11 Three other findings bear on the question of how to maximize the impact of family planning programs on maternal health. First, relatively few acceptors are of extremely high or low age and parity (Population Encyclopedia, 1982). Second, community-based family planning distribution programs reach relatively young, low parity couples, when compared to clinical programs. And third, in virtually all developing countries, the number of women who want no more children exceeds the number of contraceptive users. Granted that some of these women are pregnant, breastfeeding, infertile or their husbands are away, there is still a vast pool of unmet need for family planning. In general, the reasons for not using contraception are lack of acceptable services, fear of side effects and complications, opposition of spouse or other family members, or cultural and religious objections (World Bank, 1984). What, then, are the program implications of our knowledge about acceptor characteristics and family planning program experience?

Program Implications. Two clear conclusions follow from this brief review of family planning user characteristics and program experience. First, there is nowhere near a one-to-one relationship between the need for family planning from a health standpoint and the motivation to use contraception. On the contrary, there are large numbers of women for whom pregnancy represents a major health risk who are not practicing contraception. Many of them are among the poorest of the poor, live in rural areas of South Asia and sub-Saharan Africa, have low education, high fertility and poor health and nutritional status. Another large group at higb risk is young women in their teens, unmarried or married before they have reached full womanhood, for whom pregnancy represents a major threat to their life chances, their health and their survival. Second, there is a huge pool of unmet need for family planning services among women of lower risk, all of whom want no more children now, or no more children ever, whose health would benefit substantially from spacing or limiting their fertility. Action on three fronts is needed to meet the needs of these two groups of women: segmenting the market gor family planning services; improving the quality of famil,r planning services; and emphasizing the health benefits of family planning.

Segmenting the Market. Different approaches are needed to cater to the family planning needs of different segments of the population. For example, the needs of adolescent women, postpartum women and women with young children are different in terms of their level of motivation, method choice and mode of service delivery. Adolescent women are often hard to reach, unmotivated to use contraception and need a relatively small range of methods, for example, oral contraceptives and condoms. Their needs may be met best through social marketing, the private sector and with special outreach efforts tailored to their lifestyle. Postpartum women, on the otbsr hand, are usually highly motivated to practice family planning, need a wider method choice for spacing and limiting, and are more likely to continue with a method. Where births are institutionalized, these women's needs can be met cost-effectively in institution-based programs. Too often, unfortunately, the effectiveness of postpartum programs has been forgotten with the advent of equally cost-effective, community-based programs. The