2 21.5 4,171 20.8 21.5 20.9 19.1 17.6 6,075 19.8 20.1 20.6 20.8 18.8 Cambodia 2010 478 23.3 22.9 18.6 19.1 16.1 1,321 24.4 23.5 19.3 18.1 14.7 2,878 17.9 20.9 21.1 21.3 18.8 4,677 20.3 21.8 20.3 20.2 17.4India 2005-06 3,769 21.3 21.4 21.9 20.2 15.1 6,451 30.5 23.1 19.2 14.8 12.4 7,048 19.0 19.8 17.4 19.1 24.6 17,268 23.8 21.4 19.1 17.7 18.0Indonesia 2007 787 22.8 20.2 20.0 18.3 18.7 1,677 27.9 17.5 20.2 16.5 17.9 6,916 18.4 20.8 20.1 21.5 19.3 9,379 20.4 20.2 20.1 20.3 19.0Nepal 2011 740 15.9 16.4 27.6 21.2 19.0 1,691 21.4 20.6 19.8 21.1 17.1 1,069 23.3 20.3 19.6 16.7 20.1 3,500 20.8 19.6 21.4 19.8 18.4Pakistan 2012-13 536 16.2 21.4 21.2 21.0 20.2 1,777 26.0 22.6 18.0 18.6 14.8 2,260 10.8 17.2 23.2 24.2 24.6 4,573 17.4 19.8 20.9 21.6 20.3Philippines 2008 405 21.4 17.6 17.0 23.9 20.0 1,206 25.8 19.2 19.5 16.6 18.9 1,813 20.4 22.1 23.0 18.5 16.1 3,425 22.4 20.5 21.1 18.5 17.6Timor-Leste 2009 556 15.5 17.3 25.4 22.7 19.1 1,768 22.9 18.5 20.3 16.8 21.4 1,303 14.4 15.4 17.0 21.8 31.4 3,627 18.7 17.2 19.9 19.5 24.7

(Continued)
45

Table 13c. − ContinuedCountry 

Survey 

date 

Unmet need for a spacing method Unmet need for a limiting method 

Need for a more effective method: 

Spacing method needs limiting Total 

Number of 

respondents Poorest Poorer Middle Richer Richest 

Number of 

respondents Poorest Poorer Middle Richer Richest 

Number of 

respondents Poorest Poorer Middle Richer Richest 

Number of 

respondents Poorest Poorer Middle Richer Richest

Latin America and Caribbean

Bolivia 2008 261 16.7 20.4 25.8 22.3 14.8 1,255 35.4 24.6 18.7 12.9 8.4 2,751 21.1 22.3 21.5 19.3 15.7 4,267 25.0 22.9 21.0 17.6 13.5 

Colombia 2010 414 24.8 23.0 23.6 20.1 8.5 966 29.6 19.5 16.8 18.7 15.5 3,027 29.5 20.5 19.7 16.5 13.8 4,407 29.0 20.5 19.4 17.3 13.7

Dominican Rep. 2007 553 16.7 16.9 20.6 22.3 23.5 714 26.6 21.7 20.4 16.0 15.3 1,070 28.2 22.4 19.4 17.7 12.2 2,337 25.0 20.9 20.0 18.3 15.8Guyana 2009 173 16.2 16.9 23.1 22.5 21.3 584 26.1 20.8 16.6 19.6 16.9 490 20.3 20.7 18.4 19.7 20.8 1,247 22.5 20.2 18.2 20.0 19.1

Peru 2012 173 20.4 23.5 27.5 17.9 10.7 522 30.3 21.2 21.1 16.8 10.6 4,023 25.5 24.1 19.5 17.6 13.3 4,719 25.8 23.7 20.0 17.5 12.9

Unweighted Averages 

West and Central Africa 6,910 17.9 17.6 20.3 21.9 21.1 18,252 21.1 22.6 21.0 19.4 14.1 10,082 11.6 14.3 18.5 24.1 30.1 35,209 17.7 19.3 20.2 21.2 20.1 East and Southern Africa 4,520 22.5 19.1 18.6 19.7 20.1 14,180 23.8 22.4 20.0 18.8 14.9 19,283 14.4 17.4 20.4 23.6 24.2 37,984 19.1 19.7 20.2 21.3 19.6Middle East/North Africa 469 25.4 25.8 22.8 15.4 10.7 1,771 24.0 21.2 20.2 16.6 18.1 5,355 21.6 20.8 21.7 19.5 16.5 7,595 22.3 21.2 21.5 18.7 16.5

Eastern Europe/NIS 527 18.8 24.6 23.1 18.1 15.5 2,108 20.4 23.3 22.5 17.5 16.4 4,788 20.8 20.4 18.1 18.3 22.4 7,425 20.2 21.6 19.9 18.4 20.1

Asia 7,854 18.7 19.3 21.6 21.6 18.7 17,212 24.8 20.2 19.4 18.2 17.3 27,458 18.1 19.8 20.3 20.3 21.6 52,524 20.5 20.1 20.4 19.8 19.3

Latin America and Caribbean 1,574 19.0 20.1 24.1 21.0 15.8 4,041 29.6 21.6 18.7 16.8 13.3 11,361 24.9 22.0 19.7 18.2 15.2 16,977 25.5 21.6 19.7 18.1 15.0

Total 21,854 20.0 19.6 20.8 20.4 18.8 57,564 23.6 22.0 20.3 18.4 15.2 78,327 16.4 17.9 19.7 21.9 23.8 157,714 19.9 20.1 20.2 20.3 19.1 Note: Women with an unmet need (either desire- or fertility-risk based) and women with a need for a more effective method constitute the group who require focused family planning efforts. 
46 

Figure 4. Percent distribution of non-pregnant married and in-union women in need of focused 

family planning efforts by wealth quintile within region, 45 DHS country surveys 2006-2012 

3.6. Family Planning Characteristics for Women with a Need for Focused Family Planning 

Efforts 

Program managers who work with women who need special efforts from family planning programs will 

find it useful to know if the women have used contraception in the past. Table 14 presents the pattern of 

use for women with a combined unmet need for contraception for spacing and limiting, and for all those 

with a need for focused efforts. Among women with a combined unmet spacing need, over half (60 percent) 

have never used contraception. Among women with an unmet combined limiting need, 55 percent have 

used contraception at some time in the past. When women who are in need of a more effective method are 

added, about half of those with a need for focused family planning efforts are current users, over a quarter 

have never used (28 percent), and almost a quarter (23 percent) have used in the past but are not current 

users. Benin, Niger, São Tomé and Principe, and the Philippines did not collect information on previous 

contraception use. 

0

5

10

15

20

25

30

West and Central Africa East and Southern Africa Middle East/North Africa Eastern Europe/NIS Asia Latin America and

Caribbean

Percent of women in need of focused FP efforts

Lowest Second Middle Fourth Highest
47

Table 14. Pattern of use of contraception among married and in-union women with a need for focused family planning efforts, 41 DHS country surveys 2006-2012 Country Survey date 

Unmet need for a spacing method Unmet need for a limiting method 

Need for a more effective 

method: using spacing method 

needs limiting method All with a need for focused family planning efforts 

Number of 

respondents Used before1 Never used 

Number of 

respondents Used before1 Never used 

Number of 

respondents Currently using 

Number of 

respondents Currently using Used before1 Never used 

West and Central Africa 

Burkina Faso 2010 880 11.3 88.6 2,261 15.0 85.0 1,197 100.0 4,338 27.6 10.2 62.3 Cameroon 2011 516 36.0 64.0 1,468 35.0 65.0 1,306 100.0 3,290 39.7 21.3 39.0

DR Congo 2007 383 46.2 53.8 853 41.6 58.4 821 100.0 2,057 39.9 25.9 34.2

Ghana 2008 273 51.6 48.4 620 55.0 45.0 374 100.0 1,266 29.5 38.1 32.5

Liberia 2007 393 35.6 64.4 1,027 35.0 65.0 355 100.0 1,776 20.0 28.2 51.8Mali 2006 1,028 15.6 84.4 2,423 19.0 81.0 591 100.0 4,043 14.6 15.4 70.0

Nigeria 2008 1,093 21.0 79.0 3,079 27.1 72.9 2,257 100.0 6,430 35.1 16.5 48.3

Senegal 2010-11 908 20.1 79.9 1,913 28.2 71.8 808 100.0 3,629 22.3 19.8 57.8

Sierra Leone 2008 321 18.9 81.1 1,056 25.4 74.7 325 100.0 1,702 19.1 19.3 61.6

East and Southern Africa 

Burundi 2010 329 9.3 90.7 1,039 14.7 85.3 707 100.0 2,075 34.1 8.8 57.1 Ethiopia 2011 539 21.3 78.6 1,794 29.2 70.8 1,469 100.0 3,803 38.6 16.8 44.6

Kenya 2008-09 203 50.9 49.2 838 64.2 35.7 1,149 100.0 2,190 52.5 29.3 18.2

Lesotho 2009 246 56.1 44.0 579 61.7 38.2 728 100.0 1,553 46.9 31.9 21.2

Madagascar 2008-09 615 30.8 69.2 1,434 45.4 54.7 2,771 100.0 4,820 57.5 17.4 25.1

Malawi 2010 744 54.9 45.1 2,332 74.5 25.6 3,485 100.0 6,561 53.1 32.7 14.2

Mozambique 2011 529 19.1 80.9 1,443 29.0 71.0 657 100.0 2,628 25.0 19.8 55.2

Namibia 2006-07 99 72.8 27.2 471 76.7 23.3 766 100.0 1,336 57.4 32.4 10.2

Rwanda 2010 219 25.6 74.4 879 36.6 63.5 2,036 100.0 3,134 65.0 12.0 23.0

Swaziland 2006-07 70 69.6 30.4 338 88.4 11.6 533 100.0 941 56.7 36.9 6.4

Tanzania 2010 285 15.2 84.7 832 25.3 74.7 1,229 100.0 2,347 52.4 10.8 36.8Uganda 2011 286 34.2 65.8 1,146 42.4 57.6 1,012 100.0 2,443 41.4 23.9 34.7

Zambia 2007 183 65.6 34.4 661 71.8 28.2 1,197 100.0 2,042 58.6 29.1 12.2

Zimbabwe 2010-11 173 37.8 62.2 394 41.1 58.9 1,544 100.0 2,111 73.1 10.8 16.1

Middle East/North Africa 

Egypt 2008 281 42.4 57.6 930 85.5 14.5 2,478 100.0 3,689 67.2 24.8 8.0 Jordan 2007 188 29.1 70.9 841 83.2 16.8 2,877 100.0 3,906 73.7 19.3 7.0

Eastern Europe/NIS 

Albania 2008-09 142 69.5 30.5 485 91.6 8.4 2,053 100.0 2,680 76.6 20.2 3.1 

Armenia 2010 151 12.4 87.6 316 49.5 50.5 754 100.0 1,222 61.7 14.3 23.9Azerbaijan 2006 111 27.8 72.1 1,035 47.2 52.7 1,265 100.0 2,412 52.5 21.6 26.0

Ukraine 2007 123 60.6 39.4 272 92.8 7.2 716 100.0 1,111 64.4 29.4 6.1

Asia 

Bangladesh 2011 583 60.4 39.5 1,321 85.2 14.8 4,171 100.0 6,075 68.7 24.3 7.0 Cambodia 2010 478 28.5 71.6 1,321 65.2 34.9 2,878 100.0 4,677 61.5 21.3 17.2

India 2005-06 3,769 14.6 85.4 6,451 32.8 67.1 7,048 100.0 17,268 40.8 15.4 43.7

Indonesia 2007 787 58.2 41.8 1,677 72.7 27.3 6,916 100.0 9,379 73.7 17.9 8.4

Nepal 2011 740 34.8 65.2 1,691 72.2 27.8 1,069 100.0 3,500 30.6 42.3 27.2Pakistan 2012-13 536 14.3 85.7 1,777 57.9 42.1 2,260 100.0 4,573 49.4 24.1 26.4

Timor-Leste 2009 556 4.9 95.1 1,768 16.5 83.5 1,303 100.0 3,627 35.9 8.8 55.3

Latin America and Caribbean 

Bolivia 2008 261 59.8 40.2 1,255 56.9 43.0 2,751 100.0 4,267 64.5 20.4 15.1 Colombia 2010 414 90.5 9.5 966 92.9 7.1 3,027 100.0 4,407 68.7 28.8 2.5Dominican Rep. 2007 553 78.0 22.0 714 86.4 13.6 1,070 100.0 2,337 45.8 44.9 9.4Guyana 2009 173 57.4 42.7 584 81.4 18.5 490 100.0 1,247 39.3 46.1 14.6Peru 2012 173 84.7 15.4 522 87.8 12.2 4,023 100.0 4,719 85.3 12.9 1.9

(Continued)
48

Table 14. − Continued Country Survey date 

Unmet need for a spacing method Unmet need for a limiting method 

Need for a more effective 

method: using spacing method 

needs limiting method All with a need for focused family planning efforts 

Number of 

respondents Used before1 Never used 

Number of 

respondents Used before1 Never used 

Number of 

respondents Currently using 

Number of 

respondents Currently using Used before1 Never used 

Unweighted Averages 

West and Central Africa 5,795 28.5 71.5 14,700 31.3 68.8 8,034 100.0 28,531 27.5 21.6 50.8 

East and Southern Africa 4,520 40.2 59.8 14,180 50.1 49.9 19,283 100.0 37,984 50.9 22.3 26.8

Middle East/North Africa 469 35.8 64.3 1,771 84.4 15.7 5,355 100.0 7,595 70.5 22.1 7.5

Eastern Europe/NIS 527 42.6 57.4 2,108 70.3 29.7 4,788 100.0 7,425 63.8 21.4 14.8

Asia 7,449 30.8 69.2 16,006 57.5 42.5 25,645 100.0 49,099 51.5 22.0 26.5

Latin America and Caribbean 1,574 74.1 26.0 4,041 81.1 18.9 11,361 100.0 16,977 60.7 30.6 8.7

Total 20,334 40.2 59.8 52,806 54.6 45.4 74,466 100.0 147,611 49.3 23.0 27.71Includes used since last birth and used prior to last birth Notes: Women with an unmet need (either desire- or fertility-risk based) and women with a need for a more effective method constitute the group who require focused family planning efforts.Prior use of contraception was not asked in Benin, Niger, Sao Tome & Principe, and the Philippines.
49 

Among women who need focused family planning efforts and who visited a health facility in the preceding 

12 months, Table 15 presents the percentage who were told of family planning by the type of combined 

unmet need for contraception. Only two of five women who need focused efforts and who visited a health 

facility in the preceding year were told about family planning or contraceptive methods. The percentage is 

even lower (35 percent) for women with an unmet need for spacing or limiting (as compared to those in 

need of a more effective method) and is particularly low for women with all three types of need in the 

Eastern Europe/NIS region. 

Table 15. Among married and in-union women with a need for focused family planning efforts and who visited a 

health facility in the preceding 12 months, the percent who were told of family planning by type of unmet need 

for contraception, 45 DHS country surveys 2006-2012 

Country 

Survey 

date 

Unmet need for a 

spacing method 

Unmet need for a 

limiting method 

Need for a more effective 

method: spacing method 

needs limiting 

All with a need for 

focused family 

planning efforts 

Number of 

respondents Percent told

Number of 

respondents Percent told

Number of 

respondents Percent told 

Number of 

respondents Percent told

West and Central Africa 

Benin 2006 396 17.1 1,107 25.1 690 28.9 2,193 24.9 

Burkina Faso 2010 640 39.7 1,439 42.1 967 64.1 3,046 48.6 

Cameroon 2011 334 24.5 862 28.5 949 36.4 2,146 31.4 

DR Congo 2007 120 23.2 366 21.1 401 20.8 887 21.2 

Ghana 2008 178 40.8 337 38.2 227 38.9 742 39.1 

Liberia 2007 270 68.9 666 67.0 295 89.2 1,231 72.7 

Mali 2006 218 28.6 527 30.1 281 55.8 1,027 36.8 

Niger 2006 122 20.4 378 15.0 397 40.4 896 27.1 

Nigeria 2008 267 51.4 743 36.9 892 52.5 1,902 46.3 

Sao Tome & 

Principe 2008-09 71 73.6 193 70.4 245 70.8 509 71.0 

Senegal 2010-11 594 16.5 1,267 23.2 630 61.4 2,491 31.2 

Sierra Leone 2008 142 36.0 463 47.4 219 60.9 824 49.0 

East and Southern Africa 

Burundi 2010 268 40.0 840 38.4 614 38.5 1,721 38.6 

Ethiopia 2011 169 16.5 667 22.5 721 34.1 1,557 27.2 

Kenya 2008-09 121 25.5 483 28.4 718 33.8 1,322 31.0 

Lesotho 2009 107 34.8 259 34.8 389 33.9 755 34.3 

Madagascar 2008-09 224 44.4 515 52.6 1,455 65.5 2,194 60.3 

Malawi 2010 592 62.0 1,881 64.8 2,975 70.6 5,448 67.7 

Mozambique 2011 357 36.9 906 43.5 505 49.9 1,768 44.0 

Namibia 2006-07 20 22.2 169 22.1 312 34.3 501 29.7 

Rwanda 2010 167 62.7 611 62.7 1,491 68.4 2,268 66.5 

Swaziland 2006-07 43 40.8 175 34.9 359 50.7 576 45.2 

Tanzania 2010 219 47.2 597 42.3 943 52.4 1,759 48.3 

Uganda 2011 217 33.6 860 34.0 747 34.6 1,824 34.2 

Zambia 2007 103 37.0 326 55.1 767 63.4 1,197 58.9 

Zimbabwe 2010-11 79 44.8 150 48.9 691 53.3 920 51.9 

Middle East/North Africa 

Egypt* 2008 113 32.4 241 31.7 973 41.6 1,327 39.0 

Jordan* 2007 163 23.8 648 22.9 2,395 30.5 3,206 28.6 

Eastern Europe/NIS

Albania 2008-09 48 35.1 120 23.3 717 33.4 885 32.1 

Armenia 2010 112 15.4 126 11.6 280 13.0 519 13.2 

Azerbaijan 2006 37 12.7 277 12.6 308 14.2 623 13.4 

Ukraine 2007 84 26.7 163 8.4 353 8.9 600 11.3 

(Continued)
50 

Table 15. − Continued 

Country 

Survey 

date 

Unmet need for a 

spacing method 

Unmet need for a 

limiting method 

Need for a more effective 

method: spacing method 

needs limiting 

All with a need for 

focused family 

planning efforts 

Number of 

respondents Percent told

Number of 

respondents Percent told

Number of 

respondents Percent told 

Number of 

respondents Percent told

Asia 

Bangladesh* 2011 NA NA NA NA NA NA NA NA 

Cambodia 2010 249 44.2 514 48.5 1,175 58.3 1,938 53.9 

India 2005-06 NA NA NA NA NA NA NA NA 

Indonesia* 2007 336 22.0 527 25.1 2,953 29.9 3,815 28.5 

Nepal 2011 505 10.6 1,149 16.4 732 33.3 2,387 20.4 

Pakistan* 2012-13 430 8.5 1,396 9.9 1,879 16.2 3,705 12.9 

Philippines 2008 214 46.2 589 49.3 967 55.4 1,771 52.3 

Timor-Leste 2009 319 40.5 977 39.0 938 55.8 2,234 46.3 

Latin America and Caribbean

Bolivia 2008 198 35.6 769 42.6 1,721 50.1 2,688 46.8 

Colombia 2010 280 34.8 670 32.0 2,296 41.9 3,245 39.2 

Dominican Rep. 2007 430 40.5 535 33.4 827 39.5 1,793 37.9 

Guyana 2009 104 41.6 312 41.9 283 47.3 699 44.0 

Peru 2012 74 53.3 236 41.7 1,850 43.2 2,160 43.4 

Unweighted Averages 

West and Central Africa 3,352 36.7 8,348 37.1 6,193 51.7 17,894 41.6 

East and Southern Africa 2,686 39.2 8,439 41.8 12,687 48.8 23,810 45.6 

Middle East/North Africa 276 28.1 889 27.3 3,368 36.1 4,533 33.8 

Eastern Europe/NIS 281 22.5 686 14.0 1,658 17.4 2,627 17.5 

Asia 2,053 28.7 5,152 31.4 8,644 41.5 15,850 35.7 

Latin America and 

Caribbean 1,086 41.2 2,522 38.3 6,977 44.4 10,585 42.3 

Total 9,734 35.2 26,036 35.4 39,527 44.6 75,299 39.5 

* Ever-married samples 

NA Not asked 

Note: Women with an unmet need (either desire- or fertility-risk based) and women with a need for a more effective method constitute the group who 

require focused family planning efforts. 

