How a proposed UN measurement disparages countries where women aren’t using contraceptives

By Rebecca Oas, Ph.D. | January 27, 2016

During a recent U.S. presidential debate, Democratic candidate Martin O’Malley urged people to stop using the phrase “boots on the ground” to refer to military personnel deployed abroad. He argued that the term is dehumanizing to the troops working to keep the country secure.

When people speak of “boots on the ground,” there is an implied two-to-one ratio of boots to human soldiers. But suppose the U.S. military decided to fill a large aircraft with empty boots, drop them over foreign soil, and announce to the public that we now had “boots on the ground” in that country. The discrepancy between the technical and understood meanings of the phrase would create a false impression among the public.

Bearing that hypothetical example in mind, let’s turn to the new proposed measurement that USAID, UNFPA, and several other organizations want to use to measure access to family planning in developing countries: percent of family planning demand satisfied by modern contraception.

To most people, the phrase “demand satisfied” implies a direct request and its fulfillment. I’ve written about the problems with the notion of “unmet need” for family planning, which can be summarized by saying that it is not unmet, nor a need, and it certainly has nothing whatsoever to do with lack of access. (Its definition can be briefly summarized as including married women of childbearing age who a) wish to avoid pregnancy in the next two years and b) are not currently using a modern method of family planning.) Unlike a “demand”, a “need” can arguably be expressed on behalf of someone else – many a parent has spoken of a child’s “need” for a nap, even when the child would vigorously disagree. And when it comes to family planning, there are a lot of women who do not want contraceptives, yet are said to not only “need” but “demand” them. In short, this proposed indicator represents a step from paternalism to ventriloquism.

So what does this new measurement actually measure? “Total demand” is the sum of current contraceptive prevalence (or use) plus “unmet need.” In other words, women who have expressed a desire to not become pregnant in the next two years, whether they are currently taking steps to avoid it or not.

This indicator is problematic in that it incorporates all the shortcomings of the “unmet need” indicator, then creates further confusion by elevating the already misleading “need” to a “demand.”

But it gets even worse: to get an idea of how this will play out, here is an excerpt from an IntraHealth article discussing the new indicator:

“Unmet need by itself is a useful indicator, but it can be misleading, said Roy Jacobstein, senior medical advisor at IntraHealth. He pointed to two countries, one with unmet need of 22% (Nigeria) and the other with 27% (Rwanda). On the surface, Nigeria would seem to be in better shape—until you also factor in its 10% [contraceptive prevalence rate] and Rwanda’s 45% [contraceptive prevalence rate].

The resulting measures of demand satisfied show that Nigeria is actually meeting less than a third of total demand for modern family planning, while Rwanda is meeting two-thirds of its population’s demand.”

Let’s break this down: the definition of “demand satisfied” is:

[contraceptive prevalence]

_______________________________

[contraceptive prevalence] + [“unmet need”]

For Nigeria, that’s 10/(10+22), or 31% “demand satisfied”. For Rwanda, it’s 45/(45+27), or 63% “demand satisfied”.

So, after decades of falsely equating “unmet need” with lack of access, family planning experts are now trying a new, somewhat contradictory tactic. If “unmet need” were a measure of lack of access to contraceptives, Nigeria and Rwanda would show relatively similar performance on that indicator, with Nigeria doing slightly better. But this new indicator has Rwanda doing twice as well. Why? Because more people are using contraceptives there.

In other words, it’s not really about access at all, it’s about use. This has always been true in the family planning rhetoric – the Gates Foundation-led FP2020 initiative, for example, frequently talks about “enabling” or “empowering” 120 million more women to use family planning, or “reaching an additional 120 million women” with services, by which they really mean “adding 120 million contraceptive users.”

By making prevalence, or use, of contraceptives the most important element in the equation, this proposed indicator would penalize countries with low “demand” for contraceptives. The reason Nigeria looks worse then Rwanda in the above comparison is because there is a substantial proportion of married women of reproductive age in Nigeria who are not using contraceptives, and have no stated desire to avoid pregnancy. Unlike USAID, UNFPA, the Gates Foundation, and their allies, these women like children, and they like large families. Because they exist in large numbers in Nigeria, Nigeria will be characterized as having failed to meet the demands of its women. And that is utterly false, and inexcusable.

This proposed family planning indicator is a tool by which the governments of high-fertility countries will be held accountable, not for failing to satisfy a demand, but for failing to create it.  It manages to simultaneously amplify and silence the voices of the women who are its intended beneficiaries: it inflates a nonexistent “need” for contraceptives to a “demand” while denigrating countries where women are exercising their right to have the children they desire.

Much like “boots on the ground,” “satisfied demand” has both a literal and figurative meaning, one of which can be very dehumanizing. It’s time the global community questioned the wisdom of letting the neo-Malthusian family planning advocacy machine control the way global development progress is measured.

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