Reducing unmet need by supporting women with met need.

CONTEXT: The 2012 London Summit on family planning set a goal of providing modern contraceptives to 120 million women with unmet need by 2020. Reducing the high rate of contraceptive discontinuation by facilitating switching among methods will play a critical role in meeting that goal.
METHODS: Data collected from married women in Demographic and Health Surveys conducted in 34 countries between 2005 and 2010 were used to estimate the potential contribution of contraceptive discontinuation to current and future unmet need. An indicator of relevant discontinuation was created by calculating the proportion of past users with an unmet need for modern methods among ever-users. Regression analyses identified associations between this indicator and access to and composition of methods.
RESULTS: Women who had discontinued method use and subsequently had unmet need at the survey accounted for 38% of the total estimated unmet need. These past users represented 19% of women who had ever used modern methods. Both the access to and composition of available methods were associated with a reduction in the relevant discontinuation rate. The level of discontinuation in Sub-Saharan Africa was significantly higher than in other regions, in part due to differences in method availability.
CONCLUSIONS: High contraceptive discontinuation in the past has contributed tens of millions of cases of unmet need, and discontinuation among current users will contribute even more cases in the future. Enabling past users with unmet need to resume use and encouraging current users to continue use of the same or another method could be an effective strategy to reduce future unmet need.