In DHS surveys, women who are not using contraception are asked about their intentions to use at any time 

in the future. For women with an unmet combined need, only slightly over half said they intended to use 

contraception in the future, 11 percent were unsure, and 35 percent did not intend to use any contraception 

(Table 16). In comparisons of women by the type of need, those with a limiting need had a higher percentage 

who did not intend to use (39 percent), and those with a spacing need had a higher percentage who intended 

to use later (64 percent). Figure 5 shows the differences by region. In all regions except Eastern Europe/NIS, 

more women with an unmet need intend to use contraception in the future than do not intend to use. In that 

region, many women were unsure about future use. 
51

Table 16. Intentions to use contraception in the future among non-pregnant married and in-union women with a combined unmet need for contraception, 45 DHS country surveys 2006-2012 Country Survey date 

Unmet need for a spacing method Unmet need for a limiting method All with an unmet need 

Number of 

respondents Use later 

Unsure 

about use 

Does not 

intend 

Number of 

respondents Use later 

Unsure 

about use 

Does not 

intend 

Number of 

respondents Use later 

Unsure 

about use 

Does not 

intend 

West and Central Africa 

Benin 2006 817 53.5 15.2 31.3 2,730 48.8 13.0 38.2 3,547 49.9 13.5 36.6

Burkina Faso 2010 876 71.3 4.8 23.9 2,247 60.7 3.9 35.3 3,123 63.7 4.2 32.1

Cameroon 2011 514 61.1 9.7 29.2 1,446 52.3 9.2 38.5 1,960 54.6 9.3 36.1

DR Congo 2007 381 36.6 20.0 43.4 849 35.8 14.0 50.2 1,230 36.1 15.9 48.1

Ghana 2008 271 57.2 6.1 36.7 615 54.8 6.6 38.6 886 55.5 6.4 38.1

Liberia 2007 391 48.7 17.4 33.8 1,016 45.0 16.5 38.5 1,407 46.0 16.8 37.2

Mali 2006 1,027 50.1 16.0 33.9 2,412 38.1 10.6 51.3 3,439 41.7 12.2 46.1

Niger 2006 279 36.8 12.0 51.1 786 38.6 8.4 53.0 1,065 38.1 9.3 52.5Nigeria 2008 1,080 26.6 29.5 43.9 3,033 28.0 21.4 50.6 4,112 27.6 23.5 48.9

Sao Tome & Principe 2008-09 126 51.3 26.0 22.7 375 48.3 18.5 33.2 501 49.0 20.4 30.6

Senegal 2010-11 908 37.7 11.8 50.4 1,913 37.6 6.8 55.5 2,821 37.7 8.5 53.9Sierra Leone 2008 318 32.1 27.0 40.9 1,051 40.6 19.5 39.8 1,369 38.7 21.3 40.1

East and Southern Africa 

Burundi 2010 328 76.2 3.6 20.2 1,035 63.0 4.6 32.5 1,363 66.1 4.3 29.5 Ethiopia 2011 537 70.4 2.0 27.5 1,787 63.7 3.5 32.8 2,324 65.3 3.1 31.6Kenya 2008-09 203 71.2 2.3 26.5 836 57.4 6.7 35.9 1,039 60.1 5.8 34.0Lesotho 2009 246 83.8 5.2 11.0 578 66.8 5.4 27.8 823 71.8 5.4 22.8Madagascar 2008-09 615 58.3 18.7 23.0 1,427 44.4 13.5 42.1 2,042 48.6 15.1 36.4Malawi 2010 737 86.5 1.8 11.7 2,314 70.8 2.5 26.7 3,051 74.6 2.3 23.1Mozambique 2011 529 56.0 8.0 36.0 1,443 53.9 5.2 41.0 1,972 54.4 5.9 39.6Namibia 2006-07 98 72.1 2.3 25.6 462 60.1 7.4 32.4 560 62.2 6.5 31.2Rwanda 2010 219 87.9 1.5 10.6 872 71.3 1.3 27.4 1,091 74.6 1.3 24.0Swaziland 2006-07 70 83.2 3.8 13.0 335 61.0 3.7 35.3 405 64.8 3.7 31.5Tanzania 2010 280 73.5 5.3 21.2 825 59.0 5.4 35.5 1,106 62.7 5.4 31.9Uganda 2011 285 73.4 6.8 19.8 1,144 70.6 4.4 24.9 1,429 71.2 4.9 23.9Zambia 2007 183 79.4 6.3 14.3 658 68.6 4.5 26.9 841 71.0 4.9 24.1Zimbabwe 2010-11 173 81.2 6.2 12.6 394 59.1 4.8 36.0 567 65.9 5.3 28.9

Middle East/North Africa 

Egypt* 2008 278 81.8 8.9 9.3 919 60.2 7.2 32.6 1,197 65.2 7.6 27.2Jordan* 2007 188 75.0 3.5 21.5 841 41.0 4.2 54.8 1,029 47.2 4.1 48.7

Eastern Europe/NIS 

Albania 2008-09 142 25.8 26.6 47.5 485 16.7 12.5 70.8 627 18.7 15.7 65.6 

Armenia 2010 150 43.8 52.4 3.7 306 26.8 27.9 45.3 456 32.4 35.9 31.6Azerbaijan 2006 110 38.3 44.1 17.6 1,013 10.8 26.3 62.9 1,123 13.5 28.1 58.4

Ukraine 2007 123 37.3 43.0 19.8 263 13.2 28.4 58.4 386 20.9 33.1 46.1

Asia 

Bangladesh* 2011 580 91.3 3.0 5.6 1,311 68.1 1.6 30.2 1,891 75.2 2.1 22.7Cambodia 2010 473 72.3 8.0 19.7 1,316 43.9 7.2 48.9 1,789 51.4 7.4 41.2India 2005-06 3,755 79.5 9.0 11.4 6,422 69.7 5.9 24.4 10,177 73.3 7.0 19.6Indonesia* 2007 781 68.7 10.2 21.1 1,656 42.4 10.0 47.7 2,437 50.8 10.1 39.2Nepal 2011 740 95.9 0.7 3.4 1,691 81.9 3.7 14.4 2,431 86.2 2.8 11.0Pakistan* 2012-13 535 50.6 21.5 27.9 1,772 42.2 13.8 44.0 2,308 44.2 15.6 40.2Philippines 2008 403 58.2 7.9 33.9 1,203 40.9 4.1 55.0 1,607 45.2 5.0 49.7Timor-Leste 2009 556 26.5 30.7 42.9 1,768 14.0 27.3 58.6 2,324 17.0 28.1 54.9

(Continued)
52

Table 16. − ContinuedCountry Survey date 

Unmet need for a spacing method Unmet need for a limiting method Total 

Number of 

respondents Use later 

Unsure 

about use 

Does not 

intend 

Number of 

respondents Use later 

Unsure 

about use 

Does not 

intend 

Number of 

respondents Use later 

Unsure 

about use 

Does not 

intend 

Latin America and Caribbean 

Bolivia 2008 260 82.6 6.4 11.1 1,249 57.8 15.0 27.2 1,509 62.1 13.5 24.4 Colombia 2010 414 90.5 3.2 6.3 966 67.0 5.5 27.5 1,381 74.1 4.8 21.1 Dominican Rep. 2007 546 87.5 3.7 8.8 694 65.5 6.5 28.0 1,240 75.2 5.3 19.5 Guyana 2009 171 63.2 11.4 25.5 581 40.7 12.4 46.8 752 45.8 12.2 42.0 Peru 2012 173 92.1 2.2 5.8 522 82.6 4.5 12.9 696 85.0 3.9 11.1 

Unweighted Averages 

West and Central Africa 6,988 46.9 16.3 36.8 18,473 44.1 12.4 43.6 25,460 44.9 13.4 41.7 East and Southern Africa 4,503 75.2 5.3 19.5 14,110 62.1 5.2 32.7 18,613 65.2 5.3 29.5 Middle East/North Africa 466 78.4 6.2 15.4 1,760 50.6 5.7 43.7 2,226 56.2 5.9 38.0 Eastern Europe/NIS 525 36.3 41.5 22.2 2,067 16.9 23.8 59.4 2,592 21.4 28.2 50.4 Asia 7,823 67.9 11.4 20.7 17,139 50.4 9.2 40.4 24,964 55.4 9.8 34.8 Latin America and Caribbean 1,564 83.2 5.4 11.5 4,012 62.7 8.8 28.5 5,578 68.4 7.9 23.6 

Total 21,869 63.9 12.6 23.5 57,561 50.7 9.9 39.3 79,433 54.1 10.6 35.3 * Ever-married samples 
53 

Figure 5. Distribution of married and in-union women with an unmet need for contraception by 

intention to use in the future, according to region, 45 DHS country surveys 2006-2012 

Table 17 shows categories of reasons for not intending to use contraception for non-pregnant married 

women with an unmet need for either spacing or limiting. Women could offer multiple responses. Almost 

a third of women indicated that side effects and health concerns were reasons not to use in the future. 

Opposition by her husband, family or others, as well as religious prohibition were mentioned by over a 

quarter of women, while 11 percent cited various program-related problems. Program-related reasons 

included no access or too far, no source, no method known, no method available, preferred method 

unavailable, inconvenient to use, and/or high costs. About one-fifth of the non-pregnant married women 

mentioned a lack or infrequency of sexual relations. 

By region, no or infrequent sexual relations was cited as a reason most frequently in Latin America and the 

Caribbean; infecundity or subfecundity was cited most frequently in Eastern Europe/NIS; 

breastfeeding/postpartum amenorrhea, the opposition of others or religious prohibition, and family planning 

program problems were mentioned most often in West and Central Africa. Fatalism appeared most often in 

East and Southern Africa, while side effects and health concerns were cited most often in Asia. The 

questions on reasons for not intending to use were not asked in the two countries of the Middle East/North 

Africa region. The individual reasons for not intending to use are given in the Appendix Table A1. 

 

0

10

20

30

40

50

60

70

80

West and Central Africa East and Southern Africa Middle East/North Africa Eastern Europe/NIS Asia Latin America and

Caribbean

Percent of women in need of focused FP efforts

Use later Unsure about use Does not intend to use
54 

Table 17. Among non-pregnant married women with a combined unmet need for either a spacing or a 

limiting method of contraception but who do not intend to use in the future, distribution by summary 

of reasons for not intending to use, 40 DHS country surveys 2006-2012 

Country 

Survey 

date 

Number of 

respondents 

No or 

infrequent 

sex 

Infecund 

or 

subfecund1

Breastfeeding or 

postpartum 

amenorrheic Fatalistic 

Husband, 

family or 

other 

opposition 

or 

religious 

prohibition 

Side 

effects or 

health 

concerns 

Programrelated 

problems2

West and Central Africa 

Benin 2006 1,128 28.0 7.4 5.2 2.3 21.1 35.4 15.6 

Burkina Faso 2010 907 23.0 2.2 13.0 5.5 35.9 20.4 11.9 

Cameroon 2011 565 29.3 2.9 11.3 4.0 28.9 30.6 16.1 

DR Congo 2007 444 21.7 2.2 24.8 0.8 29.0 22.2 26.5 

Ghana 2008 291 14.8 6.0 3.1 0.2 26.8 46.8 10.5 

Liberia 2007 439 12.3 0.0 17.1 0.1 26.3 43.0 22.5 

Mali 2006 1,183 10.6 3.3 6.6 3.4 32.8 24.3 15.8 

Niger 2006 449 12.8 0.5 10.1 1.7 40.1 19.5 22.4 

Nigeria 2008 1,278 12.4 1.2 6.0 0.2 43.3 27.5 12.7 

Sao Tome & 

Principe 2008-09 133 18.1 1.1 1.0 0.0 27.7 44.5 0.0 

Senegal 2010-11 1,290 16.2 1.0 20.8 5.7 38.3 14.3 6.4 

Sierra Leone 2008 420 7.0 2.5 8.4 0.6 47.1 28.8 23.7 

East and Southern Africa 

Burundi 2010 357 9.5 3.7 9.8 24.0 39.7 23.5 2.7 

Ethiopia 2011 622 7.4 1.7 15.0 15.4 28.0 34.1 10.3 

Kenya 2008-09 313 15.7 3.6 3.1 0.2 22.3 48.6 9.4 

Lesotho 2009 184 12.6 20.2 5.1 1.3 22.6 27.9 16.8 

Madagascar 2008-09 676 15.8 7.3 2.7 1.5 26.0 44.8 13.1 

Malawi 2010 648 14.3 9.4 7.2 2.2 18.4 41.7 2.8 

Mozambique 2011 653 22.4 2.9 37.1 19.7 13.9 6.4 10.2 

Namibia 2006-07 144 13.2 2.2 5.6 0.0 23.0 27.6 12.9 

Rwanda 2010 252 21.4 0.4 5.0 19.3 18.0 34.3 2.7 

Swaziland 2006-07 124 11.3 11.2 0.0 1.5 24.3 40.4 14.8 

Tanzania 2010 317 13.5 1.4 6.8 2.1 30.4 56.1 3.3 

Uganda 2011 315 20.3 8.9 10.6 12.9 26.5 39.3 6.6 

Zambia 2007 175 27.6 21.2 5.7 3.4 16.8 34.1 6.1 

Zimbabwe 2010-11 149 30.2 8.9 1.0 6.4 37.5 14.6 1.3 

Eastern Europe/NIS 

Albania 2008-09 376 18.9 5.5 0.5 0.5 53.3 30.9 7.8 

Armenia 2010 138 26.1 36.6 0.0 0.3 27.7 7.6 14.4 

Azerbaijan 2006 639 27.3 32.4 0.1 1.2 12.9 25.0 6.5 

Ukraine 2007 160 33.2 19.5 1.0 9.1 14.9 19.9 2.0 

Asia 

Cambodia 2010 688 37.2 10.6 2.6 12.0 6.4 51.3 7.8 

India 2005-06 1,785 27.8 3.7 5.7 13.6 35.2 21.3 15.3 

Nepal 2011 255 33.8 7.3 1.5 2.9 13.4 28.2 0.5 

Philippines 2008 754 26.1 8.3 2.5 2.1 14.8 51.9 18.7 

Timor-Leste 2009 1,029 2.4 0.8 8.1 0.1 69.9 34.2 8.4 

(Continued)

 
55 

Table 17. − Continued

Country 

Survey 

date 

Number of 

respondents 

No or 

infrequent 

sex 

Infecund 

or 

subfecund1

Breastfeeding or 

postpartum 

amenorrheic Fatalistic 

Husband, 

family or 

other 

opposition 

or 

religious 

prohibition 

Side 

effects or 

health 

concerns 

Programrelated 

problems2

Latin America and Caribbean 

Bolivia 2008 360 41.6 7.8 5.2 0.0 22.6 33.3 17.2 

Colombia 2010 275 22.4 10.9 0.1 0.7 12.2 28.6 16.6 

Dominican Rep. 2007 229 18.5 10.8 0.9 5.7 25.6 31.3 9.9 

Guyana 2009 293 15.0 4.8 2.5 0.8 14.1 40.7 9.5 

Peru 2012 72 45.2 2.3 1.6 0.7 9.1 36.7 0.0 

Unweighted Averages

West and Central Africa 8,527 17.2 2.5 10.6 2.0 33.1 29.8 15.3 

East and Southern Africa 4,929 16.8 7.4 8.2 7.9 24.8 33.8 8.1 

Eastern Europe/NIS 1,313 26.4 23.5 0.4 2.8 27.2 20.9 7.7 

Asia 4,511 25.5 6.1 4.1 6.1 27.9 37.4 10.1 

Latin America and Caribbean 1,229 28.5 7.3 2.1 1.6 16.7 34.1 10.6 

Total 20,509 20.4 7.4 6.9 4.6 26.9 31.8 10.8 

Note: Reasons for not intending to use were not asked in the ever-married surveys of Bangladesh, Egypt, Indonesia, Jordan, and 

Pakistan. 

1 Includes hysterectomy and menopause 

2 Program-related problems: No access or too far, no source or method known, no method available, preferred method unavailable, 

inconvenient to use, costs too much 

3.7. Child Deaths Averted 

Satisfying fertility-risk based unmet need for contraception has the potential to avert many child and 

maternal deaths. The number of infant and child deaths that could be averted in 2015 in each of the 45 

countries is provided in Table 18. The first panel of this table contains current estimates and projections for 

fertility rates, number of births, infant and under-five mortality rates, and numbers of infant and under-five 

deaths. This panel serves as the baseline for calculating the averted number of infant and under-five deaths. 

In the second panel, the infant and under-five mortality rates that would result from satisfying the unmet 

risk-based needs are used to calculate the decreased number of deaths, assuming no change in fertility 

levels. In the third panel, a decreased number of deaths is calculated assuming a decrease in fertility due to 

satisfying risk-based unmet needs but with no reduction in infant and child mortality rates. The fourth panel 

presents the decreases in deaths with the two effects combined. The two columns in the fifth panel provide 

the number of infant and under-five deaths averted through both a fertility reduction and mortality risk 

reduction if risk-based unmet needs were eliminated. 

For the 45 countries together, about 3.2 million under-five deaths would be averted; 2.1 million of these are 

infant deaths. The deaths averted represent reductions of about 56 percent in both infant and under-five 

deaths (last panel of Table 18). The reductions are not uniform, and are the greatest in the sub-Saharan 

African regions, with 68 percent of under-five deaths averted in West and Central Africa and 61 percent in 

East and Southern Africa, and the least in Eastern Europe/NIS at 23 percent of infant deaths. Eight countries 

would have more than 70 percent of under-five deaths averted, five of which are in West and Central Africa. 

Three countries, all in Eastern Europe/NIS, would have less than 10 percent of child deaths averted; this 

includes the anomalous result of a 33 percent increase. These very low figures may be due to the very low 

fertility rates and the resulting high concentrations of births in the unavoidable risk category of first births. 
56

Table 18. Infant and under-five child deaths averted due to satisfying risk-based unmet need for contraception, 45 DHS country surveys 2006-2012 Country Survey 

Current Reduced mortality rate Reduced fertility rate Combined effect 

Total number of 

child deaths 

averted 

Percent of 

deaths that are 

averted 

Total 

Fertility 

Rate 

Births in 

1000s 

Under-five 

mortality 

rate* 

Under-five 

deaths 

Infant 

mortality 

rate* 

Infant 

deaths 

Total 

Fertility 

Rate 

Births in 

1000s 

Under-five 

mortality 

rate* 

Under-five 

deaths 

Infant 

mortality 

rate* 

Infant 

deaths 

Total 

Fertility 

Rate 

Births in 

1000s 

Under-five 

mortality 

rate* 

Under-five 

deaths 

Infant 

mortality 

rate* 

Infant 

deaths 

Total 

Fertility 

Rate 

Births in 

1000s 

Under-five 

mortality 

rate* 

Under-five 

deaths 

Infant 

mortality 

rate* 

Infant 

deaths 

Under-five 

deaths 

Infant 

deaths 

Underfive deaths 

Infant 

deaths 

West and Central Africa

Benin 2006 5.74 386.53 99.0 38,254 56.1 21,697 5.74 386.53 81.6 31,522 41.5 16,053 2.68 180.47 99.0 17,861 56.1 10,130 2.68 180.47 81.6 14,718 41.5 7,495 23,537 14,202 61.5 65.5 Burkina Faso 2010 5.99 713.51 107.6 76,766 56.6 40,395 5.99 713.51 69.4 49,484 37.1 26,440 2.62 312.08 107.6 33,577 56.6 17,669 2.62 312.08 69.4 21,644 37.1 11,565 55,122 28,831 71.8 71.4Cameroon 2011 5.09 850.10 101.6 86,339 51.9 44,134 5.09 850.10 78.6 66,831 43.7 37,157 2.42 404.17 101.6 41,049 51.9 20,983 2.42 404.17 78.6 31,774 43.7 17,666 54,564 26,468 63.2 60.0DR Congo 2007 6.28 2,983.76 129.7 387,121 82.5 246,073 6.28 2,983.76 113.6 338,947 73.7 219,853 2.58 1,225.81 129.7 159,040 82.5 101,094 2.58 1,225.81 113.6 139,249 73.7 90,322 247,872 155,751 64.0 63.3Ghana 2008 4.03 805.04 75.2 60,547 51.5 41,435 4.03 805.04 65.1 52,409 44.2 35,622 2.23 445.47 75.2 33,504 51.5 22,928 2.23 445.47 65.1 29,000 44.2 19,711 31,547 21,724 52.1 52.4Liberia 2007 5.20 155.65 93.0 14,482 62.6 9,751 5.20 155.65 68.0 10,586 43.8 6,813 2.64 79.02 93.0 7,352 62.6 4,951 2.64 79.02 68.0 5,374 43.8 3,459 9,108 6,292 62.9 64.5Mali 2006 6.58 758.89 156.5 118,747 83.3 63,247 6.58 758.89 116.5 88,429 57.1 43,301 2.54 292.94 156.5 45,839 83.3 24,415 2.54 292.94 116.5 34,135 57.1 16,715 84,612 46,532 71.3 73.6Niger 2006 7.02 954.78 132.9 126,918 61.3 58,533 7.02 954.78 87.6 83,607 37.4 35,719 2.42 329.14 132.9 43,752 61.3 20,178 2.42 329.14 87.6 28,822 37.4 12,313 98,096 46,220 77.3 79.0Nigeria 2008 5.72 7,425.49 144.2 1,070,810 71.2 529,047 5.72 7,425.49 98.5 731,061 47.7 353,924 2.46 3,193.48 144.2 460,523 71.2 227,527 2.46 3,193.48 98.5 314,407 47.7 152,212 756,403 376,835 70.6 71.2Sao Tome &  Principe 2008-09 4.90 6.54 52.6 344 34.5 226 4.90 6.54 25.0 164 18.2 119 2.46 3.29 52.6 173 34.5 113 2.46 3.29 25.0 82 18.2 60 262 166 76.1 73.5 Senegal 2010-11 4.98 548.46 63.8 34,995 40.1 22,014 4.98 548.46 51.4 28,179 42.0 23,033 2.34 257.71 63.8 16,444 40.1 10,344 2.34 257.71 51.4 13,241 42.0 10,823 21,755 11,191 62.2 50.8Sierra Leone 2008 5.12 224.47 126.6 28,418 84.4 18,954 5.12 224.47 83.0 18,639 60.5 13,578 2.50 109.60 126.6 13,876 84.4 9,255 2.50 109.60 83.0 9,101 60.5 6,630 19,317 12,325 68.0 65.0

East and Southern Africa

Burundi 2010 6.38 470.58 78.7 37,056 53.4 25,147 6.38 470.58 61.5 28,945 49.3 23,188 2.83 208.74 78.7 16,437 53.4 11,155 2.83 208.74 61.5 12,839 49.3 10,286 24,217 14,861 65.4 59.1 Ethiopia 2011 4.80 3,166.55 90.9 287,730 53.4 169,155 4.80 3,166.55 50.6 160,089 37.1 117,422 1.93 1,273.22 90.9 115,692 53.4 68,014 1.93 1,273.22 50.6 64,369 37.1 47,213 223,361 121,942 77.6 72.1Kenya 2008-09 4.56 1,578.49 66.7 105,313 47.8 75,457 4.56 1,578.49 66.5 104,960 45.7 72,077 2.36 816.94 66.7 54,504 47.8 39,052 2.36 816.94 66.5 54,321 45.7 37,303 50,992 38,154 48.4 50.6Lesotho 2009 3.30 57.02 107.2 6,115 80.2 4,575 3.30 57.02 110.4 6,295 80.7 4,599 2.32 40.09 107.2 4,299 80.2 3,217 2.32 40.09 110.4 4,425 80.7 3,233 1,690 1,342 27.6 29.3Madagascar 2008-09 4.82 829.75 70.7 58,660 44.7 37,097 4.82 829.75 72.8 60,374 29.8 24,760 2.42 416.60 70.7 29,452 44.7 18,626 2.42 416.60 72.8 30,312 29.8 12,432 28,348 24,666 48.3 66.5Malawi 2010 5.71 677.69 94.1 63,795 55.9 37,908 5.71 677.69 91.1 61,726 48.6 32,961 2.58 306.21 94.1 28,825 55.9 17,128 2.58 306.21 91.1 27,890 48.6 14,893 35,905 23,015 56.3 60.7Mozambique 2011 5.92 1,032.86 85.2 87,959 55.5 57,314 5.92 1,032.86 65.7 67,867 45.6 47,149 2.73 476.30 85.2 40,562 55.5 26,430 2.73 476.30 65.7 31,297 45.6 21,743 56,662 35,571 64.4 62.1Namibia 2006-07 3.57 60.82 68.7 4,178 44.6 2,715 3.57 60.82 68.7 4,179 42.5 2,584 2.35 40.03 68.7 2,751 44.6 1,787 2.35 40.03 68.7 2,751 42.5 1,701 1,428 1,014 34.2 37.3Rwanda 2010 4.56 421.41 61.5 25,896 44.9 18,937 4.56 421.41 70.8 29,849 44.5 18,771 2.28 210.71 61.5 12,948 44.9 9,469 2.28 210.71 70.8 14,925 44.5 9,385 10,971 9,552 42.4 50.4Swaziland 2006-07 3.85 37.27 109.2 4,070 82.3 3,066 3.85 37.27 117.5 4,378 92.1 3,431 2.33 22.55 109.2 2,463 82.3 1,856 2.33 22.55 117.5 2,650 92.1 2,076 1,421 990 34.9 32.3Tanzania 2010 5.43 1,998.47 67.4 134,794 46.9 93,796 5.43 1,998.47 59.5 118,885 42.3 84,439 2.58 949.55 67.4 64,046 46.9 44,566 2.58 949.55 59.5 56,487 42.3 40,120 78,307 53,676 58.1 57.2Uganda 2011 6.20 1,693.60 77.9 131,976 49.7 84,115 6.20 1,693.60 64.6 109,355 41.9 70,882 2.49 680.17 77.9 53,003 49.7 33,782 2.49 680.17 64.6 43,918 41.9 28,467 88,058 55,647 66.7 66.2Zambia 2007 6.17 657.09 99.9 65,673 62.7 41,192 6.17 657.09 104.6 68,710 68.5 45,038 2.63 280.09 99.9 27,994 62.7 17,558 2.63 280.09 104.6 29,288 68.5 19,198 36,385 21,994 55.4 53.4Zimbabwe 2010-11 4.10 457.00 76.2 34,820 46.9 21,429 4.10 457.00 73.5 33,579 43.8 20,024 2.81 313.21 76.2 23,865 46.9 14,686 2.81 313.21 73.5 23,014 43.8 13,723 11,806 7,705 33.9 36.0

