IPUMS PMA Data Workshop

Reasons for Unmet Need for Family Planning
in PMA Panel Surveys

Devon Kristiansen - Project Manager

Matt Gunther - Senior Data Analyst

Today’s Goals

• Introduce measures of Unmet Need in PMA Panel Surveys
• Open an IPUMS PMA data extract in Stata
• Explore women’s reasons for Unmet Need in Phase 1 of the panel
• Predict women’s Unmet Need in Phase 2 of the panel

		Now Available from IPUMS PMA
Sample	Phase 1 Data Collection*	Phase 1	Phase 2	Phase 3
Burkina Faso	Dec 2019 - Mar 2020	x	x
Kenya	Nov 2019 - Dec 2019	x	x
Cote d'Ivoire	Sep 2020 - Dec 2020	x
DRC - Kinshasa	Dec 2019 - Feb 2020	x	x
DRC - Kongo Central	Dec 2019 - Feb 2020	x	x
India - Rajasthan	Aug 2020 - Oct 2020	x
Nigeria - Kano	Dec 2019 - Jan 2020	x	x
Nigeria - Lagos	Dec 2019 - Jan 2020	x	x
Uganda	Sep 2020 - Oct 2020	x

^* Each data collection phase is spaced one year apart

Unmet Need

What is Unmet Need?

Women who are capable of becoming pregnant are said to have unmet need if they might want to limit or space births, but are not using a family planning method.

Examples:

• Layla wants to have a child someday, but she is not so sure she wants to have one soon. If neither she nor her husband are currently using any family planning method, Layla would have unmet need for spacing pregnancies.
• Yasmine is currently pregnant with her fourth child. She had planned to stop having children after her third child, so her fourth pregnancy indicates that Yasmine has unmet need for limiting pregnancies.
• At age 15, Fatimata is not using any family planning method because she is not sexually active. Fatimata has no unmet need because she is not at risk for becoming pregnant.

How is Unmet Need Measured?

PMA uses several different survey questions to determine which women are:

• Sexually active (including non-married women who have had sex within 30 days)
• Neither infecund nor menopausal
• Express uncertainty or intentions to space or limit pregnancies (including their current pregnancy, or recent pregnancy if PPA)
• Not currently using a family planning method (including prior sterilization, emergency methods within the last year, traditional methods, and all modern methods)

IPUMS PMA Harmonized Variables

UNMETNEED explains whether each female respondent has:

• unmet need for spacing births
• unmet need for limiting births
• is not at risk of becoming pregnant
• is currently using family planning for spacing births
• is currently using family planning for limiting births
• is not using family planning with no unmet need

UNMETYN is binary:

• Yes
• No

Unmet Need in Stata

Setup

Our extract includes data from two phases of the panel study in Burkina Faso and Kenya (female respondents only).

cd "C:\Users\krist108\Documents\krist108 stuff\ISRDI\ICFP 2022 workshop"
use pma_00178.dta

We drop women who only completed one of the two interviews…

keep if resultfq_1 == 1 & resultfq_2 == 1

(8,361 observations deleted)

and those who are not members of the de facto population.

keep if (resident_1 == 11 | resident_1 == 22) & (resident_2 == 11 | resident_2 == 22)

(358 observations deleted)

Unmet Need by Country at Phase 1

PANELWEIGHT is the sampling weight for panel members (controls for loss to follow-up).

EAID_1 and STRATA_1 are the sample clusters and strata used to select households at Phase 1.

svyset [pw=panelweight], psu(eaid_1) strata(strata_1)

Information from svyset can be used to produce weighted percentages like those shown to the right. (SEs would also be adjusted for cluster sampling).

svy: tab unmetneed_1 country, col

svy: tab unmetyn_1 country, col

Note: we will set NIU cases to missing (see universe tab for details).

replace unmetyn_1 = . if unmetyn_1 == 99

(2 real changes made, 2 to missing)

	Burkina Faso1	Kenya1
Unmet need
Unmet need to space	17%	7.3%
Unmet need to limit	3.7%	4.9%
Using to space	22%	24%
Using to limit	6.6%	22%
Infecund or menopausal	8.8%	5.8%
Not sexually active	17%	27%
No unmet need	24%	9.7%
No response or missing	0.1%	<0.1%
NIU (not in universe)	<0.1%	<0.1%
Total unmet need
No unmet need	79%	88%
Unmet need	21%	12%
NIU (not in universe)	<0.1%	<0.1%
1 Weighted Percent

Unmet Need by Country at Phase 2

EAID_1 and STRATA_1 can also be used for estimating Phase 2 outcomes.

