What does NFHS-5 tell us about unmet needs in contraception, family planning

Unmet needs of family planning declined in most states and Union territories except Meghalaya

By Gaurav Suresh Gunnal, Subham Kumar Mohanta
Published: Monday 11 January 2021

Poor maternal and child health outcomes can be avoided if 90 per cent unmet needs in family planning are met by averting unintended pregnancies, high fertility and short birth spacing, according to international research. The same can prevent 22 per cent maternal deaths, 22 per cent stillbirths and 8 per cent child deaths globally.

The latest round of the National Family Health Survey (NFHS-5) factsheet collected data on unmet needs of family planning among married women aged 15-49. The first phase of the survey revealed that these unmet needs declined in most states and Union territories (UT), except in Meghalaya. Demands for family planning services and its impact on fertility was met virtually in most states.

Access to contraceptives for family planning is widely viewed as essential to a variety of development goals such as improved child health, reduced poverty and hunger, universal education, environmental sustainability, and reduced maternal mortality and morbidity.

Governments, United Nations agencies as well as non-government organizations, therefore, emphasise on improving access to contraceptive technologies. Health systems worldwide cannot respond effectively to the reproductive health needs, including the contraceptive needs of indigenous and minority peoples.

Although the use of contraceptives increased in the last five years in the country, a gap in knowledge, attitude and practice exists. Family planning has two main objectives: To have only the desired number of children and to have proper spacing in pregnancies.

Knowledge and practice of family planning are strongly related to education, labour force participation and fertility. Several surveys on knowledge, attitude and practice regarding the same have been carried out covering different population groups.

India’s Family Planning programme 2020 aims to drive accessibility, choice and quality of family planning services. India continues putting efforts to expand the range and reach of contraceptive options since the initial FP2020 commitment in 2012, delivering a full range of family planning services and rolling out new contraceptives.

Family planning has been integrated into the reproductive, maternal, newborn, child and adolescent health strategy. The Union government through Family Planning Logistics Management Information System (FP-LMIS) has enhanced its supply chain system.

Why Meghalaya?

Meghalaya was the only state that showed an increasing trend of unmet needs among women in contraception. Most other states showed a decreasing trend and a few showed no change at all.

Among possible reasons were lack of knowledge and attitude towards using contraceptives and family planning practices. Apart from that, women’s contribution to adaptation of contraceptives, instead of men, played a significant role.

Migration of people and rising land ownership for mining purposes have resulted in protests and violent political conflicts. This contributes to preventing current family planning policies from being accessible to ordinary people.


Among the 17 states surveyed in NFHS-5 phase-1, Meghalaya topped the list of unmet needs, at 21.9 per cent in urban and 28.2 per cent in rural areas.

Andhra Pradesh occupied the bottom-most place; it accounted for 5.2 per cent unmet needs in urban areas and 4.4 per cent in rural areas. Andaman and Nicobar Islands and Jammu and Kashmir held the top and bottom position among UTs. Andaman and Nicobar Islands accounted for 18.3 per cent unmet needs in urban areas and 10.3 per cent in rural areas; Jammu and Kashmir had 6.1 per cent unmet needs in urban areas and 8.4 per cent in rural areas. 

The unmet needs for family planning in urban and rural areas are evenly distributed in most Indian states. The range of unmet needs was negligible in urban and rural areas, signifying a similarity in knowledge, practice and availability of contraception and family planning distributed among the community.

Manipur showed the highest decrease in unmet needs (17.9 per cent) in the last five years.

Maharashtra recorded the lowest decline of 0.1 per cent. Meghalaya alone showed a 5.7 per cent increase in unmet needs.

Unmet needs in districts of Meghalaya showed a vast range of behaviour. The inter-district scenario of Meghalaya showed that East Khasi hills had the highest unmet needs at 33 per cent, followed by South West Garo Hills. Furthermore, West Garo hills has the lowest unmet needs at 19.7 per cent.

Women’s education and occupation as well as monthly family income came across as the most significant determinant factors in using contraceptives. Doorstep delivery services of modern contraception methods should be provided free of cost and non-profits should buck up to effectively implement reproductive and child health services.

The state governments should monitor and evaluate the efficiency of their family planning policies through regulatory bodies to decrease their unmet needs. An information and education strategy should be adopted to improve knowledge related to contraception and family planning.

Hospitals and nursing homes should have a separate department to focus on the contraception practices used in the community. They should also have experienced professionals to educate and convince couples with the preference of family planning methods.

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