Middle East/North Africa

Egypt 2008 4.40 1,890.06 25.2 47,710 22.3 42,179 4.40 1,890.06 18.5 34,995 13.6 25,676 3.55 1,524.93 25.2 38,493 22.3 34,031 3.55 1,524.93 18.5 28,235 13.6 20,716 19,475 21,464 40.8 50.9 Jordan 2007 6.05 191.10 17.6 3,372 14.7 2,805 6.05 191.10 6.5 1,249 5.5 1,059 4.11 129.82 17.6 2,291 14.7 1,905 4.11 129.82 6.5 849 5.5 719 2,524 2,086 74.8 74.4

Eastern Europe/NIS

Albania 2008-09 1.59 41.79 18.0 751 17.2 717 1.59 41.79 13.8 577 9.2 384 1.42 37.32 18.0 671 17.2 641 1.42 37.32 13.8 515 9.2 343 236 374 31.4 52.2 

Armenia 2010 1.70 39.18 19.5 764 13.8 541 1.70 39.18 27.3 1,070 7.8 304 1.61 37.10 19.5 723 13.8 513 1.61 37.10 27.3 1,013 7.8 288 (250) 253 -32.7 46.8Azerbaijan 2006 2.02 161.08 48.6 7,831 41.0 6,602 2.02 161.08 49.6 7,997 33.7 5,429 1.86 148.32 48.6 7,210 41.0 6,079 1.86 148.32 49.6 7,363 33.7 4,999 467 1,603 6.0 24.3

Ukraine 2007 1.17 473.52 18.0 8,506 13.7 6,478 1.17 473.52 18.1 8,567 12.0 5,696 1.11 449.24 18.0 8,070 13.7 6,145 1.11 449.24 18.1 8,128 12.0 5,404 379 1,073 4.5 16.6

Asia 

Bangladesh 2011 2.77 3,097.68 47.4 146,944 39.9 123,577 2.77 3,097.68 42.7 132,403 31.8 98,654 2.26 2,527.35 47.4 119,889 39.9 100,824 2.26 2,527.35 42.7 108,025 31.8 80,491 38,919 43,086 26.5 34.9 Cambodia 2010 3.04 386.14 53.8 20,760 46.5 17,973 3.04 386.14 39.5 15,255 30.4 11,753 2.24 284.53 53.8 15,297 46.5 13,243 2.24 284.53 39.5 11,241 30.4 8,660 9,520 9,312 45.9 51.8India 2005-06 2.68 25,378.96 60.1 1,524,582 47.8 1,212,382 2.68 25,378.96 43.4 1,100,566 31.8 806,137 1.90 17,992.54 60.1 1,080,861 47.8 859,525 1.90 17,992.54 43.4 780,252 31.8 571,515 744,330 640,867 48.8 52.9Indonesia 2007 3.64 4,617.47 45.5 210,011 33.6 155,201 3.64 4,617.47 38.6 178,339 24.8 114,380 3.06 3,881.72 45.5 176,548 33.6 130,471 3.06 3,881.72 38.6 149,923 24.8 96,155 60,088 59,046 28.6 38.0Nepal 2011 2.60 579.34 48.5 28,105 43.9 25,411 2.60 579.34 36.4 21,067 31.5 18,254 1.93 430.05 48.5 20,863 43.9 18,863 1.93 430.05 36.4 15,638 31.5 13,550 12,467 11,861 44.4 46.7Pakistan 2012-13 5.34 4,593.80 85.3 391,671 71.1 326,482 5.34 4,593.80 85.4 392,299 73.2 336,158 3.37 2,899.09 85.3 247,178 71.1 206,038 3.37 2,899.09 85.4 247,574 73.2 212,145 144,097 114,337 36.8 35.0Philippines 2008 3.26 2,443.10 32.0 78,269 23.4 57,193 3.26 2,443.10 21.7 52,969 19.2 46,857 2.13 1,596.26 32.0 51,139 23.4 37,368 2.13 1,596.26 21.7 34,608 19.2 30,615 43,660 26,578 55.8 46.5Timor-Leste 2009 5.68 42.05 59.0 2,480 42.0 1,766 5.68 42.05 36.2 1,520 31.6 1,331 2.33 17.25 59.0 1,017 42.0 724 2.33 17.25 36.2 624 31.6 546 1,856 1,220 74.9 69.1

(Continued)
57

Table 18. − ContinuedCountry Survey 

Current Reduced mortality rate Reduced fertility rate Combined effect 

Total number of 

child deaths 

averted 

Percent of 

deaths that are 

averted 

Total 

Fertility 

Rate 

Births in 

1000s 

Under-five 

mortality 

rate* 

Under-five 

deaths 

Infant 

mortality 

rate* 

Infant 

deaths 

Total 

Fertility 

Rate 

Births in 

1000s 

Under-five 

mortality 

rate* 

Under-five 

deaths 

Infant 

mortality 

rate* 

Infant 

deaths 

Total 

Fertility 

Rate 

Births in 

1000s 

Under-five 

mortality 

rate* 

Under-five 

deaths 

Infant 

mortality 

rate* 

Infant 

deaths 

Total 

Fertility 

Rate 

Births in 

1000s 

Under-five 

mortality 

rate* 

Under-five 

deaths 

Infant 

mortality 

rate* 

Infant 

deaths 

Under-five 

deaths 

Infant 

deaths 

Underfive deaths 

Infant 

deaths 

Latin America and Caribbean 

Bolivia 2008 3.54 277.78 50.5 14,023 42.8 11,902 3.54 277.78 32.0 8,885 27.0 7,508 2.21 173.41 50.5 8,754 42.8 7,430 2.21 173.41 32.0 5,547 27.0 4,687 8,476 7,215 60.4 60.6 Colombia 2010 2.14 897.60 18.0 16,184 15.2 13,650 2.14 897.60 15.1 13,535 11.6 10,447 1.78 746.60 18.0 13,462 15.2 11,354 1.78 746.60 15.1 11,258 11.6 8,689 4,927 4,961 30.4 36.3Dominican Rep. 2007 2.43 214.03 30.3 6,492 25.1 5,370 2.43 214.03 24.9 5,324 20.5 4,379 1.92 169.11 30.3 5,129 25.1 4,243 1.92 169.11 24.9 4,206 20.5 3,460 2,285 1,910 35.2 35.6Guyana 2009 2.78 15.91 34.4 548 30.5 485 2.78 15.91 31.1 495 31.9 508 2.00 11.45 34.4 394 30.5 349 2.00 11.45 31.1 356 31.9 366 192 119 35.0 24.6Peru 2012 2.53 596.34 19.0 11,353 16.2 9,690 2.53 596.34 14.8 8,802 13.2 7,844 1.89 445.49 19.0 8,481 16.2 7,239 1.89 445.49 14.8 6,575 13.2 5,860 4,778 3,830 42.1 39.5

Unweighted Averages of Rates and Sums of Births and Deaths

West and Central Africa 5.55 15,813 106.9 2,043,742 61.4 1,095,508 5.55 15,813 78.2 1,499,857 45.6 811,611 2.49 6,833 106.9 872,990 61.4 469,587 2.49 6,833 78.2 641,548 45.6 348,970 1,402,194 746,537 68.6 68.1 East and Southern Africa 4.96 13,139 82.5 1,048,037 54.9 671,903 4.96 13,139 77.0 859,191 50.9 567,325 2.47 6,034 82.5 476,840 54.9 307,326 2.47 6,034 77.0 398,487 50.9 261,774 649,550 410,129 62.0 61.0Middle East/North Africa 5.23 2,081 21.4 51,082 18.5 44,984 5.23 2,081 12.5 36,245 9.6 26,734 3.83 1,655 21.4 40,784 18.5 35,936 3.83 1,655 12.5 29,084 9.6 21,435 21,999 23,549 43.1 52.4

Eastern Europe/NIS 1.62 716 26.0 17,852 21.4 14,338 1.62 716 27.2 18,211 15.7 11,814 1.50 672 26.0 16,675 21.4 13,378 1.50 672 27.2 17,020 15.7 11,034 832 3,304 4.7 23.0

Asia 3.63 41,139 53.9 2,402,823 43.5 1,919,984 3.63 41,139 43.0 1,894,418 34.3 1,433,525 2.40 29,629 53.9 1,712,792 43.5 1,367,057 2.40 29,629 43.0 1,347,885 34.3 1,013,677 1,054,938 906,308 43.9 47.2

Latin America and Caribbean 2.68 2,002 30.5 48,600 26.0 41,097 2.68 2,002 23.6 37,040 20.8 30,686 1.96 1,546 30.5 36,221 26.0 30,615 1.96 1,546 23.6 27,943 20.8 23,062 20,657 18,035 42.5 43.9

Total 4.34 74,889 70.4 5,612,136 46.8 3,787,814 4.34 74,889 58.0 4,344,962 38.2 2,881,694 2.38 46,369 70.4 3,156,302 46.8 2,223,899 2.38 46,369 58.0 2,461,966 38.2 1,679,952 3,150,170 2,107,863 56.1 55.6 
58 

3.8. Maternal Deaths Averted 

Among the 45 DHS country surveys included in this report, 28 included information on pregnancy-related 

maternal deaths that were obtained through the sisterhood module. Maternal deaths averted and the 

reduction in lifetime risk of a maternal death are calculated by using the same three-step procedure used for 

infant and under-five deaths: reductions due to reduced risk, reductions due to reduced fertility, and the 

combination of both reductions due to satisfying age-and parity-risk unmet needs for contraception.11

For the 28 countries together, satisfying risk-based unmet need would avert 109,000 maternal deaths in 

2015, which is 70 percent of the projected number of maternal deaths. In most of the countries with maternal 

mortality data, satisfying risk-based unmet need would substantially reduce maternal deaths and the lifetime 

risk of a maternal death. The number of maternal deaths that would be averted for 2015 varies from 26,513 

in Nigeria to 6 in São Tomé and Principe, where only 8 maternal deaths are projected. The percentage of 

maternal deaths averted varies across countries from 47 to 84 percent. The percentage reductions in lifetime 

risk of maternal deaths follows closely that of maternal deaths. Due to the reduced number of countries by 

region, no regional results are shown. 

 

11 Reductions due to satisfying birth interval-risk unmet need for contraception cannot be calculated because the 

sisterhood module did not have any information on the pregnancy intervals of the respondents’ sisters. 
59

Table 19. Maternal pregnancy-related deaths averted due to satisfying risk-based unmet needs for contraception, 28 DHS country surveys 2006-2012

Country Survey 

Current Reduced mortality rate Reduced fertility rate Combined effect 

Total 

maternal 

deaths 

averted 

Reduction 

in lifetime 

risk 

(maternal 

deaths per 

1000 

women) 

Percent 

reduction in 

maternal 

deaths 

Percent 

reduction 

in lifetime 

risk 

Total 

Fertility 

Rate 

Births in 

1000s 

Maternal 

mortality 

ratio per 

100,000 

births 

Maternal 

deaths 

Lifetime 

risk 

(maternal 

deaths per 

1000 

women) 

Total 

Fertility 

Rate 

Births in 

1000s 

Maternal 

mortality 

ratio per 

100,000 

births 

Maternal 

deaths 

Lifetime 

risk 

(maternal 

deaths per 

1000 

women) 

Total 

Fertility 

Rate 

Births in 

1000s 

Maternal 

mortality 

ratio per 

100,000 

births 

Maternal 

deaths 

Lifetime risk 

(maternal 

deaths per 

1000 

women) 

Total 

Fertility 

Rate 

Births in 

1000s 

Maternal 

mortality 

ratio per 

100,000 

births 

Maternal 

deaths 

Lifetime 

risk 

(maternal 

deaths per 

1000 

women) 

West and Central Africa 

Benin 2006 5.74 386.53 400 1,546 22.7 5.74 386.53 219 846 12.5 2.68 180.47 400 722 10.7 2.68 180.47 219 395 5.9 1,151 16.9 74.4 74.2 

Burkina Faso 2010 5.99 713.51 341 2,433 20.3 5.99 713.51 191 1,363 11.4 2.62 312.08 341 1,064 8.9 2.62 312.08 191 596 5.0 1,837 15.3 75.5 75.3Cameroon 2011 5.09 850.10 782 6,648 39.2 5.09 850.10 495 4,208 24.9 2.42 404.17 782 3,161 18.8 2.42 404.17 495 2,001 11.9 4,647 27.2 69.9 69.5DR Congo 2007 6.28 2,983.76 543 16,202 33.6 6.28 2,983.76 281 8,384 17.5 2.58 1,225.81 543 6,656 13.9 2.58 1,225.81 281 3,445 7.2 12,757 26.4 78.7 78.5Liberia 2007 5.20 155.65 994 1,547 50.6 5.20 155.65 525 817 27.0 2.64 79.02 994 785 26.0 2.64 79.02 525 415 13.8 1,132 36.8 73.2 72.7Mali 2006 6.58 758.89 465 3,529 30.2 6.58 758.89 265 2,011 17.3 2.54 292.94 465 1,362 11.8 2.54 292.94 265 776 6.7 2,753 23.5 78.0 77.8Niger 2006 7.02 954.78 709 6,769 48.7 7.02 954.78 326 3,113 22.7 2.42 329.14 709 2,334 17.1 2.42 329.14 326 1,073 7.9 5,696 40.9 84.1 83.8Nigeria 2008 5.72 7,425.49 545 40,469 30.8 5.72 7,425.49 437 32,449 24.7 2.46 3,193.48 545 17,404 13.4 2.46 3,193.48 437 13,956 10.7 26,513 20.1 65.5 65.2Sao Tome & Principe 2008-09 4.90 6.54 116 8 5.7 4.90 6.54 46 3 2.3 2.46 3.29 116 4 2.9 2.46 3.29 46 2 1.1 6 4.5 80.1 80.1Senegal 2010-11 4.98 548.46 484 2,655 23.9 4.98 548.46 321 1,761 15.9 2.34 257.71 484 1,247 11.3 2.34 257.71 321 827 7.5 1,827 16.4 68.8 68.6Sierra Leone 2008 5.12 224.47 857 1,924 43.1 5.12 224.47 556 1,248 28.1 2.50 109.60 857 939 21.3 2.50 109.60 556 609 13.8 1,314 29.3 68.3 67.9

East and Southern Africa 

Burundi 2010 6.38 470.58 500 2,353 31.5 6.38 470.58 278 1,308 17.6 2.83 208.74 500 1,044 14.1 2.83 208.74 278 580 7.8 1,773 23.6 75.3 75.1 Ethiopia 2011 4.80 3,166.55 676 21,406 32.0 4.80 3,166.55 414 13,110 19.7 1.93 1,273.22 676 8,607 13.0 1.93 1,273.22 414 5,271 8.0 16,135 24.1 75.4 75.1Kenya 2008-09 4.56 1,578.49 520 8,208 23.5 4.56 1,578.49 364 5,746 16.5 2.36 816.94 520 4,248 12.2 2.36 816.94 364 2,974 8.6 5,234 14.9 63.8 63.5Lesotho 2009 3.30 57.02 1243 709 40.4 3.30 57.02 910 519 29.7 2.32 40.09 1243 498 28.6 2.32 40.09 910 365 21.0 344 19.5 48.5 48.1Madagascar 2008-09 4.82 829.75 498 4,132 23.8 4.82 829.75 261 2,166 12.5 2.42 416.60 498 2,075 12.0 2.42 416.60 261 1,087 6.3 3,045 17.5 73.7 73.5Malawi 2010 5.71 677.69 675 4,574 37.9 5.71 677.69 407 2,758 23.0 2.58 306.21 675 2,067 17.3 2.58 306.21 407 1,246 10.5 3,328 27.5 72.8 72.4Mozambique 2011 5.92 1,032.86 408 4,214 23.9 5.92 1,032.86 292 3,016 17.2 2.73 476.30 408 1,943 11.1 2.73 476.30 292 1,391 8.0 2,823 16.0 67.0 66.7Namibia 2006-07 3.57 60.82 508 309 18.0 3.57 60.82 271 165 9.6 2.35 40.03 508 203 11.9 2.35 40.03 271 108 6.4 200 11.7 64.9 64.7Rwanda 2010 4.56 421.41 487 2,052 22.0 4.56 421.41 313 1,319 14.2 2.28 210.71 487 1,026 11.1 2.28 210.71 313 660 7.1 1,393 14.9 67.9 67.6Swaziland 2006-07 3.85 37.27 589 219 22.5 3.85 37.27 362 135 13.9 2.33 22.55 589 133 13.7 2.33 22.55 362 82 8.4 138 14.1 62.8 62.6Tanzania 2010 5.43 1,998.47 494 9,872 26.5 5.43 1,998.47 284 5,676 15.3 2.58 949.55 494 4,691 12.7 2.58 949.55 284 2,697 7.3 7,176 19.2 72.7 72.4Uganda 2010-11 6.17 457.00 591 2,701 35.9 6.17 457.00 490 2,239 29.9 2.63 194.80 591 1,151 15.5 2.63 194.80 490 955 12.8 1,746 23.1 64.7 64.3Zambia Zimbabwe 2007 6.20 473.52 432 2,046 26.5 6.20 473.52 224 1,061 13.8 2.49 190.17 432 822 10.7 2.49 190.17 224 426 5.6 1,620 20.9 79.2 79.0

Middle East/North Africa 

Egypt 2007 3.64 4,617.47 168 7,757 6.1 3.64 4,617.47 107 4,941 3.9 3.06 3,881.72 168 6,521 5.1 3.06 3,881.72 107 4,153 3.3 3,604 2.8 46.5 46.4 Jordan 2009 5.68 42.05 557 234 31.2 5.68 42.05 287 121 16.2 2.33 17.25 557 96 12.9 2.33 17.25 287 50 6.7 185 24.6 78.9 78.6

Eastern Europe/NIS 

Albania 2008 3.54 277.78 268 744 9.5 3.54 277.78 145 403 5.1 2.21 173.41 268 465 5.9 2.21 173.41 145 251 3.2 493 6.3 66.2 66.1

Armenia 2007 2.43 214.03 172 368 4.2 2.43 214.03 113 242 2.7 1.92 169.11 172 291 3.3 1.92 169.11 113 191 2.2 177 2.0 48.1 48.1Azerbaijan 5.11 31,421 537 155,629 27.3 5.11 31,421 328 101,126 16.6 2.46 15,775 537 71,560 13.1 2.46 15,775 328 46,581 8.0 109,048 19.3 69.5 69.2

61 

4. Discussion 

According to our calculations, if women were to satisfy their unmet risk-based needs for contraception or 

were to obtain more effective methods of family planning, substantial numbers of under-five deaths and 

maternal deaths could be averted. When we consider the combined effects of a reduced number of births 

and lower mortality rates, we find that over half of infant and under-five deaths could be averted, with 3.2 

million deaths averted out of the 5.6 million deaths projected for 2015 in the 45 countries included in the 

analysis. Even more spectacular is the number of maternal deaths that could be averted, with 109,000 out 

of the 155,000 projected for 2015, a reduction of 70 percent. It is unrealistic to assume that risk-based unmet 

need can be eliminated completely because of conflicts with fertility desires and rejection of contraception 

use of by some women and their husbands or partners, families, or religions. However, our calculations 

indicate that satisfying half of the unmet risk-based need would be a highly effective, cost-effective 

intervention to avert young child and maternal deaths. For many women, risk-based needs and desire-based 

needs coincide, and a substantial portion of risk-based unmet need will be satisfied if women can achieve 

their preferred number and spacing of births. 

The numbers of child deaths averted in our analyses are much greater than those predicted by the 

FamPlan/LiST model tool (Bhutta et al. 2014; Jo et al. 2014). See Walker et al. (2013) for a description of 

the LiST tool. The differences lie in the different approaches. To estimate the number of deaths averted by 

increases in contraceptive use, the FamPlan/LiST model considers only those reductions in infant and child 

deaths that are transmitted through direct causes of death for which there is published evidence that links 

fertility risks to pregnancy and delivery complications. Reductions in births are also considered. However, 

published model results represent various scenarios of increases in the contraceptive prevalence rate over a 

period of years rather than eliminating the unmet need due to fertility risk. By contrast, the approach taken 

here uses the observed risk of mortality for infant and under-five children that is associated with fertility 

behavior after controlling for a host of confounding factors. These risk estimates are not limited to 

transmission through direct causes of death for which there is published evidence. Given the lack of 

available data for middle and low income countries that link fertility risk behavior to specific causes of 

death, as well as indirect and underlying causes, we believe that the FamPlan/LiST model severely 

underestimates the potential impact of contraceptive use on mortality. Thus, there are two main differences 

between our methodology and the methodology used by the FamPlan/LiST tool. We take into account 

indirect and/or underlying causes of death, and we estimate reductions in births from satisfying risk-based 

unmet needs for contraception. 