Panel members were found in the same study area again at Phase 2.

No need to adjust svyset!

svy: tab unmetneed_2 country, col

svy: tab unmetyn_2 country, col

	Burkina Faso1	Kenya1
Unmet need
Unmet need to space	14%	6.6%
Unmet need to limit	3.5%	3.7%
Using to space	26%	30%
Using to limit	7.3%	23%
Infecund or menopausal	9.7%	5.0%
Not sexually active	15%	23%
No unmet need	24%	8.9%
No response or missing	0.1%	0%
Total unmet need
No unmet need	82%	90%
Unmet need	18%	10%
1 Weighted Percent

Research Question

How well can we predict Phase 2 Unmet Need if we only know whether a woman had Phase 1 Unmet Need?

Logistic Regression

Burkina Faso

svy: logit unmetyn_2 unmetyn_1 if country == 1, or

Kenya

svy: logit unmetyn_2 unmetyn_1 if country == 7, or

Phase 2 Unmet Need

Odds Ratios

	Burkina Faso1	95% CI2	Kenya1	95% CI2
(Intercept)	0.14***	0.12, 0.17	0.09***	0.08, 0.10
Phase 1 Unmet Need	4.22***	3.47, 5.14	3.94***	3.23, 4.80
1 *p<0.05; **p<0.01; ***p<0.001
2 CI = Confidence Interval

Logistic Regression

Burkina Faso

svy: logit unmetyn_2 unmetyn_1 if country == 1, or

Kenya

svy: logit unmetyn_2 unmetyn_1 if country == 7, or

Phase 1 Unmet Need is a significant predictor of Unmet Need at Phase 2.

Women with Unmet Need at Phase 1 have about four times the odds of Phase 2 Unmet Need compared with women who had none.

Phase 2 Unmet Need

Odds Ratios

	Burkina Faso1	95% CI2	Kenya1	95% CI2
(Intercept)	0.14***	0.12, 0.17	0.09***	0.08, 0.10
Phase 1 Unmet Need	4.22***	3.47, 5.14	3.94***	3.23, 4.80
1 *p<0.05; **p<0.01; ***p<0.001
2 CI = Confidence Interval

Reasons for Unmet Need

If we know why a woman had Phase 1 Unmet Need, does this improve our ability to predict her Phase 2 Unmet Need?

Why are Reasons Important?

Alone, Unmet Need does not explain access or desire to use family planning.

Senderowicz and Maloney (2022) suggest dividing Unmet Need into supply- and demand-driven factors.

Demand-side unmet need represents women who are choosing not to use contraception, not because contraception is inaccessible, but because they do not see a need for it in their own lives.

Machiyama et al. (2017) propose a 5-part causal framework for unmet need.

Reasons Surveyed by PMA

Can you tell me why you are not using 
a method to prevent pregnancy?

[] Not married

[] Infrequent sex / Not having sex

[] Menopausal / Hysterectomy

[] Subfecund / Infecund

[] Not menstruated since last birth

[] Breastfeeding

[] Husband away for multiple days

[] Up to God / fatalistic

[] Respondent opposed

[] Husband / partner opposed

[] Others opposed

[] Religious prohibition

[] Knows no method

[] Knows no source

[] Fear of side effects

[] Health concerns

[] Lack of access / too far

[] Costs too much

[] Preferred method not available

[] No method available

[] Inconvenient to use

[] Interferes with body's processes

[] Other

[] Do not know

[] No response

Recoding

Reasons Surveyed by PMA

Can you tell me why you are not using 
a method to prevent pregnancy?

