Claire W. Rothschild, Department of Epidemiology, University of Washington, Seattle, USA.
Win Brown, The Bill & Melinda Gates Foundation, Seattle, WA, USA.
Stud Fam Plann. 2021 Mar;52(1):95-102. doi: 10.1111/sifp.12146. Epub 2021 Feb 17.
While unmet need for contraception is commonly used to assess programmatic needs, it inadequately captures the complexity of fertility and contraceptive preferences, including women's satisfaction with their contraceptive method. In their 2019 commentary, Sarah Rominski and Rob Stephenson propose reclassifying dissatisfied current users as having an unmet need for contraception. As revising the current definition based on their proposal would require significant investment to update survey and monitoring systems, understanding the potential impact on current estimates of unmet need is critical. We estimated the impact of this approach in a Kenyan cohort of modern contraceptive users. We found the prevalence of method dissatisfaction ranges from 6.6% (95% confidence interval [CI] 5.6-7.8%) to 18.9% (95% CI 17.1-20.9%); if applied nationally, this results in a large (approximately 25-70%) increase in Kenya's current estimate of unmet need for any contraception. Our findings suggest a large impact on unmet need estimates for equivalent populations. Overall, we advocate for better measurements of method satisfaction and acceptability, with metrics developed that are robust to socioeconomic gradients and validated in low- and middle-income settings to ensure women's contraceptive needs are captured equitably.
虽然避孕需求未得到满足通常被用来评估项目需求，但它不能充分反映生育和避孕偏好的复杂性，包括妇女对其避孕方法的满意度。在 2019 年的评论中，Sarah Rominski 和 Rob Stephenson 提出将不满的现有使用者重新归类为避孕需求未得到满足。由于根据他们的建议修订当前定义需要对调查和监测系统进行重大投资，因此了解这种方法对当前未满足需求估计的潜在影响至关重要。我们在肯尼亚现代避孕药具使用者队列中估计了这种方法的影响。我们发现，方法不满的流行率范围为 6.6%（95%置信区间为 5.6-7.8%）至 18.9%（95%置信区间为 17.1-20.9%）；如果在全国范围内实施，这将导致肯尼亚目前对任何避孕措施的未满足需求估计增加约 25-70%。我们的研究结果表明，对未满足需求估计的影响对类似人群来说是巨大的。总的来说，我们提倡更好地衡量方法的满意度和可接受性，并制定出在社会经济梯度方面具有稳健性并在中低收入环境中得到验证的指标，以确保公平地满足妇女的避孕需求。
