Inequity in unmet need: Women and family planning in Central America

Purpose: This project aims to determine targeted practices for improved contraceptive program and policy planning within Central America. It describes inequities in and reasons for unmet need for family planning among different wealth quintiles redistributed by area of residence. Data and Methods: The most recent data are compared from national health surveys conducted in El Salvador, Honduras, Nicaragua and Guatemala among women 15-49 years old. Descriptive analyses are conducted to identify possible inequities in unmet need, and to determine whether the reasons women give for not using contraception vary according to wealth status. Results: In all four countries, unmet need is consistently highest among the poorest women living in rural areas, as compared to other quintiles; however the level of inequity between each quintile varies by country and area of residence. Furthermore, women are more likely to report reasons for not using modern contraception that are related to demand for contraception versus perceived obstacles related to supply. Most notably, women report not using modern contraception because they believe that they are at low-risk of becoming pregnant unintentionally. Recommendations: Programmatic and policy approaches should respond to the varying levels of contraceptive inequity within Central America, targeting certain subpopulations to improve overall contraceptive prevalence. Specific approaches include: 1) focusing resources on the poorest women living in rural areas of residence; 2) improving counseling and education around modern contraception; and 3) educating women about their risks of getting pregnant and the possible side effects that they may experience if using contraception.