Our estimates of maternal deaths averted by satisfying risk-based unmet needs compare well with those of 

Stover and Ross (2009), who found that the increase in contraceptive use between 1990 and 2005 averted 

over 1.2 million maternal deaths. This was due to the decline in the fertility rate and was associated with a 

reduction in the MMRatio of 450 points from the reduction in high-risk births. Cleland et al. (2012) and 

Ahmed et al. (2012) calculated that satisfying demand-based unmet need could avoid 30 and 29 percent of 

maternal deaths, respectively. Our estimates are based on risk-based unmet needs and needs for more 

effective contraception and could easily exceed the percentage of maternal deaths averted by satisfying just 

demand-based unmet need. 

Our estimates of infant and under-five mortality reduced by satisfying risk-based unmet needs differ in 

several ways from those estimated by Trussell and Pebley (1984). First, they estimated the reduction of 

mortality rates from eliminating each of the fertility risk factors individually rather than eliminating the 

combination of risk factors. Second, they used a different birth interval range, less than 24 months from 

birth to birth rather than less than 36 months. Their infant and under-five mortality results are based 

primarily on data from the World Fertility Surveys, which took place more than three decades ago when 

there were much higher levels of mortality. They did not estimate the number of deaths averted and did not 
62 

take into account changes in fertility levels. Their estimates of the potential change in the MMRatio are 

based only on data from one location, the Matlab (Thana, Bangladesh) surveillance site, and are also more 

than four decades old. Trussell and Pebley did not take account of the reduction in fertility from avoiding 

the maternal mortality risks and did not calculate the number of maternal deaths averted. 

Basing the analyses on our 2014 high-risks births report, we find a very high level of unmet need for 

contraception among non-pregnant women. Many thousands of maternal and child deaths could be averted 

if risk-based unmet needs were satisfied. In this study of the 45 DHS country surveys with fieldwork 

between 2006 and 2012, we find that more than two-thirds of non-pregnant women age 15-49 have an 

avoidable risk for young child and maternal death based on their fertility status. We have included only 

women who would be age 40 or more at next birth as a conservative approach, although women 35-39 years 

of age also have been shown to have an increased risk. Moreover, while it has been shown that women with 

long birth-to-pregnancy intervals are at increased risk for both child mortality and pregnancy complications, 

the use of contraception will not avert these risks and is not included in the calculation of need for 

contraception. 

Many women seem to appreciate the fertility-based risks that they are facing, since only 9 percent of those 

faced with a spacing risk (low age at birth, short interval) want another child within two years of the survey, 

and 68 percent of those women with a limiting risk do not want another child or are using a permanent 

method. Combining the fertility-risk based unmet need with unmet need based on fertility desires indicates 

the percent of women with an unmet need for contraception from both concepts. Women who are using a 

contraceptive method that is not in agreement with their desires, their risks or both are in need a more 

effective method, and more specifically, a LAPM. Two of five married, non-pregnant women have either 

an unmet need for contraception or a need to improve their method, and thus have a need for focused 

attention from family planning programs. Because DHS data was lacking in many countries, the 

calculations in this report are limited to currently married women, although women who are not currently 

married can be having sexual relations and may need focused attention as well. 

Married, non-pregnant women with an unmet need for contraception or a need for a more effective method 

live primarily in rural areas, and most have completed less than a primary education. Surprisingly, these 

women are not concentrated among the poorest. Women with an unmet need are rather evenly distributed 

across wealth quintiles. 

We found that six in ten women with an unmet need for focused family planning efforts were not told about 

family planning in recent visits to health facilities. Over a third do not intend to use contraception in the 

future, and one in nine reported that family planning program problems were a reason for not intending to 

use contraception. This finding suggests that, in many cases, family planning and health programs are not 

adequately informing women of their risks and are not responding to the unmet need for contraception or 

for a more effective method of contraception. 

This study has several limitations that should be taken into account. For the projected number of deaths 

averted in 2015, we use the latest DHS estimates of fertility, infant, under-five and maternal mortality rates. 

We assume that those rates are accurate and have not changed from the periods of measurement (three years 

before the survey for fertility rates, five years for infant and child mortality, and seven years for maternal 

mortality rates) to the current year. Population estimates for women are based on UN medium level 

population projections published in 2013 and projected from 2005-10 data. This study also assumes no 

change in other interventions to reduce mortality, which may cause fewer deaths averted to be attributable 

to contraception. 

The calculation of the reduction in deaths by satisfying risk-based unmet need for contraception does not 

take into account married women’s desires for having a future birth. Those desires could raise the number 
63 

of births averted, since some women without risk-based unmet need do not wish to have another child, and 

this would lower the reduced-risk fertility rate. On the other hand, women with an unmet risk-based need 

may be unwilling to use contraception, which could lower the number of births averted and raise the 

reduced-risk fertility rate. The calculations also do not take into account the capacity and quality of family 

planning programs needed to satisfy the unmet needs. The results here apply only to the 45 countries in the 

analysis (28 for maternal mortality), and regional averages, especially for the Middle East/North Africa, 

Eastern Europe/North Africa and Latin America/Caribbean regions, are based on very few countries. 

The appendix provides brief summaries for each country included in this report. 

65 

5. Conclusions and Policy Implications 

Avoiding high fertility behavior risk (due to inadequate birth-to-pregnancy spacing, too young or too old 

age at birth, and high parity) would go a long way toward averting substantial numbers of young child and 

maternal deaths. Many women have unmet needs for contraception based on their risk status, and in many 

cases this coincides with their unmet needs based on desires not to have or to delay a future birth. Many of 

the women with unmet needs are not being well-served by health systems. These women need to be 

informed of the fertility risks and their contraceptive choices, and to be provided with timely, effective, and 

high quality services. A majority of the women with risk-based unmet needs live in rural areas and have 

low levels of education. However, those with unmet needs are not limited to the poor and many women in 

the higher wealth quintiles also have risk-based unmet needs. It is incumbent upon national health programs, 

international health donors and private for-profit and not-for-profit health programs to serve the women 

with unmet needs for contraception in order to cost-effectively avert maternal and child deaths and to reach 

the Sustainable Development Targets 3.1 and 3.2. 

67 

References 

Ahmed, S., Q. Li, L. Liu, and A.O. Tsui. 2012. "Maternal Deaths Averted by Contraceptive Use: An 

Analysis of 172 Countries." Lancet 380 (9837):111-25. 

Alam, N. 1995. "Birth Spacing and Infant and Early Childhood Mortality in a High Fertility Area of 

Bangladesh: Age-Dependent and Interactive Effects." Journal of Biosocial Science 27:393-393. 

Alam, N., and P.H. David. 1998. "Infant and Child Mortality in Bangladesh: Age-Specific Effects of 

Previous Child's Death." Journal of Biosocial Science 30 (03):333-348. 

Bhalotra, S., and A.v. Soest. 2006. Birth Spacing and Neonatal Mortality in India: Dynamics, Frailty and 

Fecundity. Paper read at Population Association of America, at Los Angeles, California. 

Bhutta, Z.A., J.K. Das, R. Bahl, J.E. Lawn, R.A. Salam, V.K. Paul, M.J. Sankar, H. Blencowe, A. Rizvi, 

V.B. Chou, and N. Walker. 2014. "Can Available Interventions End Preventable Deaths in Mothers, 

Newborn Babies, and Stillbirths, and at What Cost?" Lancet 384 (9940):347-70. 

Boerma, J.T., and G.T. Bicego. 1992. "Preceding Birth Intervals and Child Survival: Searching for 

Pathways of Influence." Studies in Family Planning 23 (4):243-256. 

Bradley, S.E.K., T.N. Croft, J.D. Fishel, and C.F. Westoff. 2012. Revising Unmet Need for Family 

Planning. DHS Analytical Studies No. 25. Calverton, Maryland, USA: ICF International. Available 

at http://dhsprogram.com/pubs/pdf/AS25/AS25.pdf. 

Chen, L.C., M.C. Gesche, S. Ahmed, A.I. Chowdhury, and W.H. Mosley. 1974. "Maternal Mortality in 

Rural Bangladesh." Stud Fam Plann 5 (11):334-41. 

Cleland, J., A. Conde-Agudelo, H. Peterson, J. Ross, and A. Tsui. 2012. "Contraception and Health." The 

Lancet 380 (9837):149-156. 

Conde-Agudelo, A., and J.M. Belizán. 2000. "Maternal Morbidity and Mortality Associated with 

Interpregnancy Interval: Cross Sectional Study." BMJ 321 (7271):1255-1259. 

Conde-Agudelo, A., A. Rosas-Bermúdez, and A.C. Kafury-Goeta. 2006. "Birth Spacing and Risk of 

Adverse Perinatal Outcomes." JAMA: the journal of the American Medical Association 295 

(15):1809-1823. 

Conde-Agudelo, A., A. Rosas-Bermúdez, and A.C. Kafury-Goeta. 2007. "Effects of Birth Spacing on 

Maternal Health: A Systematic Review." American Journal of Obstetrics & Gynecology 196 

(4):297-308. 

Conde‐Agudelo, A., A. Rosas‐Bermudez, F. Castaño, and M.H. Norton. 2012. "Effects of Birth Spacing on 

Maternal, Perinatal, Infant, and Child Health: A Systematic Review of Causal Mechanisms." 

Studies in Family Planning 43 (2):93-114. 

DaVanzo, J., L. Hale, A. Razzaque, and M. Rahman. 2008. "The Effects of Pregnancy Spacing on Infant 

and Child Mortality in Matlab, Bangladesh: How They Vary by the Type of Pregnancy Outcome 

that Began the Interval." Popul Stud (Camb) 62 (2):131-54. 

Finlay, J.E., E. Özaltin, and D. Canning. 2011. "The Association of Maternal Age with Infant Mortality, 

Child Anthropometric Failure, Diarrhoea and Anaemia for First Births: Evidence from 55 Lowand Middle-income Countries." BMJ open 1 (2). 

Fortney, J.A. 1987. "The Importance of Family Planning In Reducing Maternal Mortality." Studies in 

Family Planning 18 (2):109-114. 

Fraser, A.M., J.E. Brockert, and R.H. Ward. 1995. "Association Of Young Maternal Age with Adverse 

Reproductive Outcomes." New England journal of medicine 332 (17):1113-1118. 

Geronimus, A.T. 1987. "On Teenage Childbearing and Neonatal Mortality in the United States." Population 

and Development Review:245-279. 

Govindasamy, P., M.K. Stewart, S.O. Rutstein, J.T. Boerma, and A.E. Sommerfelt. 1993. High-risk Births 

and Maternity Care. In Comparative Studies 8. Columbia, Maryland, USA: Macro International 

Inc. 

Handa, S., S. Koch, and S.W. Ng. 2010. "Child Mortality in Eastern and Southern Africa." Population 

Review 49 (1). 
68 

Hobcraft, J. 1987. Does Family Planning Save Childrens Lives? In International Conference on Better 

Health for Women and Children through Family Planning - See more at: 

http://www.popline.org/node/353677#sthash.egnpzdOB.dpuf. Nairobi, Kenya. 

Hobcraft, J.N., J.W. McDonald, and S.O. Rutstein. 1985. "Demographic Determinants of Infant And Early 

Child Mortality: A Comparative Analysis." Population Studies 39 (3):363-385. 

Hughes, E.A., E.B. Hunter, and R.M. Woodbury. 1923. Infant Mortality: Results of a Field Study in Gary, 

Ind., Based on Births in One Year: US Department of Labor, Children's Bureau. 

Ikamari, L.D. 2013. "Regional Variation in Neonatal and Post-neonatal Mortality in Kenya." African 

Population Studies 27 (1). 

Jo, Y., A.B. Labrique, A.E. Lefevre, G. Mehl, T. Pfaff, N. Walker, and I.K. Friberg. 2014. "Using the Lives 

Saved Tool to Model Mhealth Impact on Neonatal Survival In Resource-limited Settings." PLoS 

ONE 9 (7):e102224. 

Koenig, M.A., J.F. Phillips, O.M. Campbell, and S. D'Souza. 1990. "Birth Intervals and Childhood 

Mortality in Rural Bangladesh." Demography 27 (2):251-265. 

Kumar, C., P.K. Singh, R.K. Rai, and L. Singh. 2013. "Early Neonatal Mortality in India, 1990–2006." 

Journal of Community Health 38 (1):120-130. 

Miller, J.E., J. Trussell, A.R. Pebley, and B. Vaughan. 1992. "Birth Spacing and Child Mortality in 

Bangladesh and the Philippines." Demography 29 (2):305-318. 

Mozumder, A.K.A., T.T.K. Barkat-e-Khuda, T.T. Kane, and M.S.I. Khan. 1998. Determinants of Infant 

and Child Mortality in Rural Bangladesh: International Centre for Diarrhoeal Disease Research, 

Bangladesh. 

Nortman, D. 1974. Parental Age as a Factor in Pregnancy Outcome and Child Development. Reports on 

Population/Family Planning. New York: The Population Council. 

Reichman, N.E., and D.L. Pagnini. 1997. "Maternal Age and Birth Outcomes: Data from New Jersey." 

Family Planning Perspectives:268-295. 

Ross, J.A., and A.K. Blanc. 2012. "Why Aren’t There More Maternal Deaths? A Decomposition Analysis." 

Maternal and Child Health Journal 16 (2):456-463. 

Rutstein, S.O., and G. Rojas. 2006. Guide to DHS Statistics. Calverton, Maryland: ORC Macro. Available 

at http://www.dhsprogram.com/pubs/pdf/DHSG1/Guide_to_DHS_Statistics_ 29Oct2012_ 

DHSG1.pdf. 

Rutstein, S.O., and R. Winter. 2014. The Effects of Fertility Behavior on Child Survival and Child 

Nutritional Status: Evidence from the Demographic and Health Surveys, 2006-2012. DHS 

Analytical Studies No. 37. Rockville, Maryland, USA: ICF International. Available at 

http://dhsprogram.com/pubs/pdf/AS37/AS37.pdf. 

Saha, U.R., and A. van Soest. 2013. "Contraceptive Use, Birth Spacing, and Child Survival in Matlab, 

Bangladesh." Studies in Family Planning 44 (1):45-66. 

Stover, J., and J. Ross. 2010. "How Increased Contraceptive Use Has Reduced Maternal Mortality." 

Maternal AND Child Health Journal 14 (5):687-695. 

Trussell, J., and A.R. Pebley. 1984. "The Potential Impact of Changes in Fertility on Infant, Child and 

Maternal Mortality." Studies in Family Planning 15 (6):267-280. 

United Nations, Department of Economics and Social Affairs, and Population Division. 2013. World 

Population Prospects: The 2012 Revision, DVD Edition. 

Van der Klaauw, B., and L. Wang. 2004. Child mortality in Rural India: World Bank. 

Walker, N., Y. Tam, and I.K. Friberg. 2013. "Overview of the Lives Saved Tool (LIST)." BMC Public 

Health 13 Suppl 3:S1. 

Winikoff, B., and M. Sullivan. 1987. "Assessing the Role of Family Planning in Reducing Maternal 

Mortality." Stud Fam Plann 18 (3):128-43. 

Woodbury, R.M. 1925. Causal Factors in Infant Mortality: A statistical study based on Investigations in 

Eight Cities: US Government Printing Office. 

Zenger, E. 1993. "Siblings’ Neonatal Mortality Risks and Birth Spacing in Bangladesh." Demography 30 

(3):477-488.
69 

Appendix A 
70

Table A.1. Among non-pregnant married and in-union women with a combined unmet need for either a spacing or a limiting method of contraception but who do not intend to use in the future, distribution by reasons for not intending to use, 40 DHS country surveys 2006-2012 Country 

Survey 

date 

Number of 

respondents Not having sex Infrequent sex 

Menopausal, 

hysterectomy Subfecund, infecund 

Postpartum 

amenorrheic Breast- feeding Fatalistic Respondent opposed 

Husband, 

partner 

opposed 

Other 

opposed 

Religious 

prohibition

Health 

concerns 

Fear of side 

effects 

Interferes 

with body's 

processes 

Knows no 

method 

Knows no 

source 

Lack of 

access, 

too far 

Costs too 

much 

Inconvenient to 

use 

Preferred 

method not 

available 

No method 

available Don't know

Albania 2008-09 376 6.4 13.9 0.8 4.7 0 0.5 0.5 41.5 33.8 0.7 0.1 8 22.6 1.5 1.2 2.2 0.5 4.1 0.4 0 0 0.5 Armenia 2010 138 6.6 21.1 0 36.6 0 0 0.3 22.9 8.2 0 0.8 6.1 1.5 0.2 0.7 0 1.4 0 0 13.5 0 1.5Azerbaijan 2006 639 12.5 17.7 0.1 32.4 0.1 0.1 1.2 7.9 5.1 0.9 1 20.1 4.3 2.7 2.5 1 0.3 2.7 1.5 0 0 0.9

Bangladesh * 2011 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA

Benin 2006 1,128 12.2 17.2 1.1 6.3 1.6 3.9 2.3 15.5 4.2 0.5 2.5 15 21.8 4.5 6.4 6.7 0.4 3.4 1.2 0 0 2.2Bolivia 2008 360 13.6 30.8 3.6 4.2 4.9 1 0 13.6 10.9 0.2 1.4 11.5 23.6 3.4 10.7 3.9 1 2.2 2.1 0.7 0 0.6Burkina Faso 2010 907 7.1 16 0 2.2 1.9 11.6 5.5 15.3 23.7 0.5 4.1 0 19.3 1.5 3.5 1.3 2.9 4.1 1.3 0.3 0 0.6Burundi 2010 357 2.5 7 0 3.7 4.5 6 24 11.2 11.7 0.1 20.4 0 22.4 1.1 0 0.3 0 0 2.5 0 0 0.9Cambodia 2010 688 4.6 33 2.9 8.1 0.8 2.1 12 5.2 1.1 0 0.3 50.6 0 0.6 0.4 0 0.4 1.2 4.6 1.2 0.2 0.6Cameroon 2011 565 12 18.1 0 2.9 2.1 10 4 16.4 9.7 1 7.3 13 18.8 3.5 6.5 5.3 1.2 4.9 3 0 0 0.7Colombia 2010 275 8.3 13.9 7.2 4.2 0.1 0 0.7 10 1.9 0 0.2 19 8.6 2.9 0.6 0.7 0 0 1.4 0 0 1Congo DR 2007 444 10.6 12.3 1.1 1.1 2.4 23.6 0.8 13.8 11 0.7 7 6.3 14.1 3.9 15 6 1.1 4.9 3.1 0 0 0.9Dominican Rep. 2007 229 8.5 8.4 0.8 10 0.3 0.6 5.7 23.7 2.6 0.1 0.1 1.7 0.4 16.5 14 0.1 0 6.1 3.1 1.6 0 0.4Egypt * 2008 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NAEthiopia 2011 622 3.3 4.1 0 1.7 5.8 10.6 15.4 7.4 6.4 2 15.7 0 29.7 6.2 3 1.9 0.7 0.4 5.1 0 0 1.7Ghana 2008 291 7 7.5 0.4 5.6 0 3.1 0.2 20.4 3.7 0.1 3.6 13 32.1 6.8 3.3 2.7 0 2.4 3.2 0 0 0Guyana 2009 293 5.5 9.4 1.1 3.7 0 2.5 0.8 8.7 8.3 0.1 0.8 22.1 14.1 9.6 0.1 1.5 1.6 3.3 4.3 0 0 6.9India 2005-06 1,785 7.7 20.6 0.7 3 1.3 5 13.6 11 16.4 1 14.6 11.1 10.5 2.7 4.2 2.3 0.3 3.1 0.9 6.1 0 0Indonesia * 2007 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NAJordan * 2007 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NAKenya 2008-09 313 9.2 6.4 0.9 2.7 0.5 2.6 0.2 8.8 8.4 0 7.3 29.1 19.7 10.6 1.9 3.4 2.5 1.7 0.7 0 0 1.6Lesotho 2009 184 4.2 8.4 4.7 15.6 2.1 3.7 1.3 6 14 2.3 1.5 5 19.7 6.4 1 0 6.8 10.9 2.1 0 0 0Liberia 2007 439 6.3 5.7 0 0 0.1 17 0.1 9.9 11.4 2.7 6.5 11.6 6.1 5.9 35.3 4.7 1.8 2.2 3.2 0 0 1.8Madagascar 2008-09 676 4.1 11.4 1.3 5.9 0.6 2.1 1.5 18.5 6.4 0.6 2.4 19.1 25.2 4 6 4.7 0.9 1.7 2.4 0 0 1.5

Malawi 2010 648 6.2 8.3 5.1 4.3 1.7 5.7 2.2 10.6 5.3 0.7 1.7 15.8 23.4 5.5 0.1 0.5 1 0.6 0.6 0 0 1.7Mali 2006 1,183 3.2 7.3 1.6 1.7 0.3 6.4 3.4 20.2 7.3 0.2 6.9 12.5 6.6 6 8.8 6.7 0.2 0.7 0.7 0 0 5.1Mozambique 2011 653 7.9 14.6 0 2.9 1.4 35.9 19.7 5.1 7.5 1.2 1.1 0 5.3 1 0.1 0.8 1.8 5.8 0.5 0.9 0.3 0.4Namibia 2006-07 144 9.6 3 1 1.3 0 5.6 0 11.4 10.8 0 2.6 16.9 6 4.7 7.4 0.4 0.8 4.1 0.6 0 0 8.8Nepal 2011 255 7.8 26 0 7.3 0.2 1.2 2.9 1.2 7 0.2 5.9 0 24.6 4.1 0 0 0 0 0.5 0 0 0Niger 2006 449 3.9 8.9 0.1 0.4 1 9.2 1.7 22.7 11.2 1.6 8.2 12.6 5.6 2.5 13.3 8.1 1 1.8 2.6 0 0 2.4

Nigeria 2008 1,278 4.1 8.7 0.5 0.7 0.1 5.9 0.2 23.4 14.4 1.3 8.7 6.6 18 5.5 9.4 2.4 0.4 0.6 2.1 0 0 3Pakistan * 2012-13 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NAPeru 2012 72 25.3 21.4 2.1 0.3 1.6 0 0.7 1.4 5.5 0 2.2 7.3 29.4 1.3 0 0 0 00000

Philippines 2008 754 8.2 19.5 2.9 5.5 1.3 1.2 2.1 7.2 5.4 0.4 3.1 0.5 0.4 35 21.9 0.7 14.8 2.9 2 0 0 0.2Rwanda 2010 252 9.6 12.2 0.4 0 1.9 3.5 19.3 10.4 5.5 0.5 5.1 0 29.2 7.7 0 0 0 0 2.7 0 0 0.4Sao Tome & Principe 2008-09 133 4.6 13.6 0.8 0.2 0.2 0.8 0 22.6 7.8 0 0.6 27.7 10.2 9.4 0 0 0 0 0 0 0 3.1Senegal 2010-11 1,290 6.9 9.6 0 1 3 18.2 5.7 23.6 11.6 0.7 4.7 0 12.5 1.8 2.2 1.5 0.4 1.4 1 0 0 4.2Sierra Leone 2008 420 3.1 2.1 1.2 1.3 0.2 8.2 0.6 21.5 20.7 1.8 12.6 12.2 17.7 3.4 13.9 2.7 0.7 6.8 1.1 0 0 1.2Swaziland 2006-07 124 0 11.3 7.3 3.8 0 0 1.5 4.8 16.1 0 3.4 19.4 20.2 5 0 0.5 0 1.6 2.5 3.2 7.1 0Tanzania 2010 317 5.8 7.7 1.4 0 3 3.8 2.1 15.1 17.1 0.7 1.9 17.4 45 2.6 0.5 0.5 0.6 0.8 1.1 0 0 0.9Timor-Leste 2009 1,029 0.8 1.9 0.4 0.3 0.1 8.1 0.1 63.8 26.5 0.5 1.3 15.7 16.7 3.9 7.3 0.3 1.3 0 0.2 0 0 0.8

Uganda 2011 315 7.8 13.2 0 8.9 4.7 7.5 12.9 16.7 6.8 4.2 3 0 36.6 5.8 1.2 1.3 0 1.4 3.6 0.4 0 1.4Ukraine 2007 160 6.8 27.1 1.3 18.6 0.6 0.4 9.1 11.1 6.5 1.2 2.7 16.9 0.9 3.2 0 0 0 0.9 1.1 0 0 0Zambia 2007 175 9.7 19.5 1 20.2 0.8 4.9 3.4 9.4 5 1.8 3 11.3 24.6 3.4 2.3 1.4 1.3 2.4 0.4 0 0 0.2Zimbabwe 2010-11 149 14.2 16.7 1.4 7.4 0.3 0.7 6.4 7.4 10.2 1.6 20.9 0 14.6 0.3 0 0 0 1.3 0 0 0 0.4

* Ever-married samples 

NA = not asked 
71 

Appendix B: 

Country Summaries: Reduced Child and Maternal 

Mortality through Reduced Fertility Risk and 

Eliminating Unmet Need for Contraception 
72 

Reduced Child Mortality through Reduced Fertility Risk and 

Eliminating Unmet Need for Contraception in Albania 

In 2015, there will be an estimated 751 deaths to under-five children in Albania. If women would have only 

those births they desired and with adequate birth spacing (36 months or more), age at birth (18 to 39 years), 

and parity (less than 4), 236 of those under-five deaths (31 percent) would be averted. These reductions in 

mortality are due to a lower number of births and lower mortality rates. Under these conditions, the total 

fertility rate would be 1.42 births per woman instead of 1.59, and the under-five mortality rate would be 14 

deaths per thousand births instead of 18. 

