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Measuring the unmet need of sexual and reproductive health

A systematic review on measuring unmet need in sexual and reproductive health has concluded that the emphasis is on contraception for women in low-income countries, while unmet need for sexual health in general, especially among men, and unmet reproductive health need in high-income settings lack much evidence.

The review in the journal Perspectives in Public Health of published literature also indicates that using more data collection methods, analyses and definitions for these unmet needs would enable a clearer understanding of health inequality.1

Five databases were searched for studies published between 2010 and 2021 that described quantitative measurement of unmet need within sexual and/or reproductive health: PubMed, Web of Science, Scopus, the Cumulative Index to Nursing and Allied Health Literature and Health Management and Policy Database.

The review consisted of 216 studies, of which 190 were analyses of unmet need in reproductive health. Of those 190 studies, 179 collected information via questionnaires.

Among the 190 studies in reproductive health, 137 analyzed trends in populations living in low or lower-middle income countries, compared to only 51 studies that comprised populations from upper-middle and high-income countries. The 2 remaining studies were global comparisons.

Half of the reproductive health studies extrapolated at the national or multinational level, while the other half focused on the regional level.

Six of these 190 studies considered the contraceptive needs of men. The other 184 studies were limited to unmet need in women, of which 89 analyzed women of reproductive age only. A significant majority of studies also restricted analysis to married women or who were in a union similar to marriage.

Overall, 165 of the 216 studies used the Demographic and Health Surveys definition of unmet need. “According to this definition, women are considered to have unmet need if they report being fecund and sexually active, would like to stop or postpone childbearing, and are not currently using a modern contraceptive method,” wrote the authors.

The authors noted that “unmet need for family planning” is a key indicator of the United Nations, without much discourse of unmet need in other areas of sexual and reproductive health. It is also easier to define and measure unmet need for contraception than for sexual health because of the defined endpoint for contraception: unplanned pregnancy.

By contrast, measuring unmet need in sexual health is much more difficult, due to the lack of data from people not receiving care.

Because there remains a large and under-treated global burden of morbidity in sexual health, the conceptualization and measurement of unmet need in sexual health should be a research priority, according to the authors.

There is also a need for data collection using a range of methods that reflect regional patterns, sub-group trends and can begin to determine the causes of unmet need.

“If these gaps are not addressed, we run the risk of repeatedly measuring unmet need within sexual and reproductive health but not collecting the data that will allow us to make significant and sustainable change,” wrote the authors.

Reference

  1. Solomon D, Cabecinha M, Gibbs J, et al. How do we measure unmet need within sexual and reproductive health? A systematic review. Perspect Public Health. Published online September 20, 2022. doi:10.1177/17579139221118778