State of World Population 2012 - Country Page List - UNFPA

Demand and supply over time
5 per cent and equal a third or more of female
sterilizations, suggesting that increased female
empowerment in Nepal may be having an effect
on contraceptive choice (EngenderHealth, 2002).
Female sterilization is a significantly more
invasive, costly and risky procedure than male
sterilization, and is somewhat less effective,
Measures of contraceptive prevalence and unmet need are limited in their
ability to capture the dynamic nature of individuals’ decisions regarding their
sexual activity, as well as the context in which these decisions take place. For
example, contraceptive prevalence and unmet need are influenced by factors
that women in need of contraceptives cannot control, including changing
availability and supply of contraceptives over a period of time. Furthermore,
unmet need for family planning reflects both individuals’ demand for specific
methods and the supply. As more people learn about the benefits of exercising
their right to plan their families, the demand for services can potentially
outpace supply. This may occur in hard-to-reach regions and among populations
whose sexual activity defies commonly held beliefs about when sex is
appropriate.
While contraceptive prevalence and unmet need are important indicators,
the limitations of contraceptive prevalence and unmet need call
attention to the need for additional indicators that better capture the proportion
of demand for contraceptives that health systems satisfy (UNFPA,
2011). One such indicator is the “proportion of demand satisfied.” This indicator
is derived from current data collection methods and more accurately
monitors whether women’s stated desires for family planning are being
met. Additionally, more consistent use of adjusted urban vs. rural quintile
analyses can help policymakers and development practitioners design
tailored need-based family planning strategies and programmes.
WOMEN USING ANY METHOD
OF CONTRACEPTION
WOMEN
USING
ANY METHOD OF
CONTRACEPTION
DIVIDED BY
+
WOMEN NOT USING
CONTRACEPTION AND
WANTING NO MORE
CHILDREN OR WANTING TO
DELAY THE NEXT BIRTH
Source: United Nations Population Fund (2010). Sexual and Reproductive Health for All:
Reducing poverty, advancing development and protecting human rights. New York: UNFPA
=
PROPORTION
OF
DEMAND
SATISFIED
yet its prevalence dramatically surpasses vasectomy
everywhere except in North America
and Western Europe (Greene and Gold, n.d.;
Shih, Turok and Parker, 2011). That female
sterilization has become the norm, while male
sterilization remains rare, is a clarifying moment
of gender inequality. The lack of access to and
failure to promote vasectomy compromises both
men’s and women’s rights.
Given these realities, what factors do couples
take into consideration, if indeed they discuss
which of them will be sterilized One multicountry
study showed that some men who chose
vasectomy did so out of concern for their partners’
health (Landry and Ward, 1997). Other
men were dissatisfied with the choice of methods
available, or their wives had discontinued other
methods due to side effects. In some poor families,
vasectomy was chosen because women could
not be spared from child and household care for
the time it would take them to recover. Some
men decided that they had enough children and
did not consult their wives before being sterilized.
In the United States, prevalence of vasectomy is
highest among men with higher educations and
incomes, whereas female sterilization is more
prevalent among women with lower incomes
and education (Anderson et al., 2012).
Vasectomy is uncommon in sub-Saharan
Africa, where rates are well below 1 per cent
(Bunce et al., 2007). Few providers are trained
to perform vasectomies and many, if not most
men and women, have not heard of the method.
A study of the acceptability of vasectomy in
Tanzania found that both men and women had
concerns about sexual side effects (Bunce et al.,
2007). While some women feared their husbands
would become unfaithful, men had heard rumors
that vasectomy caused impotence and feared
their wives might leave them if their sexual
performance suffered.
28 CHAPTER:
2: ANALYSING DATA AND TRENDS TO UNDERSTAND THE needs