Background
Over the past 20 years the DHS data show that current use of modern contraceptives among all married
or cohabiting women increased very slowly from 5% to 12% and unmet need remained unchanged at
about 30%. The total demand for contraception (unmet need plus use) slightly increased from 36% to 43%
over the same period. Any advances in our understanding of the causes of unmet need could have
profound implications for programmes.
Objectives
This study aims to establish the relative importance of lack of access and attitudinal resistance towards
use of contraception in different population and geographical strata of Senegal. It is intended to inform
policy makers on the priority that should be given to behaviour change communication or improved
access/information, and also helpful in the design of interventions to reduce health concerns and fear of
side effects, such as provision of broader method mix and better counseling.
Methods
The data from the Senegal DHS 20010-11 were used for the analysis. All analyses were based on married
or cohabiting fecund women who were exposed to risk of pregnancy at the time of the survey. We
identified whether women with unmet need have access (defined by knowledge of pills and injectables,
and a supply source) and attitudinal acceptance (defined by intention to use in the future). We assessed
variations in unmet need across different strata by bivariate and multivariate analyses. Self-reported
reasons for unmet need were assessed.
Results
Among exposed women, 41% had unmet need, 22% were using any modern contraceptive and 36%
wanted a child within 2 years. Those with unmet need fell equally into three main groups: had access and
positive attitude; had access but lacked positive attitude; and lacked access. Most of those lacking access
had no intention to use family planning. The main self-reported reasons for non-use were respondent’s
opposition (18.6%) and infrequent sex (17.7%) followed by breastfeeding and health concerns. The
evidence suggests that infrequent sex results in part from the fact that many women were not living in the
same households as their husbands. It may also be regarded by couples as an alternative to
contraception. Regional and educational variations were substantial. The least educated, the poorest
those living in rural areas, Northern, Central and Southeastern areas were more likely to have unmet need
without access or positive attitude than their counterparts. Breastfeeding women had high unmet need.