To achieve these levels, 55 percent of non-pregnant married women require focused family planning efforts 

to reduce the 10 percent with an unmet need for limiting births (i.e., using a long-acting or permanent 

contraceptive method—LAPM), the 3 percent with an unmet need for a spacing method, and the 42 percent 

who need to shift from non-LAPM to LAPM. 

Who are the women in need of focused family planning efforts, i.e., non-pregnant married women with a 

combined unmet need for contraception or a need for a long-term or permanent method of contraception? 

Forty percent of the married women who have a need for focused family planning efforts live in urban 

areas, just 2 percent have no education or incomplete primary schooling, and 42 percent live in households 

in the lowest two wealth quintiles. 

Three of four married women who need focused family planning efforts are users in need of a better method 

(LAPM—77 percent), 3 percent have never used a method, and 20 percent have used a method in the past 

but are not current users. 

Two-thirds (68 percent) of the women with a focused family planning need who visited a health facility in 

the 12 months before the survey were not advised about family planning. 

Married women with an unmet need for contraception for either desires or risk were asked about their 

intentions to use contraception in the future. Two of three women (66 percent) said that they did not intend 

to use contraception in the future, and gave the following reasons for their intentions not to use: Are 

breastfeeding (1 percent), are fatalistic (1 percent), have infrequent sexual relations (14 percent) or are not 

having sexual relations (6 percent), fear side effects or have health concerns (31 percent), say that 

contraception interferes with the body’s processes (2 percent), have a husband who is opposed (34 percent) 

or they are opposed (42 percent), and believe they are subfecund or infecund (6 percent). Eight percent 

cited family planning program reasons (no method or preferred method not available, inconvenient to use, 

costs too much, lack of access or too far away, knows no method, or knows no source) as the reason they 

do not intend to use contraception in the future. 
73 

Reduced Child Mortality through Reduced Fertility Risk and 

Eliminating Unmet Need for Contraception in Armenia 

In 2015, there will be an estimated 764 deaths to under-five children in Armenia. If women would have 

only those births they desired and with adequate birth spacing (36 months or more), age at birth (18 to 39 

years), and parity (less than 4), 250 of those under-five deaths (33 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 1.61 births per woman instead of 1.70. The under-five mortality 

rate would actually be slightly higher, at 27 deaths per thousand births instead of 19, because the decrease 

that would otherwise have occurred is counteracted by an increase in the percentage of births that are firstbirths. First-births are unavoidably at higher risk than later births. However, the number of under-five deaths 

would still be reduced due to the lower number of births. 

To achieve these levels, 36 percent of non-pregnant married women require focused family planning efforts 

to reduce the 9 percent with an unmet need for limiting births (i.e., using a long-acting or permanent 

contraceptive method—LAPM), the 4 percent with an unmet need for a spacing method, and the 22 percent 

who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married women with a 

combined unmet need for contraception or a need for a long-term or permanent method of contraception? 

Over half (54 percent) of the married women who have a need for focused family planning efforts live in 

urban areas, 100 percent have completed at least primary education, and nearly half (47 percent) live in 

households in the lowest two wealth quintiles. 

About three in five married women with a need for focused family planning efforts are users who need of 

a better method (LAPM—62 percent), 24 percent have never used a method, and 14 percent have used a 

method in the past but are not current users. 

A vast majority (87 percent) of the women with a focused family planning need who visited a health facility 

in the 12 months before the survey were not advised about family planning. 

Married women with an unmet need for contraception for either desires or risk were asked about their 

intentions to use contraception in the future. One in three (32 percent) said that they did not intend to use 

contraception in the future, and gave the following reasons for not intending to use: Have infrequent sexual 

relations (21 percent) or are not having sexual relations (7 percent), fear side effects or have health concerns 

(8 percent), have a husband who is opposed (8 percent) or they are opposed (23 percent), believe they are 

subfecund or infecund (37 percent), and cite a religious prohibition (1 percent). One in seven (14 percent) 

cited family planning program reasons (no method or preferred method not available, inconvenient to use, 

costs too much, lack of access or too far away, knows no method or knows no source) as the reason they 

do not intend to use contraception in the future. 
74 

Reduced Child Mortality through Reduced Fertility Risk and 

Eliminating Unmet Need for Contraception in Azerbaijan 

In 2015, there will be an estimated 7,831 deaths to under-five children in Azerbaijan. If women would have 

only those births they desired and with adequate birth spacing (36 months or more), age at birth (18 to 39 

years), and parity (less than 4), 467 of those under-five deaths (6 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 1.86 births per woman instead of 2.02. The under-five mortality 

rate would be actually be slightly higher, at 50 deaths per thousand births instead of 49, because the decrease 

that would otherwise have occurred is counteracted by an increase in the percentage of births that are firstbirths. First-births are unavoidably at higher risk than later births. However, the number of under-five deaths 

would still be reduced due to the lower number of births. 

To achieve these levels, 48 percent of non-pregnant married women require focused family planning efforts 

to reduce the 21 percent with an unmet need for limiting births (i.e., using a long-acting or permanent 

contraceptive method—LAPM), the 2 percent with an unmet need for a spacing method, and the 25 percent 

who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married women with a 

combined unmet need for contraception or a need for a long-term or permanent method of contraception? 

About half (51 percent) of the married women who have a need for focused family planning efforts live in 

urban areas, 1 percent have no education and another 1 percent have incomplete primary schooling, and 43 

percent live in households in the lowest two wealth quintiles. 

Over half of the married women who need focused family planning efforts are users who need of a better 

method (LAPM—52 percent), 26 percent have never used a method, and 22 percent have used a method in 

the past but are not current users. 

A vast majority (87 percent) of the women with a focused family planning need who visited a health facility 

in the 12 months preceding the survey were not advised about family planning. 

Married women with an unmet need for contraception for either desires or risk were asked about their 

intentions to use contraception in the future. Over half (58 percent) said that they did not intend to use 

contraception in the future, and gave the following reasons for not intending to use: Are fatalistic 

(1 percent), have infrequent sexual relations (18 percent) or are not having sexual relations (13 percent), 

fear side effects or have health concerns (25 percent), say that contraception interferes with the body’s 

processes (3 percent), have a husband who is opposed (5 percent) or they are opposed (8 percent), believe 

they are subfecund or infecund (32 percent), and cite a religious prohibition (1 percent). Seven percent cited 

family planning program reasons (no method or preferred method not available, inconvenient to use, costs 

too much, lack of access or too far away, knows no method or knows no source) as the reason they do not 

intend to use contraception in the future. 
75 

Reduced Child Mortality through Reduced Fertility Risk and 

Eliminating Unmet Need for Contraception in Bangladesh 

In 2015, there will be an estimated 146,944 deaths to under-five children in Bangladesh. If women would 

have only those births they desired and with adequate birth spacing (36 months or more), age at birth (18 

to 39 years), and parity (less than 4), 38,919 of those under-five deaths (26 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 2.26 births per woman instead of 2.77 and the under-five 

mortality rate would be 43 deaths per thousand births instead of 47. 

To achieve these levels, 39 percent of non-pregnant married women require focused family planning efforts 

in order to reduce the 9 percent with an unmet need for limiting births (i.e. using a long-acting or permanent 

contraceptive method—LAPM), the 4 percent with an unmet need for a spacing method, and the 27 percent 

who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married women with a 

combined unmet need for contraception or a need for a long-term or permanent method of contraception? 

More than one in five (22 percent) of the married women who need focused family planning efforts live in 

urban areas, 34 percent have no education and another 22 percent have incomplete primary schooling, and 

40 percent live in households in the lowest two wealth quintiles. 

Two of three married women with a need for focused family planning efforts are users in need of a better 

method (LAPM—69 percent), 7 percent have never used a method, and 24 percent have used a method in 

the past but are not current users. 

Married women with an unmet need for contraception for either desires or risk were asked about their 

intentions to use in the future. Almost one in four (23 percent) said that they did not intend to use 

contraception in the future, although the survey did not ask women about reasons they did not intend to use 

contraception in the future. 
76 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception in Benin 

In 2015, there will be an estimated 38,254 deaths to under-five children and 1,546 pregnancy related deaths 

of mothers in Benin. If women would have only those births they desired and with adequate birth spacing 

(36 months or more), age at birth (18 to 39 years), and parity (less than 4), 23,537 of those under-five deaths 

(62 percent) and 1,151 pregnancy-related deaths (74 percent) would be averted. These reductions in 

mortality are due to a lower number of births and lower mortality rates. Under these conditions, the total 

fertility rate would be 2.68 births per woman instead of 5.74, the under-five mortality rate would be 82 

deaths per thousand births instead of 99, and the maternal mortality ratio would be 219 per hundred 

thousand births instead of 400. 

To achieve these levels, 43 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 24 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 7 percent with an unmet need for a spacing method, and 

the 12 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Thirty-eight percent of the married and in-union women who need focused family planning efforts live in 

urban areas, 71 percent have no education and 18 percent have incomplete primary schooling, and 36 

percent live in households in the lowest two wealth quintiles. 

About 28 percent of the married and in-union women who need focused family planning efforts are users 

in need of a better method (LAPM). 

A large majority (75 percent) of women with a focused family planning need who visited a health facility 

in the 12 months preceding the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. Some 37 percent said that they did not intend to 

use contraception in the future, and gave the following reasons for not intending to use: Are breastfeeding 

(5 percent), are fatalistic (2 percent), have infrequent sexual relations (17 percent) or are not having sexual 

relations (12 percent), fear side effects or have health concerns (35 percent), say that contraception 

interferes with the body’s processes (5 percent), have a husband who is opposed (4 percent) or they are 

opposed (16 percent), believe they are subfecund or infecund (7 percent), and say there is a religious 

prohibition (3 percent). One in six (16 percent) cited family planning program reasons (no method or 

preferred method not available, inconvenient to use, costs too much, lack of access or too far away, knows 

no method or knows no source) as the reason they do not intend to use contraception in the future. 
77 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception in Bolivia 

In 2015, there will be an estimated 14,023 deaths to under-five children and 744 pregnancy related deaths 

of mothers in Bolivia. If women would have only those births they desired and with adequate birth spacing 

(36 months or more), age at birth (18 to 39 years), and parity (less than 4), 8,476 of those under-five deaths 

(60 percent) and 493 pregnancy-related deaths (66 percent) would be averted. These reductions in mortality 

are due to a lower number of births and lower mortality rates. Under these conditions, the total fertility rate 

would be 2.21 births per woman instead of 3.54, the under-five mortality rate would be 32 deaths per 

thousand births instead of 50, and the maternal mortality ratio would be 145 per hundred thousand births 

instead of 268. 

To achieve these levels, 46 percent of non-pregnant married and in-union women require focused family 

planning efforts in order to reduce the 13 percent with an unmet need for limiting births (i.e., using a longacting or permanent contraceptive method—LAPM), the 3 percent with an unmet need for a spacing 

method, and the 29 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Over half (52 percent) of the married and in-union women who need focused family planning efforts live 

in urban areas, 8 percent have no education and another 57 percent have incomplete primary schooling, and 

nearly half (48 percent) live in households in the lowest two wealth quintiles. 

Almost two of three married and in-union women who need focused family planning efforts are users in 

need of a better method (LAPM—64 percent), 15 percent have never used a method, and 20 percent have 

used a method in the past but are not current users. 

A majority (53 percent) of the women with a focused family planning need who visited a health facility in 

the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. Almost a quarter (24 percent) said that they did not 

intend to use contraception in the future, and gave the following reasons for not intending to use: Are 

breastfeeding (5 percent), have infrequent sexual relations (31 percent) or are not having sexual relations 

(14 percent), fear side effects or have health concerns (33 percent), say that contraception interferes with 

the body’s processes (3 percent), have a husband who is opposed (11 percent) or they are opposed 

(14 percent), believe they are subfecund or infecund (8 percent), and cite a religious prohibition (1 percent). 

One in six (17 percent) cited family planning program reasons (no method or preferred method not 

available, inconvenient to use, costs too much, lack of access or too far away, knows no method or knows 

no source) as the reason they do not intend to use contraception in the future. 
78 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception 

in Burkina Faso 

In 2015, there will be an estimated 76,766 deaths to under-five children and 2,433 pregnancy related deaths 

of mothers in Burkina Faso. If women would have only those births they desired and with adequate birth 

spacing (36 months or more), age at birth (18 to 39 years), and parity (less than 4), 55,122 of those underfive deaths (72 percent) and 1,837 pregnancy-related deaths (76 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 2.62 births per woman instead of 5.99, the under-five mortality 

rate would be 69 deaths per thousand births instead of 108, and the maternal mortality ratio would be 191 

per hundred thousand births instead of 341. 

To achieve these levels, 37 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 19 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 7 percent with an unmet need for a spacing method, and 

the 10 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Almost a quarter (23 percent) of the married and in-union women who need focused family planning efforts 

live in urban areas, 81 percent have no education and another 10 percent have incomplete primary 

schooling, and 37 percent live in households in the lowest two wealth quintiles. 

Some 28 percent of married and in-union women who need focused family planning efforts are users in 

need of a better method (LAPM), 62 percent have never used a method, and 10 percent have used a method 

in the past but are not current users. 

Over half (51 percent) of the women with a focused family planning need who visited a health facility in 

the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. One in three (32 percent) said that they did not 

intend to use contraception in the future, and gave the following reasons for not intending to use: Are 

breastfeeding (13 percent), are fatalistic (6 percent), have infrequent sexual relations (16 percent) or are not 

having sexual relations (7 percent), fear side effects or have health concerns (20 percent), say that 

contraception interferes with the body’s processes (2 percent), have a husband who is opposed (24 percent) 

or they are opposed (15 percent), believe they are subfecund or infecund (2 percent), and say there is a 

religious prohibition (4 percent). Twelve percent cited family planning program reasons (no method or 

preferred method not available, inconvenient to use, costs too much, lack of access or too far away, knows 

no method or knows no source) as the reason they do not intend to use contraception in the future. 
79 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception in Burundi 

In 2015, there will be an estimated 37,056 deaths to under-five children and 2,353 pregnancy related deaths 

of mother in Burundi. If women would have only those births they desired and with adequate birth spacing 

(36 months or more), age at birth (18 to 39 years), and parity (less than 4), 24,217 of those under-five deaths 

(65 percent) and 1,773 pregnancy-related deaths (75 percent) would be averted. These reductions in 

mortality are due to a lower number of births and lower mortality rates. Under these conditions, the total 

fertility rate would be 2.83 births per woman instead of 6.38, the under-five mortality rate would be 62 

deaths per thousand births instead of 79, and the maternal mortality ratio would be 278 per hundred 

thousand births instead of 500. 

To achieve these levels, 46 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 23 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 7 percent with an unmet need for a spacing method, and 

the 16 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Only eight percent of the married and in-union women who need focused family planning efforts live in 

urban areas, 54 percent have no education and another 25 percent have incomplete primary schooling, and 

41 percent live in households in the lowest two wealth quintiles. 

About one in three married and in-union women who need focused family planning efforts are users in need 

of a better method (LAPM—34 percent), 57 percent have never used a method, and 9 percent have used a 

method in the past but are not current users. 

A majority (61 percent) of the women with a focused family planning need who visited a health facility in 

the 12 months preceding the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. Almost one in three (30 percent) said that they did 

not intend to use contraception in the future, and gave the following reasons for not intending to use: Are 

breastfeeding (10 percent), are fatalistic (24 percent), have infrequent sexual relations (7 percent) or are not 

having sexual relations (3 percent), fear side effects or have health concerns (24 percent), say that 

contraception interferes with the body’s processes (1 percent), have a husband who is opposed (12 percent) 

or they are opposed (11 percent), believe they are subfecund or infecund (4 percent), and say there is a 

religious prohibition (20 percent). Few (3 percent) cited family planning program reasons (no method or 

preferred method not available, inconvenient to use, costs too much, lack of access or too far away, knows 

no method or knows no source) as the reason they do not intend to use contraception in the future. 
80 

Reduced Child Mortality through Reduced Fertility Risk and 

Eliminating Unmet Need for Contraception in Cambodia 

In 2015, there will be an estimated 20,760 deaths to under-five children in Cambodia. If women would have 

only those births that they desired and with adequate birth spacing (36 months or more), age at birth (18 to 

39 years), and parity (less than 4), 9,520 of those under-five deaths (46 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 2.24 births per woman instead of 3.04 and the under-five 

mortality rate would be 40 deaths per thousand births instead of 54. 

To achieve these levels, 44 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 12 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 5 percent with an unmet need for a spacing method, and 

the 27 percent who need to shift from non-LAPM to LAPM. 

Who are the women in need of focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Fifteen percent of the married and in-union women who need focused family planning efforts live in urban 

areas, 20 percent have no education and another 53 percent have incomplete primary schooling, and 42 

percent live in households in the lowest two wealth quintiles. 

More than three of five married and in-union women who need focused family planning efforts are users 

in need of a better method (LAPM—62 percent), 17 percent have never used a method, and 21 percent have 

used a method in the past but are not current users. 

Slightly less than half (46 percent) of the women with a focused family planning need who visited a health 

facility in the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. Two out of five (41 percent) said that they did not 

intend to use contraception in the future, and they gave the following reasons for not intending to use: Are 

breastfeeding (3 percent), are fatalistic (12 percent), have infrequent sexual relations (33 percent) or are not 

having sexual relations (5 percent), fear side effects or have health concerns (51 percent), say that 

contraception interferes with the body’s processes (1 percent), have a husband who is opposed (1 percent) 

or they are opposed (5 percent), and believe they are subfecund or infecund (11 percent). Eight percent 

cited family planning program reasons (no method or preferred method not available, inconvenient to use, 

costs too much, lack of access or too far away, knows no method or knows no source) as the reason they 

do not intend to use contraception in the future. 
81 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception in Cameroon 

In 2015, there will be an estimated 86,339 deaths to under-five children and 6,648 pregnancy related deaths 

of mothers in Cameroon. If women would have only those births that they desired and with adequate birth 

spacing (36 months or more), age at birth (18 to 39 years), and parity (less than 4), 54,564 of those underfive deaths (63 percent) and 4,647 pregnancy-related deaths (70 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 2.42 births per woman instead of 5.09, the under-five mortality 

rate would be 79 deaths per thousand births instead of 102, and the maternal mortality ratio would be 495 

per hundred thousand births instead of 782. 

To achieve these levels, 39 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 17 percent with an unmet need for limiting births (i.e. using a long-acting or 

permanent contraceptive method—LAPM), the 6 percent with an unmet need for a spacing method, and 

the 16 percent who need to shift from non-LAPM to LAPM. 

Who are the women in need of focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Over half (52 percent) of the married and in-union women who need focused family planning efforts live 

in urban areas, 20 percent have no education, and another 22 percent have incomplete primary schooling. 

Surprisingly, only 33 percent live in households in the lowest two wealth quintiles. 

Two of five married and in-union women who need focused family planning efforts are users in need of a 

better method (LAPM—40 percent), 39 percent have never used a method, and 21 percent have used a 

method in the past but are not current users. 

Over two out of three (69 percent) of the women with a focused family planning need who visited a health 

facility in the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. More than one in three (36 percent) said that they 

did not intend to use contraception in the future, and they gave the following reasons for not intending to 

use: Are breastfeeding (11 percent), are fatalistic (4 percent), have infrequent sexual relations (18 percent) 

or are not having sexual relations (12 percent), fear side effects or have health concerns (31 percent), say 

that contraception interferes with the body’s processes (4 percent), have a husband who is opposed 

(10 percent) or they are opposed (16 percent), believe they are subfecund or infecund (3 percent), and say 

there is a religious prohibition (7 percent). Sixteen percent cited family planning program reasons (no 

method or preferred method not available, inconvenient to use, costs too much, lack of access or too far 

away, knows no method or knows no source) as the reason they do not intend to use contraception in 

the future. 
82 

Reduced Child Mortality through Reduced Fertility Risk and 

Eliminating Unmet Need for Contraception in Colombia 

In 2015, there will be an estimated 16,184 deaths to under-five children in Colombia. If women would have 

only those births that they desired and with adequate birth spacing (36 months or more), age at birth (18 to 

39 years), and parity (less than 4), 4,927 of those under-five deaths (30 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 1.78 births per woman instead of 2.14 and the under-five 

mortality rate would be 15 deaths per thousand births instead of 18. 

