According to world health organization (WHO), unmet need for contraception is the proportion of currently married women or in a sexual union desiring to limit or space childbearing but not using any contraceptive methods. The concept of unmet need points to the gap between women's reproductive intentions and their contraceptive behavior (1).It remains a useful tool for identifying and targeting women at high risk of unintended pregnancy. Unmet need for contraception is one of the several frequently used indicators for monitoring of family planning programs, and it was lastly added to the millennium development goal(MDG) of improving child and maternal health (2). The use of modern contraceptive method remains an important component in the reduction of fertility, maternal, infant and child mortality. This allows couples to fulfill their fertility desires and will improve the health of mothers, children, and the family. The method used to give couples the ability to space child births, the ability of women and their partners to plan their pregnancies and avoid unwanted pregnancy which may lead to unsafe abortions that have negative health consequences for the women (3, 4).
Family planning has many potential benefits. It reduces poverty, maternal and child mortality; empowers women by lightening the burden of excessive childbearing and it reduces environmental degradation by stabilizing the population of the planet. (5, 6)
Unintended pregnancy related to unmet need is a worldwide problem that affects women and their families and societies at large. About 40% of all births that occurred globally in 2012 were unwanted posing hardships for families and jeopardizing the health of millions of women and children (7).
"Family Planning; is the Changing Path of Unmet Need" . Unmet need for family planning is defined as percentage of all fecund reproductive age women who are married and in consensual union and presumed to be sexually active but are not using any method of contraception, either do not want to have more children, "Limiter" or want to postpone their next birth for at least two years, "Spacer" [9–11].
In order for modern methods of FP to be used, they need to be available, affordable and acceptable. Interventions that make FP methods more available and affordable are necessary but not sufficient. Use of contraception increased in areas where it was more readily available and not cost prohibitive for a population with few to no discretionary funds. However, efforts to improve rates of contraception uptake in low resourced areas such as sub-Saharan Africa should include factors of acceptability (12)
Results of different literature reviews indicate that many women have only limited access to health centers or FP services. Increasing utilization of FP methods are a safe and affordable intervention that will not only decrease maternal mortality, but also improve maternal morbidity, infant mortality, women's opportunities for education, reduce poverty, and decrease unsafe abortion (13,14).
When human reproduction is left unchecked, it causes high birth rates, getting large family size with the negative effects on the health of mothers and children. Consequently, this leads to negative impact on the family, community and nation at large as a result of economic crisis. Globally, the prevalence of contraceptive use has been increasing, but the unmet need for contraception still remains a problem especially in sub-Saharan Africa. More than 80 million unwanted pregnancies occur each year worldwide leading to high rates of induced abortion, maternal morbidity and mortality, and infant mortality. Women with unmet need for contraception account for over 80% of unintended pregnancy (15, 16)
Globally, 12% of married or in-union women are estimated to have had unmet need for contraceptive methods. The level is much higher, 22%, in the least developed countries. Many of the latter countries are in sub-Saharan Africa, which is also the region where unmet need for contraception method is highest (24%), double the world average. More than half a million women aged 15–49 years die annually from preventable pregnancy-related complications (17, 18).
According to the WHO report, the contraceptive use has increased in many parts of the world, especially in Asia and Latin America, but continues to be low in sub-Saharan Africa.The prevalence of unmet need for contraception in Africa, Asia, and Latin America is 23.2%, 10.9% and 10.4% respectively. This high magnitude of unmet need caused for a rapid population growth and a shortage of services particularly in less developed countries (19).
In Saudi Arabia the prevalence of unmet need was 32.6%. The proportion of spacers and limiters among this group was 65.7% and 34.4% respectively (20). In sub-Saharan Africa, 25% of women of reproductive age who are married or in union have anUnmet need for family planning (21).
In Nigeria the level of unmet need is like the other African countries the unmet need for family planning was 16.1%.( 22)
According to the latest national survey, almost one-quarter of young married women in Tanzania reported having an unmet need for family planning, and one-third of sexually active unmarried women reported having an unmet need. (23)
Modern contraceptive use by currently married Ethiopian women has steadily increased over the last 15 years, jumping from 6% of women using modern contraceptive method in 2000 to 35% in 2016. Analysis conducted on demographic health survey shows that unmet need for family planning has decreased over time as contraceptive use has risen. From 2000 to 2011, the unmet need for family planning declined by 10.3 absolute percentage points, from 36.6 percent in 2000 to 26.3 percent in 2011. The results show that there was 38 percent decline in unmet need for limiting and a 21 percent decline in unmet need for spacing. According to the few surveys conducted on unmet need for FP suggested that unwanted pregnancy and unsafe abortion are main causes of maternal mortality in Ethiopia .According to the 2016 Ethiopian demographic and health survey, the level of unmet need in Ethiopia was 22% and the level of unmet need for family planning in Tigray is lower than the national level 18%(24–26) and thisis supported by the single study conducted in shire endasilasie 21.4%.(27)
According to an estimate, 225 million women in developing countries had an unmet need for contraception. Annually, an estimated 74 million unintended pregnancies occur in developing regions, most of them are women using no contraception or a traditional method. If all unmet need for modern methods were met, 70,000 deaths from pregnancy related causes could be prevented (28).
Even if the level of contraceptive prevalence rate was increased from time to time large number of currently married women was still found with high number of unmet need for modern family planning. To the best of my knowledge little is known about the level of unmet need among currently married women of Mekelle city. That’s why this study aims to assess the level of unmet need among currently married women of Mekelle city, Tigray region, northern Ethiopia