The study indicates that although women and their partners had positive perception towards family planning (81%), unmet need among women was still high (66%). Elsewhere in Senegal, Hindin et al., (2015), also found as high as 70% of women with unmet need, as well as Chebet et al., (2015). Reasons such as limited access to family planning services, poor family planning education and counselling, perception about side effects associated with contraceptives could account for this shortfall in translating perception into practice. Meanwhile other regional surveys in Ghana recorded low unmet need, contrary to findings of this study (Eliason et al., 2014). Again, both this study and earlier studies have indicated the significance of education on the impact of unmet need and mistimed pregnancy (Ajong et al., 2016 ; Ibrahim & Iwaoeye, 2012 ; Ajong et al., 2016). Educational attainment had resulted in the reduction of mistimed pregnancies (Blum, Astone, Decker, & Mouli, 2015 ; Prusty, 2014 ; Relwani et al., 2015). This may be because education increases women’s knowledge on where, how and when to access contraceptives. Further, education may also result in increased decision-making autonomy: this weakens the top-down patriarchal imposition of decisions on spending, improved communication and when or what healthcare services to seek. In addition, education demystifies the negative perception towards contraceptives and increase confidence in the use of FP services. Contrary to this, other studies in low income countries among women of reproductive age, suggest that education was negatively associated with unmet need and was not a determinant of mistimed pregnancy (Wulifan et al., 2016). It is reasonable to conclude that motivation for childbirth, limited access to FP services and non-abstinence from sex could account for less influence of education on reducing unmet need.
National surveys in Ghana reported an unmet need rate of 29% (GSS et al, 2014), 16% in Nigeria (Aransiola, Akinyemi, & Fatusi, 2014), and 45% in Kenya (Beguy, Mumah, & Gottschalk, 2014). This notwithstanding, other researchers have argued that countries can reduce their unmet need rate by advancing efforts in spousal communication and emphasizing its relevance on mistimed pregnancy (Ali, Mawani, Bano, & Ali, 2016 ; Thapa, Giri, & Sharma, 2015). These findings are similar to findings of this study and further supported by Mulatu & Mekonnen, (2016). Spousal communication enhances understanding between couples and improves decision making on the use of family planning services, thereby reducing unmet need and limiting mistimed pregnancies. Contrary, preliminary investigations among African Americans suggest that most couples lacked communication skills and were more likely to nonverbally communicate about methods such as condoms, leading to increased mistimed pregnancies (Higgins & Smith, 2016). Though spousal communication and approval of family planning is considered a significant factor in reducing mistimed pregnancies (Ezeanolue et al., 2015), majority of respondents’ partners in the current study never approved the use of family planning. This is possible with the reason that traditional, cultural and religious limitations could influence partner decisions on approving family planning. However, this did not determine the unmet need of respondents, contrary to studies in Ethiopia where non-partner approval of contraceptive use still led to reduction in unmet need (Arega et al., 2016). In the current study, reasons such as lack of autonomy in decision making to spend self-earnings, education and interest in birth spacing could determine the unmet need of respondents of this study.
Previous studies have cited working status and place of residence as significant determinants of a woman’s unmet need (Begum, Nair, Donta, & Prakasam, 2014), contrary to findings of this study. Considering that work status and place of residence are potential access barriers to family planning services, it is possible for these factors to determine the mistimed pregnancy rate of respondents. Consequently, the study reported a high unmet need rate with low mistimed pregnancy (9.4%). This is contrary to findings by Kennedy et al., (2013) who reported that more than half of child birth were due to mistimed pregnancies. Similarly, mistimed pregnancy varies in different African countries and previous research have reported 26% in Kenya (Beguy et al., 2014), 28% in Ethiopia (Dibaba, Fantahun, & Hindin, 2013), and 10% in Nigeria (Monjok, Smesny, Ekabua, & Essien, 2010). In the current study, autonomy to spend own earning (49%) significantly influenced unmet need, similar to findings of Osamor & Grady, (2016), which reported that 38% of women were autonomous in taking decisions on how to spend their own earnings. Women’s autonomy as a significant factor in determining unmet need and mistimed pregnancy has been widely observed (Najafi-sharjabad, Zainiyah, Yahya, Rahman, & Hanafiah, 2013 ; Najafi-sharjabad et al., 2013 ; GSS et al., 2009 ; GSS et al., 2015). This is because when women are empowered on decision-making, their desire to direct resources into healthcare and family planning decisions also increases (Beguy et al., 2014).