To achieve these levels, 18 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 4 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 2 percent with an unmet need for a spacing method, and 

the 12 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Two-thirds (66 percent) of the married and in-union women who need focused family planning efforts live 

in urban areas, 4 percent have no education and another 21 percent have incomplete primary schooling, and 

half (50 percent) live in households in the lowest two wealth quintiles. 

More than two-thirds of married and in-union women who need focused family planning efforts are users 

in need of a better method (LAPM—68 percent), 3 percent have never used a method, and 29 percent have 

used a method in the past but are not current users. 

A large majority (61 percent) of the women with a focused family planning need who visited a health 

facility in the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. One in five (21 percent) women said that they did 

not intend to use contraception in the future, and gave the following reasons for not intending to use: Are 

fatalistic (1 percent), have infrequent sexual relations (14 percent) or are not having sexual relations (8 

percent), fear side effects or have health concerns (29 percent), say that contraception interferes with the 

body’s processes (3 percent), have a husband who is opposed (2 percent) or they are opposed (10 percent), 

and believe they are subfecund or infecund (11 percent). One in six (17 percent) cited family planning 

program reasons (no method or preferred method not available, inconvenient to use, costs too much, lack 

of access or too far away, knows no method or knows no source) as the reason they do not intend to use 

contraception in the future. 
83 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception in the 

Democratic Republic of the Congo 

In 2015, there will be an estimated 387,121 deaths to under-five children and 16,202 pregnancy related 

deaths of mothers in the Democratic Republic of the Congo. If women would have only those births that 

they desired and with adequate birth spacing (36 months or more), age at birth (18 to 39 years), and parity 

(less than 4), 247,872 of those under-five deaths (64 percent) and 12,757 pregnancy-related deaths 

(79 percent) would be averted. These reductions in mortality are due to a lower number of births and lower 

mortality rates. Under these conditions, the total fertility rate would be 2.58 births per woman instead of 

6.28, the under-five mortality rate would be 114 deaths per thousand births instead of 130, and the maternal 

mortality ratio would be 281 per hundred thousand births instead of 543. 

To achieve these levels, 37 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 15 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 7 percent with an unmet need for a spacing method, and 

the 15 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Forty-five percent of the married and in-union women with a need for focused family planning efforts live 

in urban areas, 20 percent have no education and another 31 percent have incomplete primary schooling, 

and 38 percent live in households in the lowest two wealth quintiles. 

About 40 percent of married and in-union women who need focused family planning efforts are users in 

need of a better method (LAPM), 34 percent have never used a method, and 26 percent have used a method 

in the past but are not current users. 

More than three quarters (79 percent) of the women with a focused family planning need who visited a 

health facility in the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. Nearly half (48 percent) said that they did not intend 

to use contraception in the future, and gave the following reasons for not intending to use: Are breastfeeding 

(25 percent), are fatalistic (1 percent), have infrequent sexual relations (12 percent) or are not having sexual 

relations (11 percent), fear side effects or have health concerns (22 percent), say that contraception 

interferes with the body’s processes (4 percent), have a husband who is opposed (11 percent) or they are 

opposed (14 percent), believe they are subfecund or infecund (2 percent), and say there is a religious 

prohibition (7 percent). More than one in four (27 percent) cited family planning program reasons (no 

method or preferred method not available, inconvenient to use, costs too much, lack of access or too far 

away, knows no method or knows no source) as the reason they do not intend to use contraception in 

the future. 
84 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception 

in the Dominican Republic 

In 2015, there will be an estimated 6,492 deaths to under-five children and 368 pregnancy related deaths of 

mothers in the Dominican Republic. If women would have only those births that they desired and with 

adequate birth spacing (36 months or more), age at birth (18 to 39 years), and parity (less than 4), 2,285 of 

those under-five deaths (35 percent) and 177 pregnancy-related deaths (48 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 1.92 births per woman instead of 2.43, the under-five mortality 

rate would be 25 deaths per thousand births instead of 30, and the maternal mortality ratio would be 113 

per hundred thousand births instead of 172. 

To achieve these levels, 16 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 5 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 4 percent with an unmet need for a spacing method, and 

the 7 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Seven in ten (70 percent) married and in-union women who need focused family planning efforts live in 

urban areas, 5 percent have no education and another 37 percent have incomplete primary schooling, and 

46 percent live in households in the lowest two wealth quintiles. 

Some 46 percent of married and in-union women who need focused family planning efforts are users in 

need of a better method (LAPM), 9 percent have never used a method, and 45 percent have used a method 

in the past but are not current users. 

A majority (62 percent) of the women with a focused family planning need who visited a health facility in 

the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. One in five (20 percent) said that they did not intend 

to use contraception in the future, and gave the following reasons for not intending to use: Are breastfeeding 

(1 percent), are fatalistic (6 percent), have infrequent sexual relations (8 percent) or are not having sexual 

relations (9 percent), fear side effects or have health concerns (31 percent), say that contraception interferes 

with the body’s processes (17 percent), have a husband who is opposed (3 percent) or they are opposed (24 

percent), and believe they are subfecund or infecund (11 percent). One in ten (10 percent) cited family 

planning program reasons (no method or preferred method not available, inconvenient to use, costs too 

much, lack of access or too far away, knows no method or knows no source) as the reason they do not 

intend to use contraception in the future. 
85 

Reduced Child Mortality through Reduced Fertility Risk and 

Eliminating Unmet Need for Contraception in Egypt 

In 2015, there will be an estimated 47,710 deaths to under-five children in Egypt. If women would have 

only those births that they desired and with adequate birth spacing (36 months or more), age at birth (18 to 

39 years), and parity (less than 4), 19,475 of those under-five deaths (41 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 3.55 births per woman instead of 4.40 and the under-five 

mortality rate would be 19 deaths per thousand births instead of 25. 

To achieve these levels, 27 percent of non-pregnant married women require focused family planning efforts 

to reduce the 7 percent with an unmet need for limiting births (i.e., using a long-acting or permanent 

contraceptive method—LAPM), the 2 percent with an unmet need for a spacing method, and the 18 percent 

who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married women with a 

combined unmet need for contraception or a need for a long-term or permanent method of contraception? 

A third (34 percent) of the married women who need focused family planning efforts live in urban areas, 

39 percent have no education and another 10 percent have incomplete primary schooling, and nearly half 

(47 percent) live in households in the lowest two wealth quintiles. 

Two-thirds (67 percent) of the married women with a need for focused family planning efforts are users in 

need of a better method (LAPM), 8 percent have never used a method, and 25 percent have used a method 

in the past but are not current users. 

A majority (61 percent) of the women with a focused family planning need who visited a health facility in 

the 12 months before the survey were not advised about family planning. 

Married women with an unmet need for contraception for either desires or risk were asked about their 

intentions to use contraception in the future. More than one in four (27 percent) said that they did not intend 

to use contraception in the future. The survey did not ask the women why they did not intend to use in 

the future. 
86 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception in Ethiopia 

In 2015, there will be an estimated 287,730 deaths to under-five children and 21,406 pregnancy related 

deaths of mothers in Ethiopia. If women would have only those births that they desired and with adequate 

birth spacing (36 months or more), age at birth (18 to 39 years), and parity (less than 4), 223,361 of those 

under-five deaths (78 percent) and 16,135 pregnancy-related deaths (75 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 1.93 births per woman instead of 4.80, the under-five mortality 

rate would be 51 deaths per thousand births instead of 91, and the maternal mortality ratio would be 414 

per hundred thousand births instead of 676. 

To achieve these levels, 42 percent of non-pregnant married women require focused family planning efforts 

to reduce the 20 percent with an unmet need for limiting births (i.e., using a long-acting or permanent 

contraceptive method—LAPM), the 6 percent with an unmet need for a spacing method, and the 16 percent 

who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married women with a 

combined unmet need for contraception or a need for a long-term or permanent method of contraception? 

The 16 percent of the married women who need focused family planning efforts live in urban areas, 

68 percent have no education and another 26 percent have incomplete primary schooling, and 39 percent 

live in households in the lowest two wealth quintiles. 

The 38 percent of the married women who need focused family planning efforts are users in need of a better 

method (LAPM), 45 percent have never used a method, and 17 percent have used a method in the past but 

are not current users. 

Almost three quarters (73 percent) of the women with a focused family planning need who visited a health 

facility in the 12 months before the survey were not advised about family planning. 

Married women with an unmet need for contraception for either desires or risk were asked about their 

intentions to use contraception in the future. Almost a third (32 percent) said that they did not intend to use 

contraception in the future, and they gave the following reasons for not intending to use: Are breastfeeding 

(15 percent), are fatalistic (15 percent), have infrequent sexual relations (4 percent) or are not having sexual 

relations (3 percent), fear side effects or have health concerns (34 percent), say that contraception interferes 

with the body’s processes (6 percent), have a husband who is opposed (6 percent) or they are opposed 

(7 percent), believe they are subfecund or infecund (2 percent), and say there is a religious prohibition 

(16 percent). Ten percent cited family planning program reasons (no method or preferred method not 

available, inconvenient to use, costs too much, lack of access or too far away, knows no method or knows 

no source) as the reason they do not intend to use contraception in the future. 
87 

Reduced Child Mortality through Reduced Fertility Risk and 

Eliminating Unmet Need for Contraception in Ghana 

In 2015, there will be an estimated 60,547 deaths to under-five children in Ghana. If women would have 

only those births that they desired and with adequate birth spacing (36 months or more), age at birth (18 to 

39 years), and parity (less than 4), 31,547 of those under-five deaths (52 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 2.23 births per woman instead of 4.03 and the under-five 

mortality rate would be 65 deaths per thousand births instead of 75. 

To achieve these levels, 50 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 24 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 11 percent with an unmet need for a spacing method, and 

the 15 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Two out of five (41 percent) of the married and in-union women with a need for focused family planning 

efforts live in urban areas, 28 percent have no education and another 21 percent have incomplete primary 

schooling, and 42 percent live in households in the lowest two wealth quintiles. 

Some 29 percent of the married and in-union women with a need for focused family planning efforts are 

users in need of a better method (LAPM), 33 percent have never used a method, and 38 percent have used 

a method in the past but are not current users. 

A majority (61 percent) of the women with a focused family planning need who visited a health facility in 

the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. Almost two in five (38 percent) said that they did 

not intend to use contraception in the future. They gave the following reasons for not intending to use: Are 

breastfeeding (3 percent), have infrequent sexual relations (8 percent) or are not having sexual relations 

(7 percent), fear side effects or have health concerns (47 percent), say that contraception interferes with the 

body’s processes (7 percent), have a husband who is opposed (4 percent) or they are opposed (20 percent), 

believe they are subfecund or infecund (6 percent), and say there is a religious prohibition (4 percent). 

Eleven percent cited family planning program reasons (no method or preferred method not available, 

inconvenient to use, costs too much, lack of access or too far away, knows no method or knows no source) 

as the reason they do not intend to use contraception in the future. 
88 

Reduced Child Mortality through Reduced Fertility Risk and 

Eliminating Unmet Need for Contraception in Guyana 

In 2015, there will be an estimated 548 deaths to under-five children in Guyana. If women would have only 

those births that they desired and with adequate birth spacing (36 months or more), age at birth (18 to 39 

years), and parity (less than 4), 192 of those under-five deaths (35 percent would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 2.00 births per woman instead of 2.78 and the under-five 

mortality rate would be 31 deaths per thousand births instead of 34. 

To achieve these levels, 45 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 21 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 6 percent with an unmet need for a spacing method, and 

the 18 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Twenty-two percent of the married and in-union women with a need for focused family planning efforts 

live in urban areas, 2 percent have no education and another 16 percent have incomplete primary schooling, 

and 43 percent live in households in the lowest two wealth quintiles. 

The 29 percent of the married and in-union women who need focused family planning efforts are users in 

need of a better method (LAPM), 15 percent have never used a method, and 46 percent have used a method 

in the past but are not current users. 

A majority (56 percent) of the women with a focused family planning need who visited a health facility in 

the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. More than two in five (42 percent) said that they 

did not intend to use contraception in the future, and gave the following reasons for not intending to use: 

Are breastfeeding (3 percent), are fatalistic (1 percent), have infrequent sexual relations (9 percent) or are 

not having sexual relations (6 percent), fear side effects or have health concerns (41 percent), say that 

contraception interferes with the body’s processes (10 percent), have a husband who is opposed (8 percent) 

or they are opposed (9 percent), believe they are subfecund or infecund (5 percent), and say there is a 

religious prohibition (1 percent). A tenth (10 percent) cited family planning program reasons (no method 

or preferred method not available, inconvenient to use, costs too much, lack of access or too far away, 

knows no method or knows no source) as the reason they do not intend to use contraception in the future. 
89 

Reduced Child Mortality through Reduced Fertility Risk and 

Eliminating Unmet Need for Contraception in India 

In 2015, there will be an estimated 1,524,582 deaths to under-five children In India. If women would have 

only those births that they desired and with adequate birth spacing (36 months or more), age at birth (18 to 

39 years), and parity (less than 4), 744,330 of those under-five deaths (49 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 1.90 births per woman instead of 2.68 and the under-five 

mortality rate would be 43 deaths per thousand births instead of 60. 

To achieve these levels, 20 percent of non-pregnant married women require focused family planning efforts 

to reduce the 7 percent with an unmet need for limiting births (i.e., using a long-acting or permanent 

contraceptive method—LAPM), the 4 percent with an unmet need for a spacing method, and the 8 percent 

who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married women with a 

combined unmet need for contraception or a need for a long-term or permanent method of contraception? 

More than a quarter (28 percent) of the married women with a need for focused family planning efforts live 

in urban areas, 50 percent have no education and another 7 percent have incomplete primary schooling, and 

45 percent live in households in the lowest two wealth quintiles. 

More than two of five married women with a need for focused family planning efforts are users in need of 

a better method (LAPM—41 percent), 44 percent have never used a method, and 15 percent have used a 

method in the past but are not current users. 

Married women with an unmet need for contraception for either desires or risk were asked about their 

intentions to use contraception in the future. One in five (20 percent) women said that they did not intend 

to use contraception in the future, and gave the following reasons for not intending to use: Are breastfeeding 

(6 percent), are fatalistic (14 percent), have infrequent sexual relations (21 percent) or are not having sexual 

relations (8 percent), fear side effects or have health concerns (21 percent), say that contraception interferes 

with the body’s processes (3 percent), have a husband who is opposed (16 percent) or they are opposed 

(11 percent), believe they are subfecund or infecund (4 percent), and say there is a religious prohibition 

(15 percent). About one in seven (15 percent) cited family planning program reasons (no method or 

preferred method not available, inconvenient to use, costs too much, lack of access or too far away, knows 

no method or knows no source) as the reason they do not intend to use contraception in the future. 
90 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception in Indonesia 

In 2015, there will be an estimated 210,011 deaths to under-five children and 7,757 pregnancy related deaths 

of mothers in Indonesia. If women would have only those births that they desired and with adequate birth 

spacing (36 months or more), age at birth (18 to 39 years), and parity (less than 4), 60,088 of those underfive deaths (29 percent) and 3,604 pregnancy-related deaths (46 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 3.06 births per woman instead of 3.64, the under-five mortality 

rate would be 39 deaths per thousand births instead of 45, and the maternal mortality ratio would be 107 

per hundred thousand births instead of 168. 

To achieve these levels, 32 percent of non-pregnant married women require focused family planning efforts 

to reduce the 6 percent with an unmet need for limiting births (i.e., using a long-acting or permanent 

contraceptive method—LAPM), the 3 percent with an unmet need for a spacing method, and the 24 percent 

who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married women with a 

combined unmet need for contraception or a need for a long-term or permanent method of contraception? 

Two out of five (41 percent) of the married women who need focused family planning efforts live in urban 

areas, 8 percent have no education and another 20 percent have incomplete primary schooling, and 

41 percent live in households in the lowest two wealth quintiles. 

About three quarters of married women who need focused family planning efforts are users in need of a 

better method (LAPM—74 percent), 8 percent have never used a method, and 18 percent have used a 

method in the past but are not current users. 

A large majority (71 percent) of the women with a focused family planning need who visited a health 

facility in the 12 months before the survey were not informed about family planning. 

Married women with an unmet need for contraception for either desires or risk were asked about their 

intentions to use contraception in the future. Almost two in five women said that they did not intend to use 

contraception in the future. The survey did not ask women about reasons they did not intend to use in 

the future. 
91 

Reduced Child Mortality through Reduced Fertility Risk and 

Eliminating Unmet Need for Contraception in Jordan 

In 2015, there will be an estimated 3,372 deaths to under-five children in Jordan. If women would have 

only those births that they desired and with adequate birth spacing (36 months or more), age at birth (18 to 

39 years), and parity (less than 4), 2,524 of those under-five deaths (75 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 4.11 births per woman instead of 6.05 and the under-five 

mortality rate would be 7 deaths per thousand births instead of 18. 

To achieve these levels, 43 percent of non-pregnant married women require focused family planning efforts 

to reduce the 9 percent with an unmet need for limiting births (i.e., using a long-acting or permanent 

contraceptive method—LAPM), the 2 percent with an unmet need for a spacing method, and the 32 percent 

who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married women with a 

combined unmet need for contraception or a need for a long-term or permanent method of contraception? 

Most (85 percent) of the married women who need focused family planning efforts live in urban areas, 

4 percent have no education and another 4 percent have incomplete primary schooling, and 40 percent live 

in households in the lowest two wealth quintiles. 

Close to three in four married women who need focused family planning efforts are users in need of a better 

method (LAPM—74 percent), 7 percent have never used a method, and 19 percent have used a method in 

the past but are not current users. 

A large majority (71 percent) of the women with a focused family planning need who visited a health 

facility in the 12 months before the survey were not advised about family planning. 

Married women with an unmet need for contraception for either desires or risk were asked about their 

intentions to use in the future. Almost half (49 percent) said that they did not intend to use in the future. 

The survey did not ask women about reasons they did not intend to use in the future. 

 
92 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception in Kenya 

In 2015, there will be an estimated 105,313 deaths to under-five children and 8,208 pregnancy related deaths 

of mothers in Kenya. If women would have only those births that they desired and with adequate birth 

spacing (36 months or more), age at birth (18 to 39 years), and parity (less than 4), 50,992 of those underfive deaths (48 percent) and 5,234 pregnancy-related deaths (64 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 2.36 births per woman instead of 4.56, the under-five mortality 

rate would be 66 deaths per thousand births instead of 67, and the maternal mortality ratio would be 364 

per hundred thousand births instead of 520. 

To achieve these levels, 50 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 19 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 5 percent with an unmet need for a spacing method, and 

the 26 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Seventeen percent of the married and in-union women who need focused family planning efforts live in 

urban areas, 8 percent have no education and another 35 percent have incomplete primary schooling, and 

41 percent live in households in the lowest two wealth quintiles. 

Over half of the married and in-union women who need focused family planning efforts are users in need 

of a better method (LAPM—53 percent), 18 percent have never used a method, and 29 percent have used 

a method in the past but are not current users. 

Two-thirds (69 percent) of the women with a focused family planning need who visited a health facility in 

the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. A third (34 percent) said that they did not intend to 

use contraception in the future, and gave the following reasons for not intending to use: Are breastfeeding 

(3 percent), have infrequent sexual relations (6 percent) or are not having sexual relations (9 percent), fear 

side effects or have health concerns (49 percent), say that contraception interferes with the body’s processes 

(11 percent), have a husband who is opposed (8 percent) or they are opposed (9 percent), believe they are 

subfecund or infecund (4 percent), and say there is a religious prohibition (7 percent). Nine percent cited 

family planning program reasons (no method or preferred method not available, inconvenient to use, costs 

too much, lack of access or too far away, knows no method or knows no source) as the reason they do not 

intend to use contraception in the future. 
93 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception in Lesotho 

In 2015, there will be an estimated 6,115 deaths to under-five children and 709 pregnancy related deaths of 

mothers in Lesotho. If women would have only those births that they desired and with adequate birth 

spacing (36 months or more), age at birth (18 to 39 years), and parity (less than 4), 1,690 of those underfive deaths (28 percent) and 344 pregnancy-related deaths (49 percent) would be averted. These reductions 

in mortality are due to a lower number of births and lower mortality rates. Under these conditions, the total 

fertility rate would be 2.32 births per woman instead of 3.30 and the maternal mortality ratio would be 910 

per hundred thousand births instead of 1243. The under-five mortality rate would actually be slightly higher, 

at 110 deaths per thousand births instead of 107, because the decrease that would otherwise have occurred 

is counteracted by an increase in the percentage of births that are first-births. First-births are unavoidably 

at higher risk than later births. However, the number of under-five deaths would still be reduced due to the 

lower number of births. 

To achieve these levels, 41 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 15 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 7 percent with an unmet need for a spacing method, and 

the 19 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

One in four (24 percent) married and in-union women who need focused family planning efforts live in 

urban areas, 1 percent have no education and another 31 percent have incomplete primary schooling, and 

39 percent live in households in the lowest two wealth quintiles. 

Close to half of the married and in-union women who need focused family planning efforts are users in 

need of a better method (LAPM—47 percent), 21 percent have never used a method, and 32 percent have 

used a method in the past but are not current users. 

Two thirds (66 percent) of women with a focused need for family planning who visited a health facility in 

the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. Almost a quarter (23 percent) said that they did not 

intend to use contraception in the future, and gave the following reasons for not intending to use: Are 

breastfeeding (5 percent), are fatalistic (1 percent), have infrequent sexual relations (8 percent) or are not 

having sexual relations (4 percent), fear side effects or have health concerns (28 percent), say that 

contraception interferes with the body’s processes (6 percent), have a husband who is opposed (14 percent) 

or they are opposed (6 percent), believe they are subfecund or infecund (20 percent), and say there is a 

religious prohibition (2 percent). One in six (17 percent) cited family planning program reasons (no method 

or preferred method not available, inconvenient to use, costs too much, lack of access or too far away, 

knows no method or knows no source) as the reason they do not intend to use contraception in the future. 
94 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception in Liberia 

In 2015, there will be an estimated 14,482 deaths to under-five children and 1,547 pregnancy related deaths 

of mothers in Liberia. If women would have only those births that they desired and with adequate birth 

spacing (36 months or more), age at birth (18 to 39 years), and parity (less than 4), 9,108 of those underfive deaths (63 percent) and 1,132 pregnancy-related deaths (73 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 2.64 births per woman instead of 5.2, the under-five mortality 

rate would be 68 deaths per thousand births instead of 93, and the maternal mortality ratio would be 525 

per hundred thousand births instead of 994. 

