Contraception is an integral part of family planning demand (FP) . Demand for family planning includes the women who desire no additional births (limiting demand) and to delay their next births for at least two or more years during the survey (spacing demand) . Globally, the existing demand for spacing is noticeably lower than limiting demand, especially in developing countries . The demand for spacing is mainly concentrated among the early reproductive women (aged 15–19 years) and low parity (two or less) .
The high unmet need for family planning is one of the main hindrances to achieving SDG-3 goals in lower-and middle-income countries (LMICs) . Unmet need for family planning (UFP) denotes “the number of currently married women or in the union who are fecund and want to either terminate or delay childbearing, but not using any contraceptive method” . Similarly, the unmet need for spacing (UNS) denotes “the number of currently married women or in the union who are fecund and want to delay next births for at least two years or more, but not using any contraceptive method” .
The UFP decreased from 21.2% in 1990 to 16% in the developing world in 2010 . Globally, UFP includes 153 million women, most of them from LMICs (138 million) in 2015. Unmet need was found almost two times higher in spacing demand compared to limiting demand among them. In India, UFP was 19% in 2015-16 . At the same time, the UNS was 51% among the women who had demand for spacing.
UNS is significantly associated with millions of unintended births, mistimed births, neonatal mortality, pregnancy loss, induced abortions, small size births, and malnutrition [6, 7]. The risk of maternal death, the third trimester bleeding, anaemia, and pre-eclampsia was 2.5, 1.7, 1.3, and 1.8 times, respectively higher among the women who followed shorter inter-pregnancy intervals (less than two years) compared to longer inter-pregnancy intervals . Similarly, the risk of small size birth and pre-time birth was found 40% higher among the women with shorter inter-pregnancy intervals than longer ones . By reducing the UNS, the risk of maternal and infant mortality and morbidities can be abridged in LMICs .
Existing pieces of literature were predominantly observed the trends, patterns, and socio-economic correlates of spacing demand, globally [3, 9–11]. Primarily, spacing demand is high among young women with low parity found in LMICs . A global pattern of demand for family planning shows that the spacing demand was considerably higher than limiting demand in Muslim populated countries . The use of spacing contraceptive methods was higher among the Muslims because of religious beliefs and faiths suggested by many previous studies [13, 14]. In India, spacing demand was found comparatively higher among the women in the young age group and residents of the North-east region .
Several previous studies also examined the association between spacing births and maternal and child mortality and morbidities in India and elsewhere. Little studies were looked over the existing demand and unmet need for spacing in LMICs [9, 15]. Women’s age, parity, level of education, wealth status, place of residence, and mass media exposure were found to be significant determinants of unmet need spacing (UNS) in Burundi. The UNS was prominent among young, illiterate, poor women . Similar findings were also found in rural Burkina Faso .
India achieved below replacement level TFR except for few states and socio-economic groups in 2015-16 . This achievement occurred mainly due to continuous focus on limiting family planning, promotion of incentives based on male and female sterilization, and socio-economic development [16, 17]. However, the prime focus on family planning for limiting births has been lessening the attention on “demand, unmet need and using contraceptive dynamics for spacing births”. National Family Health Survey (NFHS) in 2015-16, suggested that the unmet need for contraception was almost three times higher among the women who desired to spacing births than limiting births in India . Still, studies have paid limited attention to understanding the factors influencing the unmet need for spacing. The only available study focuses on patterns of demand for spacing  and unmet need for family planning  rather than on the unmet need for spacing itself . With this backdrop, this study seeks to fill this research gap by examining district-level spatial patterns of unmet need for spacing (UNS) and its socio-economic determinants in India. Findings are anticipated to guide policymakers concerned in designing programs and policies to reduce UNS to lessen maternal and child mortality and malnutrition.