[] Not married

[] Infrequent sex / Not having sex

[] Menopausal / Hysterectomy

[] Subfecund / Infecund

[] Not menstruated since last birth

[] Breastfeeding

[] Husband away for multiple days

[] Up to God / fatalistic

[] Respondent opposed

[] Husband / partner opposed

[] Others opposed

[] Religious prohibition

[] Knows no method

[] Knows no source

[] Fear of side effects

[] Health concerns

[] Lack of access / too far

[] Costs too much

[] Preferred method not available

[] No method available

[] Inconvenient to use

[] Interferes with body's processes

[] Other

[] Do not know

[] No response

Recoding

Low risk of becoming pregnant

Reasons Surveyed by PMA

Can you tell me why you are not using 
a method to prevent pregnancy?

[] Not married

[] Infrequent sex / Not having sex

[] Menopausal / Hysterectomy

[] Subfecund / Infecund

[] Not menstruated since last birth

[] Breastfeeding

[] Husband away for multiple days

[] Up to God / fatalistic

[] Respondent opposed

[] Husband / partner opposed

[] Others opposed

[] Religious prohibition

[] Knows no method

[] Knows no source

[] Fear of side effects

[] Health concerns

[] Lack of access / too far

[] Costs too much

[] Preferred method not available

[] No method available

[] Inconvenient to use

[] Interferes with body's processes

[] Other

[] Do not know

[] No response

Recoding

Low risk of becoming pregnant

Opposition or prohibition

Reasons Surveyed by PMA

Can you tell me why you are not using 
a method to prevent pregnancy?

[] Not married

[] Infrequent sex / Not having sex

[] Menopausal / Hysterectomy

[] Subfecund / Infecund

[] Not menstruated since last birth

[] Breastfeeding

[] Husband away for multiple days

[] Up to God / fatalistic

[] Respondent opposed

[] Husband / partner opposed

[] Others opposed

[] Religious prohibition

[] Knows no method

[] Knows no source

[] Fear of side effects

[] Health concerns

[] Lack of access / too far

[] Costs too much

[] Preferred method not available

[] No method available

[] Inconvenient to use

[] Interferes with body's processes

[] Other

[] Do not know

[] No response

Recoding

Low risk of becoming pregnant

Opposition or prohibition

Method Access

Other / Unknown

Who gave reasons?

Most - but not all - women with unmet need were asked to give reasons for non-use.

Most - but not all - women who gave reasons for non-use also have unmet need.

Who gave reasons?

Most - but not all - women with unmet need were asked to give reasons for non-use.

Most - but not all - women who gave reasons for non-use also have unmet need.

Who gave reasons?

Most - but not all - women with unmet need were asked to give reasons for non-use.

Most - but not all - women who gave reasons for non-use also have unmet need.

Who gave reasons?

Most - but not all - women with unmet need were asked to give reasons for non-use.

Most - but not all - women who gave reasons for non-use also have unmet need.

Popularity of Reasons For Phase 1 Unmet Need

Recoding

foreach var of varlist fpynot* {
  replace `var' = 0 if unmetyn_1 == 1 & `var' == 99
  recode `var' (0=0) (1=1) (else=0)
}

replace pregnant_1 = 0 if pregnant_1 > 90


egen fpyopposed = rowmax(fpynotrelig_1 fpynotoppf_1 fpynotfate_1 /// 
  fpynotopph_1 fpynotoppo_1 fpynotsidef_1 fpynotsdhlth_1 ///
  fpynotconv_1 fpynotbody_1)
replace fpyopposed = 0 if unmetyn_1 != 1
  
  
egen fpymethod = rowmax(fpynotfar_1 fpynotcost_1 fpynotkno_1 /// 
  fpynotsrc_1 fpynotavail_1 fpynotavailp_1 pregnant_1)
replace fpymethod = 0 if unmetyn_1 != 1
    
    
egen fpylowrisk = rowmax(fpynotbstfd_1 fpynothsbaway_1 ///
  fpynotmeno_1 fpynotamen_1 fpynotnosex_1 ///
  fpynotmar_1 fpynotinf_1)
replace fpylowrisk = 0 if unmetyn_1 != 1


gen fpyother = 0
replace fpyother = 1 if unmetyn_1 == 1 & fpyopposed !=1 & ///
  fpymethod !=1 & fpylowrisk !=1