To achieve these levels, 45 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 26 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 10 percent with an unmet need for a spacing method, and 

the 9 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Thirty-seven percent of the married and in-union women who need focused family planning efforts live in 

urban areas, 47 percent have no education and another 28 percent have incomplete primary schooling, and 

37 percent live in households in the lowest two wealth quintiles. 

One in five married and in-union women with a need for focused family planning efforts are users in need 

of a better method (LAPM—20 percent), 52 percent have never used a method, and 28 percent have used 

a method in the past but are not current users. 

Over a quarter (27 percent) of the women with a focused family planning need who visited a health facility 

in the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. More than a third (37 percent) said that they did 

not intend to use contraception in the future, and gave the following reasons for not intending to use: Are 

breastfeeding (17 percent), have infrequent sexual relations (6 percent) or are not having sexual relations 

(6 percent), fear side effects or have health concerns (43 percent), say that contraception interferes with the 

body’s processes (6 percent), have a husband who is opposed (11 percent) or they are opposed (10 percent), 

and say that there is a religious prohibition (7 percent). Close to a quarter (23 percent) cited family planning 

program reasons (no method or preferred method not available, inconvenient to use, costs too much, lack 

of access or too far away, knows no method or knows no source) as the reason they do not intend to use 

contraception in the future. 
95 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception in Madagascar 

In 2015, there will be an estimated 58,660 deaths to under-five children and 4,132 pregnancy related deaths 

of mothers in Madagascar. If women would have only those births that they desired and with adequate birth 

spacing (36 months or more), age at birth (18 to 39 years), and parity (less than 4), 28,348 of those underfive deaths (48 percent) and 3,045 pregnancy-related deaths (74 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 2.42 births per woman instead of 4.82 and the maternal mortality 

ratio would be 261 per hundred thousand births instead of 498. The under-five mortality rate would actually 

be slightly higher, at 73 deaths per thousand births instead of 71, because the decrease that would otherwise 

have occurred is counteracted by an increase in the percentage of births that are first-births. First-births are 

unavoidably at higher risk than later births. However, the number of under-five deaths would still be 

reduced due to the lower number of births. 

To achieve these levels, 45 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 13 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 6 percent with an unmet need for a spacing method, and 

the 26 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

One in seven (15 percent) of the married and in-union women who need focused family planning efforts 

live in urban areas, 17 percent have no education and another 48 percent have incomplete primary 

schooling, and 34 percent live in households in the lowest two wealth quintiles. 

The 58 percent of the married and in-union women with a need for focused family planning efforts are users 

in need of a better method (LAPM), 25 percent have never used a method, and 17 percent have used a 

method in the past but are not current users. 

Two out of five (40 percent) women with a focused family planning need who visited a health facility in 

the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. More than a third (36 percent) said that they did 

not intend to use contraception in the future, and gave the following reasons for not intending to use: Are 

breastfeeding (3 percent), are fatalistic (2 percent), have infrequent sexual relations (11 percent) or are not 

having sexual relations (4 percent), fear side effects or have health concerns (45 percent), say that 

contraception interferes with the body’s processes (4 percent), have a husband who is opposed (6 percent) 

or they are opposed (19 percent), believe they are subfecund or infecund (7 percent), and say there is a 

religious prohibition (2 percent). Thirteen percent cited family planning program reasons (no method or 

preferred method not available, inconvenient to use, costs too much, lack of access or too far away, knows 

no method or knows no source) as the reason they do not intend to use contraception in the future. 
96 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception in Malawi 

In 2015, there will be an estimated 63,795 deaths to under-five children and 4,574 pregnancy related deaths 

of mothers in Malawi. If women would have only those births that they desired and with adequate birth 

spacing (36 months or more), age at birth (18 to 39 years), and parity (less than 4), 35,905 of those underfive deaths (56 percent) and 3,328 pregnancy-related deaths (73 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 2.58 births per woman instead of 5.71, the under-five mortality 

rate would be 91 deaths per thousand births instead of 94, and the maternal mortality ratio would be 407 

per hundred thousand births instead of 675. 

To achieve these levels, 48 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 17 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 6 percent with an unmet need for a spacing method, and 

the 26 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

About one in six (16 percent) of the married and in-union women who need focused family planning efforts 

live in urban areas, 19 percent have no education and another 60 percent have incomplete primary 

schooling, and 38 percent live in households in the lowest two wealth quintiles. 

More than half of the married and in-union women with a need for focused family planning efforts are users 

in need of a better method (LAPM—53 percent), 14 percent have never used a method, and 33 percent have 

used a method in the past but are not current users. 

One in three (32 percent) women with a focused family planning need who visited a health facility in the 

12 months before the survey was not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. Almost one in four (23 percent) said that they did 

not intend to use contraception in the future, and gave the following reasons for not intending to use: Are 

breastfeeding (7 percent), are fatalistic (2 percent), have infrequent sexual relations (8 percent) or are not 

having sexual relations (6 percent), fear side effects or have health concerns (42 percent), say that 

contraception interferes with the body’s processes (6 percent), have a husband who is opposed (5 percent) 

or they are opposed (11 percent), believe they are subfecund or infecund (9 percent), and say there is a 

religious prohibition (2 percent). Three percent cited family planning program reasons (no method or 

preferred method not available, inconvenient to use, costs too much, lack of access or too far away, knows 

no method or knows no source) as the reason they do not intend to use contraception in the future. 
97 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception in Mali 

In 2015, there will be an estimated 118,747 deaths to under-five children and 3,529 pregnancy related deaths 

of mothers in Mali. If women would have only those births that they desired and with adequate birth spacing 

(36 months or more), age at birth (18 to 39 years), and parity (less than 4), 84,612 of those under-five deaths 

(71 percent) and 2,753 pregnancy-related deaths (78 percent) would be averted. These reductions in 

mortality are due to a lower number of births and lower mortality rates. Under these conditions, the total 

fertility rate would be 2.54 births per woman instead of 6.58, the under-five mortality rate would be 117 

deaths per thousand births instead of 156, and the maternal mortality ratio would be 265 per hundred 

thousand births instead of 465. 

To achieve these levels, 38 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 23 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 10 percent with an unmet need for a spacing method, and 

the 6 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

More than a third (35 percent) of the married and in-union women who need focused family planning efforts 

live in urban areas, 78 percent have no education and another 10 percent have incomplete primary 

schooling, and 36 percent live in households in the lowest two wealth quintiles. 

While only 15 percent of the married and in-union women who need focused family planning efforts are 

users in need of a better method (LAPM), 70 percent have never used a method, and 15 percent have used 

a method in the past but are not current users. 

A majority (63 percent) of the women with a focused family planning need who visited a health facility in 

the 12 months before the survey were not advises about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. Close to half (46 percent) said that they did not 

intend to use contraception in the future, and gave the following reasons for not intending to use: Are 

breastfeeding (7 percent), are fatalistic (3 percent), have infrequent sexual relations (7 percent) or are not 

having sexual relations (3 percent), fear side effects or have health concerns (24 percent), say that 

contraception interferes with the body’s processes (6 percent), have a husband who is opposed (7 percent) 

or they are opposed (20 percent), believe they are subfecund or infecund (3 percent), and say there is a 

religious prohibition (7 percent). One in six (16 percent) cited family planning program reasons (no method 

or preferred method not available, inconvenient to use, costs too much, lack of access or too far away, 

knows no method or knows no source) as the reason they do not intend to use contraception in the future. 
98 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception 

in Mozambique 

In 2015, there will be an estimated 87,959 deaths to under-five children and 4,214 pregnancy related deaths 

of mothers in Mozambique. If women would have only those births that they desired and with adequate 

birth spacing (36 months or more), age at birth (18 to 39 years), and parity (less than 4), 56,662 of those 

under-five deaths (64 percent) and 2,823 pregnancy-related deaths (67 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 2.73 births per woman instead of 5.92, the under-five mortality 

rate would be 66 deaths per thousand births instead of 85, and the maternal mortality ratio would be 292 

per hundred thousand births instead of 408. 

To achieve these levels, 33 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 18 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 7 percent with an unmet need for a spacing method, and 

the 8 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Thirty-seven percent of the married and in-union women who need focused family planning efforts live in 

urban areas, 31 percent have no education, and another 47 percent have incomplete primary schooling. 

Surprisingly, only 33 percent live in households in the lowest two wealth quintiles. 

A quarter (25 percent) of the married and in-union women who need focused family planning efforts are 

users in need of a better method (LAPM), 55 percent have never used a method, and 20 percent have used 

a method in the past but are not current users. 

A majority (56 percent) of the women with a focused family planning need who visited a health facility in 

the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. Two in five (40 percent) said that they did not 

intend to use contraception in the future, and gave the following reasons for not intending to use: Are 

breastfeeding (37 percent), are fatalistic (20 percent), have infrequent sexual relations (15 percent) or are 

not having sexual relations (8 percent), fear side effects or have health concerns (6 percent), say that 

contraception interferes with the body’s processes (1 percent), have a husband who is opposed (8 percent) 

or they are opposed (5 percent), believe they are subfecund or infecund (3 percent), and say there is a 

religious prohibition (1 percent). One in ten (10 percent) cited family planning program reasons (no method 

or preferred method not available, inconvenient to use, costs too much, lack of access or too far away, 

knows no method or knows no source) as the reason they do not intend to use contraception in the future. 
99 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception in Namibia 

In 2015, there will be an estimated 4,178 deaths to under-five children and 309 pregnancy related deaths of 

mothers in Namibia. If women would have only those births that they desired and with adequate birth 

spacing (36 months or more), age at birth (18 to 39 years), and parity (less than 4), 1,428 of those underfive deaths (34 percent) and 200 pregnancy-related deaths (65 percent) would be averted. These reductions 

in mortality are due to lower mortality rates and a lower number of births. Under these conditions, the total 

fertility rate would be 2.35 births per woman instead of 3.57 and the maternal mortality ratio would be 271 

per hundred thousand births instead of 508. The under-five mortality rate would remain the same, at 69 

deaths per thousand births, because the decrease that would otherwise have occurred is counteracted by an 

increase in the percentage of births that are first-births. First-births are unavoidably at higher risk than later 

births. However, the number of under-five deaths would still be reduced due to the lower number of births. 

To achieve these levels, 42 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 15 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 3 percent with an unmet need for a spacing method, and 

the 24 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Nearly half (45 percent) of the married and in-union women who need focused family planning efforts live 

in urban areas, 14 percent have no education and another 28 percent have incomplete primary schooling, 

and 36 percent live in households in the lowest two wealth quintiles. 

The 58 percent of the married and in-union women who need focused family planning efforts are users in 

need of a better method (LAPM-24 percent), 10 percent have never used a method, and 32 percent have 

used a method in the past but are not current users. 

A large majority (70 percent) of women with a focused family planning need who visited a health facility 

in the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. Three in ten (31 percent) said that they did not 

intend to use contraception in the future, and gave the following reasons for not intending to use: Are 

breastfeeding (6 percent), have infrequent sexual relations (3 percent) or are not having sexual relations 

(10 percent), fear side effects or have health concerns (28 percent), say that contraception interferes with 

the body’s processes (5 percent), have a husband who is opposed (11 percent) or they are opposed 

(11 percent), believe they are subfecund or infecund (2 percent), and say there is a religious prohibition 

(3 percent). Thirteen percent cited family planning program reasons (no method or preferred method not 

available, inconvenient to use, costs too much, lack of access or too far away, knows no method or knows 

no source) as the reason they do not intend to use contraception in the future. 
100 

Reduced Child Mortality through Reduced Fertility Risk and 

Eliminating Unmet Need for Contraception in Nepal 

In 2015, there will be an estimated 28,105 deaths to under-five children in Nepal. If women would have 

only those births that they desired and with adequate birth spacing (36 months or more), age at birth (18 to 

39 years), and parity (less than 4), 12,467 of those under-five deaths (44 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 1.93 births per woman instead of 2.6 and the under-five mortality 

rate would be 36 deaths per thousand births instead of 49. 

To achieve these levels, 39 percent of non-pregnant married women require focused family planning efforts 

to reduce the 19 percent with an unmet need for limiting births (i.e., using a long-acting or permanent 

contraceptive method—LAPM), the 8 percent with an unmet need for a spacing method, and the 12 percent 

who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married women with a 

combined unmet need for contraception or a need for a long-term or permanent method of contraception? 

Eleven percent of the married women who need focused family planning efforts live in urban areas, 

45 percent have no education and another 15 percent have incomplete primary schooling, and 40 percent 

live in households in the lowest two wealth quintiles. 

About three of ten married women with a need for focused family planning efforts are users in need of a 

better method (LAPM—31 percent), 27 percent have never used a method, and 42 percent have used a 

method in the past but are not current users. 

Four out of five (80 percent) women with a focused family planning need who visited a health facility in 

the 12 months preceding the survey were not advised about family planning. 

Married women with an unmet need for contraception for either desires or risk were asked about their 

intentions to use contraception in the future. One in nine (11 percent) said that they did not intend to use 

contraception in the future, and gave the following reasons for not intending to use: Are breastfeeding 

(2 percent), are fatalistic (3 percent), have infrequent sexual relations (26 percent) or are not having sexual 

relations (8 percent), fear side effects or have health concerns (28 percent), say that contraception interferes 

with the body’s processes (4 percent), have a husband who is opposed (7 percent) or they are opposed 

(1 percent), believe they are subfecund or infecund (7 percent), and say there is a religious prohibition 

(6 percent). One percent cited family planning program reasons (no method or preferred method not 

available, inconvenient to use, costs too much, lack of access or too far away, knows no method or knows 

no source) as the reason they do not intend to use contraception in the future. 
101 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception in Niger 

In 2015, there will be an estimated 126,918 deaths to under-five children and 6,769 pregnancy related deaths 

of mothers in Niger. If women would have only those births that they desired and with adequate birth 

spacing (36 months or more), age at birth (18 to 39 years), and parity (less than 4), 98,096 of those underfive deaths (77 percent) and 5,696 pregnancy-related deaths (84 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 2.42 births per woman instead of 7.02, the under-five mortality 

rate would be 88 deaths per thousand births instead of 133, and the maternal mortality ratio would be 326 

per hundred thousand births instead of 709. 

To achieve these levels, 26 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 12 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 4 percent with an unmet need for a spacing method, and 

the 10 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

A quarter (24 percent) of the married and in-union women who need focused family planning efforts live 

in urban areas, 83 percent have no education and another 10 percent have incomplete primary schooling, 

and 38 percent live in households in the lowest two wealth quintiles. 

Some 38 percent of the married and in-union women who need focused family planning efforts are users 

in need of a better method (LAPM). 

A majority (73 percent) of the women with a focused family planning need who visited a health facility in 

the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. Over half (53 percent) said that they did not intend 

to use contraception in the future, and gave the following reasons for not intending to use: Are breastfeeding 

(10 percent), are fatalistic (2 percent), have infrequent sexual relations (9 percent) or are not having sexual 

relations (4 percent), fear side effects or have health concerns (20 percent), say that contraception interferes 

with the body’s processes (3 percent), have a husband who is opposed (11 percent) or they are opposed 

(23 percent), believe they are subfecund or infecund (1 percent), and say there is a religious prohibition 

(8 percent). More than one in five (22 percent) cited family planning program reasons (no method or 

preferred method not available, inconvenient to use, costs too much, lack of access or too far away, knows 

no method or knows no source) as the reason they do not intend to use contraception in the future. 
102 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception in Nigeria 

In 2015, there will be an estimated 1,070,810 deaths to under-five children and 40,469 pregnancy related 

deaths of mothers in Nigeria. If women would have only those births that they desired and with adequate 

birth spacing (36 months or more), age at birth (18 to 39 years), and parity (less than 4), 756,403 of those 

under-five deaths (71 percent) and 26,513 pregnancy-related deaths (66 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 2.46 births per woman instead of 5.72, the under-five mortality 

rate would be 98 deaths per thousand births instead of 144, and the maternal mortality ratio would be 437 

per hundred thousand births instead of 545. 

To achieve these levels, 32 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 15 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 5 percent with an unmet need for a spacing method, and 

the 11 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

The 38 percent of the married and in-union women who need focused family planning efforts live in urban 

areas, 34 percent have no education, and another 7 percent have incomplete primary schooling. 

Surprisingly, only 33 percent live in households in the lowest two wealth quintiles. 

About a third (35 percent) of the married and in-union women who need focused family planning efforts 

are users in need of a better method (LAPM), 48 percent have never used a method, and 17 percent have 

used a method in the past but are not current users. 

A majority (54 percent) of the women with a focused family planning need who visited a health facility in 

the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. Almost half (49 percent) said that they did not 

intend to use contraception in the future, and gave the following reasons for not intending to use: Are 

breastfeeding (6 percent), have infrequent sexual relations (9 percent) or are not having sexual relations 

(4 percent), fear side effects or have health concerns (28 percent), say that contraception interferes with the 

body’s processes (6 percent), have a husband who is opposed (14 percent) or they are opposed (23 percent), 

believe they are subfecund or infecund (1 percent), and say there is a religious prohibition (9 percent). 

About one in eight (13 percent) cited family planning program reasons (no method or preferred method not 

available, inconvenient to use, costs too much, lack of access or too far away, knows no method or knows 

no source) as the reason they do not intend to use contraception in the future. 
103 

Reduced Child Mortality through Reduced Fertility Risk and 

Eliminating Unmet Need for Contraception in Pakistan 

In 2015, there will be an estimated 391,671 deaths to under-five children in Pakistan. If women would have 

only those births that they desired and with adequate birth spacing (36 months or more), age at birth (18 to 

39 years), and parity (less than 4), 144,097 of those under-five deaths (37 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 3.37 births per woman instead of 5.34. The under-five mortality 

rate would actually remain unchanged, at 85 deaths per thousand births, because the decrease that would 

otherwise have occurred is counteracted by an increase in the percentage of births that are first-births. Firstbirths are unavoidably at higher risk than later births. However, the number of under-five deaths would still 

be reduced due to the lower number of births. 

To achieve these levels, 40 percent of non-pregnant married women require focused family planning efforts 

to reduce the 16 percent with an unmet need for limiting births (i.e., using a long-acting or permanent 

contraceptive method—LAPM), the 5 percent with an unmet need for a spacing method, and the 20 percent 

who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married women with a 

combined unmet need for contraception or a need for a long-term or permanent method of contraception? 

The 35 percent of the married women who need focused family planning efforts live in urban areas, 

57 percent have no education and another 7 percent have incomplete primary schooling, and 37 percent live 

in households in the lowest two wealth quintiles. 

Half of the married women with a need for focused family planning efforts are users in need of a better 

method (LAPM—50 percent), 26 percent have never used a method, and 24 percent have used a method in 

the past but are not current users. 

A vast majority (87 percent) of the women with a focused family planning need who visited a health facility 

in the 12 months before the survey were not advised about family planning. 

Married women with an unmet need for contraception for either desires or risk were asked about their 

intentions to use contraception in the future. Two in five (40 percent) women said that they did not intend 

to use contraception in the future. The survey did not ask women about the reasons they did not intend to 

use contraception in the future. 
104 

Reduced Child Mortality through Reduced Fertility Risk and 

Eliminating Unmet Need for Contraception in Peru 

In 2015, there will be an estimated 11,353 deaths to under-five children in Peru. If women would have only 

those births that they desired and with adequate birth spacing (36 months or more), age at birth (18 to 39 

years), and parity (less than 4), 4,778 of those under-five deaths (42 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 1.89 births per woman instead of 2.53 and the under-five 

mortality rate would be 15 deaths per thousand births instead of 19. 

To achieve these levels, 39 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 4 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 1 percent with an unmet need for a spacing method, and 

the 33 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Three out of five (61 percent) married and in-union women who need focused family planning efforts live 

in urban areas, 5 percent have no education and another 29 percent have incomplete primary schooling, and 

50 percent live in households in the lowest two wealth quintiles. 

Most married and in-union women who need focused family planning efforts are users in need of a better 

method (LAPM—85 percent), 2 percent have never used a method, and 13 percent have used a method in 

the past but are not current users. 

A majority (57 percent) of the women with a focused family planning need who visited a health facility in 

the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. One in nine (11 percent) said that they did not 

intend to use contraception in the future, and gave the following reasons for not intending to use: Are 

breastfeeding (2 percent), are fatalistic (1 percent), have infrequent sexual relations (21 percent) or are not 

having sexual relations (25 percent), fear side effects or have health concerns (37 percent), say that 

contraception interferes with the body’s processes (1 percent), have a husband who is opposed (6 percent) 

or they are opposed (1 percent), believe they are subfecund or infecund (2 percent), and say there is a 

religious prohibition (2 percent). No women cited family planning program reasons (no method or preferred 

method not available, inconvenient to use, costs too much, lack of access or too far away, knows no method 

or knows no source) as the reason they do not intend to use contraception in the future. 
105 

Reduced Child Mortality through Reduced Fertility Risk and 

Eliminating Unmet Need for Contraception in the Philippines 

In 2015, there will be an estimated 78,269 deaths to under-five children in the Philippines. If women would 

have only those births that they desired and with adequate birth spacing (36 months or more), age at birth 

(18 to 39 years), and parity (less than 4), 43,660 of those under-five deaths (56 percent) would be averted. 

These reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 2.13 births per woman instead of 3.26 and the under-five 

mortality rate would be 22 deaths per thousand births instead of 32. 

To achieve these levels, 52 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 15 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 4 percent with an unmet need for a spacing method, and 

the 34 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Almost half (49 percent) of the married and in-union women who need focused family planning efforts live 

in urban areas, 1 percent have no education and another 11 percent have incomplete primary schooling, and 

43 percent live in households in the lowest two wealth quintiles. 

About two-thirds of the married and in-union women with a need for focused family planning efforts are 

users in need of a better method (LAPM—65 percent). 

