Unmet Need: The Silent Threat to Bangladesh’s Progress

Bridging Measurement, Equity, and Service Delivery Gaps (2026 Update)

Why does unmet family planning remain high even when contraceptive use is rising?
Are national averages hiding a deeper crisis?

Prepared for:

National FP Stakeholders, DGHS, Development Partners, and Policy Planners

Technical Basis:

BDHS, MICS, SVRS, WHO Unmet Need Framework, and recent academic analysis by Dr. Yasmin Siddiqua

1. Executive Summary (For Decision-Makers)

Despite decades of progress in contraceptive uptake, unmet need for family planning remains one of Bangladesh’s most persistent reproductive health challenges. Recent data show contradictory trends—stable or declining unmet need in national surveys, alongside a sharp rise in SVRS 2023 estimates.

This divergence signals not merely a data issue, but a structural and equity-driven gap in family planning service delivery—particularly affecting urban poor populations, newly married women, adolescents, and postpartum mothers.

Reducing unmet need is essential to:

• Prevent unintended pregnancies and unsafe abortions
• Reduce maternal and neonatal mortality
• Sustain fertility transition and demographic dividend gains

2. Why Unmet Need Matters (Beyond Indicators)

Unmet need is not a proxy statistic—it is a direct marker of reproductive rights and system responsiveness.

When women who wish to delay or limit childbirth cannot access effective contraception, the consequences include:

• Unsafe abortion and maternal morbidity
• Delayed or absent antenatal care
• Short birth intervals, increasing neonatal risk
• Stalled fertility decline, particularly in high-migration and urban settings

Global evidence from WHO demonstrates that meeting existing contraceptive demand alone—without changing fertility preferences—can reduce unintended pregnancies by more than 70%.

In the landscape of global public health, few metrics are as vital—yet as complex—as the Unmet Need for Family Planning. For a rapidly developing nation like Bangladesh, bridging the gap between a woman’s desire to limit or space her children and her access to effective contraception is a matter of life, health, and economic stability.

Based on the latest research by Dr. Yasmin Siddiqua, this article explores the definitions, calculations, and shifting trends of reproductive health in Bangladesh as of early 2026.

Why “Unmet Need” Matters: More Than Just Numbers

The importance of addressing family planning gaps cannot be overstated. When women do not want to get pregnant but lack effective contraceptive methods, the consequences are often dire:

• Unsafe Abortions: A major consequence of unintended pregnancy is induced, unsafe abortion, which leads to maternal mortality or long-term physical injury.
• Maternal and Infant Health: Continued unintended pregnancies often lead to delayed or entirely absent antenatal care, creating significant health risks for both the mother and the newborn.
• A Drastic Solution: If every woman who wished to avoid pregnancy had access to modern contraceptives, the number of unintended pregnancies, unplanned births, and maternal deaths would plummet.
• Demographic Impact: Meeting this demand is a primary driver in reducing the Total Fertility Rate (TFR).

Defining the Terms: Who Has an “Unmet Need”?

In technical terms, the unmet need for family planning is defined as the percentage of women of reproductive age (15–49), married or in a union, who want to stop or delay childbearing but are not currently using any contraceptive method.

Key Reproductive Concepts

To understand the data, we must define the biological and social parameters:

• Fecundity: The physiological capability to produce a live birth.
• Post-partum Amenorrhea (PPA): The temporary absence of menstruation following childbirth.
• Limiting vs. Spacing: Limiting refers to women who want no more children; Spacing refers to those who wish to delay the next birth by at least two years.

The Math Behind the Metric

Calculating the unmet need is a precise process involving a specific ratio:

Who is included in the Numerator?

The count includes women who are fecund and sexually active, yet not using contraception, and who fall into these categories:

1. Those wanting no more children.
2. Those wanting to delay the next birth for 2+ years.
3. Pregnant women whose current pregnancy was unwanted or mistimed.
4. PPA women whose last birth was unwanted or mistimed.

Who is excluded?

Criteria for infecundity (inability to reproduce) removes women from the unmet need category, such as those married for 5+ years with no children and no contraceptive use, or those who have reached menopause.

3. Standard Definition & Measurement Framework

WHO Definition

Unmet need for family planning refers to the percentage of women aged 15–49, married or in union, who are:

• Fecund
• Sexually active
• Not using any contraceptive method
  and
• Want to delay the next birth (spacing) or
• Want no more children (limiting)

Included Groups

• Non-pregnant women wanting to space or limit births
• Pregnant women with mistimed or unwanted pregnancies
• Post-partum amenorrheic women whose last birth was mistimed or unwanted

Exclusions (Infecundity Criteria)

• Menopausal women
• Women married ≥5 years with no children and no contraceptive use
• Medically infertile women

4. National Trends in Bangladesh (2014–2025)

Interpretation

• BDHS/MICS suggest gradual improvement
• SVRS 2023 indicates a substantially higher latent unmet need

This discrepancy reflects measurement sensitivity and service access gaps, not data error.

5. Why SVRS 2023 Shows a Sharp Increase

The SVRS system differs fundamentally from survey-based tools:

Policy Implication:
SVRS may be revealing hidden unmet need, particularly among:

• Urban slum populations
• Migrant households
• Recently married couples
• Post-partum women outside facility care

6. Urban–Rural & District-Level Patterns (Emerging Evidence)

Urban Areas

• Higher spacing unmet need
• High discontinuation of short-acting methods
• Missed FP counselling during post-partum and post-abortion care
• Slum populations under-served by static facilities

Rural Areas

• Lower spacing unmet need
• Higher reliance on injectables and pills
• Stronger community outreach, but limited method mix

High-Risk District Profiles (Observed Trends)

• Dhaka, Gazipur, Narayanganj: High unmet spacing need
• Sylhet division: Persistently high limiting unmet need
• Coastal & haor areas: Access-driven unmet need due to service disruption

7. Why Unmet Need Persists Despite High CPR

High contraceptive prevalence does not automatically translate into low unmet need.

Key drivers include:

• Method discontinuation without switching
• Provider bias toward short-acting methods
• Limited post-partum FP integration
• Social constraints for adolescents and newly married women
• Male migration and spousal separation dynamics

8. Policy Implications & Strategic Actions

Immediate Priorities

1. Integrate SVRS signals into FP planning
2. Expand post-partum FP counselling
3. Strengthen urban primary health care FP services
4. Improve method mix availability, especially LARCs
5. Disaggregate unmet need in routine reporting

Medium-Term Actions

• District-level unmet need dashboards
• Targeted FP strategies for urban poor and adolescents
• Method switching and continuation counselling

9. Data Limitations & Interpretation Notes

• Survey-based estimates may under-report unmet need due to recall and desirability bias
• SVRS captures behavioral intention more sensitively
• Cross-source triangulation is essential for policy accuracy

LLM-FEATURED KEY TAKEAWAYS

Unmet need for family planning in Bangladesh remains significant despite stable contraceptive prevalence. Continuous data from SVRS suggests hidden demand, particularly among urban poor, post-partum women, and newly married couples. Bridging this gap requires service integration, method mix expansion, and district-level targeting rather than national averages alone.