* Check results 
tabstat fpyopposed fpymethod fpylowrisk fpyother ///
  if unmetyn_1 == 1 [weight=panelweight], by(country)

Phase 1 Reasons

for Unmet Need

	Burkina Faso1	Kenya1
Opposition or prohibition	38%	38%
Method access	20%	24%
Low risk of becoming pregnant	32%	46%
Other / Unknown Reason	19%	7.9%
1 Weighted Percent; Women could list multiple reasons

Logistic Regression

Burkina Faso

svy: logit unmetyn_2 fpyopposed fpymethod fpylowrisk ///
  unmetyn_1 if country == 1, or

Kenya

svy: logit unmetyn_2 fpyopposed fpymethod fpylowrisk ///
  unmetyn_1 if country == 7, or

Phase 2 Unmet Need

Odds Ratios

	Burkina Faso1	95% CI2	Kenya1	95% CI2
(Intercept)	0.14***	0.12, 0.17	0.09***	0.08, 0.10
Opposition or prohibition	1.55*	1.10, 2.19	1.77*	1.14, 2.73
Method access	1.88	0.99, 3.59	0.84	0.48, 1.45
Low risk of becoming pregnant	1.44	0.91, 2.29	0.77	0.52, 1.14
Phase 1 Unmet Need	2.78***	1.90, 4.06	3.61***	2.34, 5.58
1 *p<0.05; **p<0.01; ***p<0.001
2 CI = Confidence Interval

Logistic Regression

Burkina Faso

svy: logit unmetyn_2 fpyopposed fpymethod fpylowrisk ///
  unmetyn_1 if country == 1, or

Kenya

svy: logit unmetyn_2 fpyopposed fpymethod fpylowrisk ///
  unmetyn_1 if country == 7, or

Compared to women who gave no reason, women who were opposed to using family planning were significantly more likely to have Phase 2 unmet need.

Women with method access issues or at low risk of becoming pregnant - less clear!

Phase 2 Unmet Need

Odds Ratios

	Burkina Faso1	95% CI2	Kenya1	95% CI2
(Intercept)	0.14***	0.12, 0.17	0.09***	0.08, 0.10
Opposition or prohibition	1.55*	1.10, 2.19	1.77*	1.14, 2.73
Method access	1.88	0.99, 3.59	0.84	0.48, 1.45
Low risk of becoming pregnant	1.44	0.91, 2.29	0.77	0.52, 1.14
Phase 1 Unmet Need	2.78***	1.90, 4.06	3.61***	2.34, 5.58
1 *p<0.05; **p<0.01; ***p<0.001
2 CI = Confidence Interval

Next Steps

What controls could we add to our model?

• AGE age
• MARSTAT marital status
• WEALTHQ household wealth (quartile or tertile)
• CHEB parity
• FPUSPLAN plans for future use of a method

Comparison with results from other IPUMS Global Health surveys

• IPUMS DHS: Why Not Use Family Planning variable group; UNMETNEED, UNMETNEED2, and UNMETNEED3,
• IPUMS MICS: coming soon!

New at IPUMS

References

Machiyama, Kazuyo, John B Casterline, Joyce N Mumah, Fauzia Akhter Huda, Francis Obare, George Odwe, Caroline W Kabiru, Sharifa Yeasmin, and John Cleland. 2017. “Reasons for Unmet Need for Family Planning, with Attention to the Measurement of Fertility Preferences: Protocol for a Multi-Site Cohort Study.” Reproductive Health 14 (1): 23. http://dx.doi.org/10.1186/s12978-016-0268-z.

Senderowicz, Leigh, and Nicole Maloney. 2022. “Supply-Side Versus Demand-Side Unmet Need: Implications for Family Planning Programs.” Population and Development Review 48 (3): 689–722. https://onlinelibrary.wiley.com/doi/10.1111/padr.12478.