Close to half (48 percent) of the women with a focused family planning need who visited a health facility 

in the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. Half (50 percent) of the women said that they did 

not intend to use contraception in the future, and gave the following reasons for not intending to use: Are 

breastfeeding (3 percent), are fatalistic (2 percent), have infrequent sexual relations (20 percent) or are not 

having sexual relations (8 percent), fear side effects or have health concerns (52 percent), say that 

contraception interferes with the body’s processes (35 percent), have a husband who is opposed (5 percent) 

or they are opposed (7 percent), believe they are subfecund or infecund (8 percent), and say there is a 

religious prohibition (3 percent). One in five (19 percent) cited family planning program reasons (no method 

or preferred method not available, inconvenient to use, costs too much, lack of access or too far away, 

knows no method or knows no source) as the reason they do not intend to use contraception in the future. 
106 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception in Rwanda 

In 2015, there will be an estimated 25,896 deaths to under-five children and 2,052 pregnancy related deaths 

of mothers in Rwanda. If women would have only those births that they desired and with adequate birth 

spacing (36 months or more), age at birth (18 to 39 years), and parity (less than 4), 10,971 of those underfive deaths (42 percent) and 1,393 pregnancy-related deaths (68 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 2.28 births per woman instead of 4.56 and the maternal mortality 

ratio would be 313 per hundred thousand births instead of 487. The under-five mortality rate would actually 

be higher, at 71 deaths per thousand births instead of 61, because the decrease that would otherwise have 

occurred is counteracted by an increase in the percentage of births that are first-births. First-births are 

unavoidably at higher risk than later births. However, the number of under-five deaths would still be 

reduced due to the lower number of births. 

To achieve these levels, 44 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 16 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 5 percent with an unmet need for a spacing method, and 

the 23 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Only 12 percent of the married and in-union women who need focused family planning efforts live in urban 

areas, 22 percent have no education and another 55 percent have incomplete primary schooling, and 

41 percent live in households in the lowest two wealth quintiles. 

Almost two out of three (65 percent) married and in-union women with a need for focused family planning 

efforts are users in need of a better method (LAPM), another 23 percent have never used a method, and 

12 percent have used a method in the past but are not current users. 

A third (34 percent) of the women with a focused family planning need who visited a health facility in the 

12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. Almost a quarter (24 percent) said that they did not 

intend to use contraception in the future, and gave the following reasons for not intending to use: Are 

breastfeeding (5 percent), are fatalistic (19 percent), have infrequent sexual relations (12 percent) or are not 

having sexual relations (10 percent), fear side effects or have health concerns (34 percent), say that 

contraception interferes with the body’s processes (8 percent), have a husband who is opposed (6 percent) 

or they are opposed (10 percent), and say there is a religious prohibition (5 percent). Three percent cited 

family planning program reasons (no method or preferred method not available, inconvenient to use, costs 

too much, lack of access or too far away, knows no method or knows no source) as the reason they do not 

intend to use contraception in the future. 
107 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception 

in São Tomé and Principe 

In 2015, there will be an estimated 344 deaths to under-five children and 8 pregnancy related deaths of 

mothers in São Tomé and Principe. If women would have only those births that they desired and with 

adequate birth spacing (36 months or more), age at birth (18 to 39 years), and parity (less than 4), 262 of 

those under-five deaths (76 percent) and 6 pregnancy-related deaths (80 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 2.46 births per woman instead of 4.9, the under-five mortality 

rate would be 25 deaths per thousand births instead of 53, and the maternal mortality ratio would be 46 per 

hundred thousand births instead of 116. 

To achieve these levels, 62 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 25 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 8 percent with an unmet need for a spacing method, and 

the 28 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Over half (51 percent) of the married and in-union women who need focused family planning efforts live 

in urban areas, 6 percent have no education and another 57 percent have incomplete primary schooling, and 

40 percent live in households in the lowest two wealth quintiles. 

The 46 percent of the married and in-union women who need focused family planning efforts are users in 

need of a better method (LAPM). 

More than a quarter (29 percent) of the women with a focused family planning need who visited a health 

facility in the 12 months before the survey was not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. Almost a third (31 percent) said that they did not 

intend to use contraception in the future, and gave the following reasons for not intending to use: Are 

breastfeeding (1 percent), have infrequent sexual relations (14 percent) or are not having sexual relations 

(5 percent), fear side effects or have health concerns (45 percent), say that contraception interferes with the 

body’s processes (9 percent), have a husband who is opposed (8 percent) or they are opposed (23 percent), 

believe they are subfecund or infecund (1 percent), and say there is a religious prohibition (1 percent). No 

women cited family planning program reasons (no method or preferred method not available, inconvenient 

to use, costs too much, lack of access or too far away, knows no method or knows no source) as the reason 

they do not intend to use contraception in the future. 
108 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception in Senegal 

In 2015, there will be an estimated 34,995 deaths to under-five children and 2,655 pregnancy related deaths 

of mothers in Senegal. If women would have only those births that they desired and with adequate birth 

spacing (36 months or more), age at birth (18 to 39 years), and parity (less than 4), 21,755 of those underfive deaths (62 percent) and 1,827 pregnancy-related deaths (69 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 2.34 births per woman instead of 4.98, the under-five mortality 

rate would be 51 deaths per thousand births instead of 64, and the maternal mortality ratio would be 321 

per hundred thousand births instead of 484. 

To achieve these levels, 40 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 21 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 10 percent with an unmet need for a spacing method, and 

the 9 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Close to half (47 percent) of the married and in-union women who need for focused family planning efforts 

live in urban areas, 66 percent have no education and another 20 percent have incomplete primary 

schooling, and 37 percent live in households in the lowest two wealth quintiles. 

The 22 percent of married and in-union women who need focused family planning efforts are users in need 

of a better method (LAPM), 58 percent have never used a method, and 20 percent have used a method in 

the past but are not current users. 

More than two-thirds (69 percent) of the women with a focused family planning need who visited a health 

facility in the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. Over half (54 percent) said that they did not intend 

to use contraception in the future, and gave the following reasons for not intending to use: Are breastfeeding 

(21 percent), are fatalistic (6 percent), have infrequent sexual relations (10 percent) or are not having sexual 

relations (7 percent), fear side effects or have health concerns (14 percent), say that contraception interferes 

with the body’s processes (2 percent), have a husband who is opposed (12 percent) or they are opposed 

(24 percent), believe they are subfecund or infecund (1 percent), and say there is a religious prohibition 

(5 percent). Six percent cited family planning program reasons (no method or preferred method not 

available, inconvenient to use, costs too much, lack of access or too far away, knows no method or knows 

no source) as the reason they do not intend to use contraception in the future. 
109 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception 

in Sierra Leone 

In 2015, there will be an estimated 28,418 deaths to under-five children and 1,924 pregnancy related deaths 

of mothers in Sierra Leone. If women would have only those births that they desired and with adequate 

birth spacing (36 months or more), age at birth (18 to 39 years), and parity (less than 4), 19,317 of those 

under-five deaths (68 percent) and 1,314 pregnancy-related deaths (68 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 2.50 births per woman instead of 5.12, the under-five mortality 

rate would be 83 deaths per thousand births instead of 127, and the maternal mortality ratio would be 556 

per hundred thousand births instead of 857. 

To achieve these levels, 34 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 21 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 6 percent with an unmet need for a spacing method, and 

the 7 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

A third (33 percent) of the married and in-union women who need focused family planning efforts live in 

urban areas, 73 percent have no education and another 10 percent have incomplete primary schooling, and 

38 percent live in households in the lowest two wealth quintiles. 

The 19 percent of the married and in-union women who need focused family planning efforts are users in 

need of a better method (LAPM), 62 percent have never used a method, and 19 percent have used a method 

in the past but are not current users. 

About half (51 percent) of the women with a focused family planning need who visited a health facility in 

the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. Two out of five (40 percent) women said that they 

did not intend to use contraception in the future, and gave the following reasons for not intending to use: 

Are breastfeeding (8 percent), are fatalistic (1 percent), have infrequent sexual relations (2 percent) or are 

not having sexual relations (3 percent), fear side effects or have health concerns (29 percent), say that 

contraception interferes with the body’s processes (3 percent), have a husband who is opposed (21 percent) 

or they are opposed (22 percent), believe they are subfecund or infecund (3 percent), and say there is a 

religious prohibition (13 percent). A quarter (24 percent) cited family planning program reasons (no method 

or preferred method not available, inconvenient to use, costs too much, lack of access or too far away, 

knows no method or knows no source) as the reason they do not intend to use contraception in the future. 
110 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception in Swaziland 

In 2015, there will be an estimated 4,070 deaths to under-five children and 219 pregnancy related deaths of 

mothers in Swaziland. If women would have only those births that they desired and with adequate birth 

spacing (36 months or more), age at birth (18 to 39 years), and parity (less than 4), 1,421 of those underfive deaths (35 percent) and 138 pregnancy-related deaths (63 percent) would be averted. These reductions 

in mortality are due to a lower number of births and lower mortality rates. Under these conditions, the total 

fertility rate would be 2.33 births per woman instead of 3.85 and the maternal mortality ratio would be 362 

per hundred thousand births instead of 589. The under-five mortality rate would actually be slightly higher, 

at 117 deaths per thousand births instead of 109, because the decrease that would otherwise have occurred 

is counteracted by an increase in the percentage of births that are first-births. First-births are unavoidably 

at higher risk than later births. However, the number of under-five deaths would still be reduced due to the 

lower number of births. 

To achieve these levels, 50 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 18 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 4 percent with an unmet need for a spacing method, and 

the 28 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Almost a quarter (23 percent) of the married and in-union women who need focused family planning efforts 

live in urban areas, 11 percent have no education and another 23 percent have incomplete primary 

schooling, and 37 percent live in households in the lowest two wealth quintiles. 

Almost three in five married and in-union women who need focused family planning efforts are users in 

need of a better method (LAPM—57 percent), 6 percent have never used a method, and 37 percent have 

used a method in the past but are not current users. 

A majority (55 percent) of the women with a focused family planning need who visited a health facility in 

the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. Almost a third (32 percent) of the women said that 

they did not intend to use contraception in the future, and gave the following reasons for not intending to 

use: Are fatalistic (2 percent), fear side effects or have health concerns (40 percent), say that contraception 

interferes with the body’s processes (5 percent), have a husband who is opposed (16 percent) or they are 

opposed (5 percent), believe they are subfecund or infecund (11 percent), and say there is a religious 

prohibition (3 percent). One in seven (15 percent) cited family planning program reasons (no method or 

preferred method not available, inconvenient to use, costs too much, lack of access or too far away, knows 

no method or knows no source) as the reason they do not intend to use contraception in the future. 
111 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception in Tanzania 

In 2015, there will be an estimated 134,794 deaths to under-five children and 9,872 pregnancy related deaths 

of mothers in Tanzania. If women would have only those births that they desired and with adequate birth 

spacing (36 months or more), age at birth (18 to 39 years), and parity (less than 4), 78,307 of those underfive deaths (58 percent) and 7,176 pregnancy-related deaths (73 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 2.58 births per woman instead of 5.43, the under-five mortality 

rate would be 59 deaths per thousand births instead of 67, and the maternal mortality ratio would be 284 

per hundred thousand births instead of 494. 

To achieve these levels, 42 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 15 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 5 percent with an unmet need for a spacing method, and 

the 22 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Almost one in four (23 percent) of the married and in-union women who need focused family planning 

efforts live in urban areas, 23 percent have no education and another 13 percent have incomplete primary 

schooling, and 39 percent live in households in the lowest two wealth quintiles. 

A little over half of the married and in-union women with a need for focused family planning efforts are 

users in need of a better method (LAPM—52 percent), 37 percent have never used a method, and 11 percent 

have used a method in the past but are not current users. 

A majority (52 percent) of the women with a focused family planning need who visited a health facility in 

the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. One in three (32 percent) women said that they did 

not intend to use contraception in the future, and gave the following reasons for not intending to use: Are 

breastfeeding (7 percent), are fatalistic (2 percent), have infrequent sexual relations (8 percent) or are not 

having sexual relations (6 percent), fear side effects or have health concerns (56 percent), say that 

contraception interferes with the body’s processes (3 percent), have a husband who is opposed (17 percent) 

or they are opposed (15 percent), believe they are subfecund or infecund (1 percent), and say there is a 

religious prohibition (2 percent). Three percent cited family planning program reasons (no method or 

preferred method not available, inconvenient to use, costs too much, lack of access or too far away, knows 

no method or knows no source) as the reason they do not intend to use contraception in the future. 
112 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception 

in Timor-Leste 

In 2015, there will be an estimated 2,480 deaths to under-five children and 234 pregnancy related deaths of 

mothers in Timor-Leste. If women would have only those births that they desired and with adequate birth 

spacing (36 months or more), age at birth (18 to 39 years), and parity (less than 4), 1,856 of those underfive deaths (75 percent) and 185 pregnancy-related deaths (79 percent) would be averted. These reductions 

in mortality are due to a lower number of births and lower mortality rates. Under these conditions, the total 

fertility rate would be 2.33 births per woman instead of 5.68, the under-five mortality rate would be 36 

deaths per thousand births instead of 59, and the maternal mortality ratio would be 287 per hundred 

thousand births instead of 557. 

To achieve these levels, 52 percent of non-pregnant married women require focused family planning efforts 

to reduce the 25 percent with an unmet need for limiting births (i.e., using a long-acting or permanent 

contraceptive method—LAPM), the 8 percent with an unmet need for a spacing method, and the 19 percent 

who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married women with a 

combined unmet need for contraception or a need for a long-term or permanent method of contraception? 

Over one in four (26 percent) of the married women who need focused family planning efforts live in urban 

areas, 35 percent have no education and another 15 percent have incomplete primary schooling, and 

36 percent live in households in the lowest two wealth quintiles. 

More than one in three married women who need focused family planning efforts are users in need of a 

better method (LAPM—36 percent), 55 percent have never used a method, and 9 percent have used a 

method in the past but are not current users. 

A majority (54 percent) of the women with a focused family planning need who visited a health facility in 

the 12 months before the survey were not advised about family planning. 

Married women with an unmet need for contraception for either desires or risk were asked about their 

intentions to use contraception in the future. Over half (55 percent) said that they did not intend to use 

contraception in the future, and gave the following reasons for not intending to use: Are breastfeeding 

(8 percent), have infrequent sexual relations (2 percent) or are not having sexual relations (1 percent), fear 

side effects or have health concerns (34 percent), say that contraception interferes with the body’s processes 

(4 percent), have a husband who is opposed (27 percent) or they are opposed (64 percent), believe they are 

subfecund or infecund (1 percent), and say there is a religious prohibition (1 percent). Eight percent cited 

family planning program reasons (no method or preferred method not available, inconvenient to use, costs 

too much, lack of access or too far away, knows no method or knows no source) as the reason they do not 

intend to use contraception in the future. 
113 

Reduced Child Mortality through Reduced Fertility Risk and 

Eliminating Unmet Need for Contraception in Uganda 

In 2015, there will be an estimated 131,976 deaths to under-five children in Uganda. If women would have 

only those births that they desired and with adequate birth spacing (36 months or more), age at birth (18 to 

39 years), and parity (less than 4), 42,311 of those under-five deaths (32 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 2.96 births per woman instead of 3.61 and the under-five 

mortality rate would be 65 deaths per thousand births instead of 78. 

To achieve these levels, 54 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 25 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 6 percent with an unmet need for a spacing method, and 

the 22 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Fifteen percent of the married and in-union women who need focused family planning efforts live in urban 

areas, 15 percent have no education and another 52 percent have incomplete primary schooling, and 

39 percent while in households in the lowest two wealth quintiles. 

The 41 percent of the married and in-union women with a need for focused family planning efforts are users 

in need of a better method (LAPM), 35 percent have never used a method, and 24 percent have used a 

method in the past but are not current users. 

Two-thirds (66 percent) of the women with a focused family planning need who visited a health facility in 

the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. A quarter (24 percent) said that they did not intend 

to use contraception in the future, and gave the following reasons for not intending to use: Are breastfeeding 

(11 percent), are fatalistic (13 percent), have infrequent sexual relations (13 percent) or are not having 

sexual relations (8 percent), fear side effects or have health concerns (39 percent), say that contraception 

interferes with the body’s processes (6 percent), have a husband who is opposed (7 percent) or they are 

opposed (17 percent), believe they are subfecund or infecund (9 percent), and say there is a religious 

prohibition (3 percent). Seven percent cited family planning program reasons (no method or preferred 

method not available, inconvenient to use, costs too much, lack of access or too far away, knows no method 

or knows no source) as the reason they do not intend to use contraception in the future. 
114 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception in Ukraine 

In 2015, there will be an estimated 8,506 deaths to under-five children and 2,046 pregnancy related deaths 

of mothers in Ukraine. If women would have only those births that they desired and with adequate birth 

spacing (36 months or more), age at birth (18 to 39 years), and parity (less than 4), 5,066 of those underfive deaths (60 percent) and 1,620 pregnancy-related deaths (79 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 2.49 births per woman instead of 6.2 and the maternal mortality 

ratio would be 224 per hundred thousand births instead of 432. The under-five mortality rate would remain 

unchanged, at 18 deaths per thousand births, because the decrease that would otherwise have occurred is 

counteracted by an increase in the percentage of births that are first-births. First-births are unavoidably at 

higher risk than later births. However, the number of under-five deaths would still be reduced due to the 

lower number of births. 

To achieve these levels, 28 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 7 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 3 percent with an unmet need for a spacing method, and 

the 18 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Two-thirds (66 percent) of the married and in-union women who need focused family planning efforts live 

in urban areas, 100 percent have completed at least primary school, and 36 percent live in households in 

the lowest two wealth quintiles. 

Almost two in three married and in-union women with a need for focused family planning efforts are users 

in need of a better method (LAPM—65 percent), 6 percent have never used a method, and 29 percent have 

used a method in the past but are not current users. 

A vast majority (89 percent) of the women with a focused family planning need who visited a health facility 

in the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. Close to half (46 percent) of the women said that 

they did not intend to use contraception in the future, and gave the following reasons for not intending to 

use: Are breastfeeding (1 percent), are fatalistic (9 percent), have infrequent sexual relations (27 percent) 

or are not having sexual relations (7 percent), fear side effects or have health concerns (20 percent), say that 

contraception interferes with the body’s processes (3 percent), have a husband who is opposed (7 percent) 

or they are opposed (11 percent), believe they are subfecund or infecund (20 percent), and say there is a 

religious prohibition (3 percent). Two percent cited family planning program reasons (no method or 

preferred method not available, inconvenient to use, costs too much, lack of access or too far away, knows 

no method or knows no source) as the reason they do not intend to use contraception in the future. 
115 

Reduced Child Mortality through Reduced Fertility Risk and 

Eliminating Unmet Need for Contraception in Zambia 

In 2015, there will be an estimated 65,673 deaths to under-five children in Zambia. If women would have 

only those births that they desired and with adequate birth spacing (36 months or more), age at birth (18 to 

39 years), and parity (less than 4), 487 of those under-five deaths (1 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 1.11 births per woman instead of 1.17. The under-five mortality 

rate would actually be slightly higher, at 105 deaths per thousand births instead of 100, because the decrease 

that would otherwise have occurred is counteracted by an increase in the percentage of births that are firstbirths. First-births are unavoidably at higher risk than later births. However, the number of under-five deaths 

would still be reduced due to the lower number of births. 

To achieve these levels, 55 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 18 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 5 percent with an unmet need for a spacing method, and 

the 32 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

A third (33 percent) of the married and in-union women who need focused family planning efforts live in 

urban areas, 14 percent have no education and another 43 percent have incomplete primary schooling, and 

44 percent live in households in the lowest two wealth quintiles. 

About three of five married and in-union women with a need for focused family planning efforts are users 

in need of a better method (LAPM—59 percent), 12 percent have never used a method, and 29 percent have 

used a method in the past but are not current users. 

Two out of five (41 percent) of the women with a focused family planning need who visited a health facility 

in the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. Almost one out of four (24 percent) said that they 

did not intend to use contraception in the future, and gave the following reasons for not intending to use: 

Are breastfeeding (6 percent), are fatalistic (3 percent), have infrequent sexual relations (20 percent) or are 

not having sexual relations (10 percent), fear side effects or have health concerns (34 percent), say that 

contraception interferes with the body’s processes (3 percent), have a husband who is opposed (5 percent) 

or they are opposed (9 percent), believe they are subfecund or infecund (21 percent), and say there is a 

religious prohibition (3 percent). Six percent cited family planning program reasons (no method or preferred 

method not available, inconvenient to use, costs too much, lack of access or too far away, knows no method 

or knows no source) as the reason they do not intend to use contraception in the future. 
116 

Reduced Child and Maternal Mortality through Reduced Fertility 

Risk and Eliminating Unmet Need for Contraception in Zimbabwe 

In 2015, there will be an estimated 34,820 deaths to under-five children and 2,701 pregnancy related deaths 

of mothers in Zimbabwe. If women would have only those births that they desired and with adequate birth 

spacing (36 months or more), age at birth (18 to 39 years), and parity (less than 4), 20,507 of those underfive deaths (59 percent) and 1,746 pregnancy-related deaths (65 percent) would be averted. These 

reductions in mortality are due to a lower number of births and lower mortality rates. Under these 

conditions, the total fertility rate would be 2.63 births per woman instead of 6.17, the under-five mortality 

rate would be 73 deaths per thousand births instead of 76, and the maternal mortality ratio would be 490 

per hundred thousand births instead of 591. 

To achieve these levels, 42 percent of non-pregnant married and in-union women require focused family 

planning efforts to reduce the 8 percent with an unmet need for limiting births (i.e., using a long-acting or 

permanent contraceptive method—LAPM), the 4 percent with an unmet need for a spacing method, and 

the 31 percent who need to shift from non-LAPM to LAPM. 

Who are the women who need focused family planning efforts, i.e., non-pregnant married and in-union 

women with a combined unmet need for contraception or a need for a long-term or permanent method of 

contraception? 

Over a quarter (28 percent) of the married and in-union women who need focused family planning efforts 

live in urban areas, 3 percent have no education and another 16 percent have incomplete primary schooling, 

and 43 percent live in households in the lowest two wealth quintiles. 

Almost three of four married and in-union women with a need for focused family planning efforts are users 

in need of a better method (LAPM—73 percent), 16 percent have never used a method, and 11 percent have 

used a method in the past but are not current users. 

Almost half (48 percent) of the women with a focused family planning need who visited a health facility in 

the 12 months before the survey were not advised about family planning. 

Married and in-union women with an unmet need for contraception for either desires or risk were asked 

about their intentions to use contraception in the future. Three in ten (29 percent) women said that they did 

not intend to use contraception in the future, and gave the following reasons for not intending to use: Are 

breastfeeding (1 percent), are fatalistic (6 percent), have infrequent sexual relations (17 percent) or are not 

having sexual relations (14 percent), fear side effects or have health concerns (15 percent), have a husband 

who is opposed (10 percent) or they are opposed (7 percent), believe they are subfecund or infecund 

(9 percent), and say there is a religious prohibition (21 percent). Only 1 percent cited family planning 

program reasons (no method or preferred method not available, inconvenient to use, costs too much, lack 

of access or too far away, knows no method or knows no source) as the reason they do not intend to use 

contraception in the future.