Unmet need plays a critical role in reproductive health research, evaluation, and advocacy. Although conceptually straightforward, its estimation suffers from a number of methodological limitations, most notably its reliance on biased measures of women's stated fertility preferences. We propose a counterfactual-based approach to measuring unmet need at the population level. Using data from 56 countries, we calculate unmet need in a population as the difference between: (1) the observed contraceptive prevalence in the population; and (2) the calculated contraceptive prevalence in a subsample of women who are identified to be from “ideal” family planning environments. Women from “ideal” environments are selected on characteristics that signal their contraceptive autonomy and decision-making over family planning. We find significant differences between our approach and existing methods to calculating unmet need, and we observe variation across countries when comparing indicators. We argue that our indicator of unmet need is preferable to existing population-level indicators due to its independence from biases that are generated from the use of reported preference measures, the simplicity with which it can be derived, and its relevance for cross-country comparisons as well as context-specific analyses.

中文翻译：

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衡量未满足的避孕需求：一种反事实方法

未满足的需求在生殖健康研究、评估和宣传中起着关键作用。虽然在概念上很简单，但其估计受到许多方法上的限制，最显着的是它依赖于对女性陈述的生育偏好的有偏见的衡量。我们提出了一种基于反事实的方法来衡量人口层面未满足的需求。我们使用来自 56 个国家/地区的数据，将人口中未满足的需求计算为以下两者之间的差异：(1) 人口中观察到的避孕普及率；(2) 计算得出的来自“理想”计划生育环境的女性子样本的避孕普及率。来自“理想”环境的女性是根据表明她们的避孕自主权和计划生育决策权的特征来选择的。我们发现我们计算未满足需求的方法与现有方法之间存在显着差异，并且我们在比较指标时观察到各国之间的差异。我们认为，我们的未满足需求指标优于现有的人口水平指标，因为它不受使用报告的偏好措施产生的偏差的影响，它可以简单地推导出来，以及它与跨国比较的相关性以及特定上下文的分析。