Opinion
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This is the second part of a look at the “unmet need” for contraceptives in the developing world.  Part one can be found here.

Previously, I discussed how the concept of “unmet need” for contraception formed the basis of a widespread fallacy that women in the developing world are denied access to modern family planning methods.  As it turns out, when asked directly why they aren’t using these commodities that they supposedly “need,” women respond that they don’t want them, don’t require them, have religious or other objections to using them, and are concerned about potential risks to their health.

This isn’t new – women said the same thing back in 2011, when the Guttmacher Institute reported that only 8% of “unmet need” was due to lack of access or cost.  In other words, you can lead a woman to contraceptives, but you can’t make her use them.  What is important is the increased frankness among the architects of the “unmet need” concept about the fact that the phrase is (and always has been) an advocacy construct.  Summarizing the history of the concept, Cleland, Harbison, and Shah write:

“[S]upporters of the international family planning movement were obliged to demonstrate the existence of a need, or potential demand, for averting pregnancy in the poor, high-fertility countries of Africa, Asia, and Latin America and the Caribbean. … [T]he concept of unmet need has played an important role in family planning research, evaluation, and advocacy.  Unmet need has proved to be an invaluable bridge between a human rights and feminist approach to fertility control and a demographic–economic rationale.”

In a paper from the same series, Bradley and Casterline add that “unmet need” serves “as a conceptual bridge between concerns regarding population growth and the inability of women and couples to achieve their reproductive goals without coercion.”

Given the history of distrust between population controllers and feminists, this “invaluable bridge” is not trivial.  The common ground between their camps is essentially this: women have the right to control the number and spacing of their children, and must be able to access modern contraceptives to achieve their reproductive goals.  To the feminists, this is an assertion of women’s autonomy; to Malthusian population alarmists, it’s a less coercive way of achieving a reduction in population growth – at least as long as women’s desired fertility is sufficiently low.

To feminist groups, particularly those in the Global South, there remains some skepticism toward population groups’ exuberant interest in giving women what they want.  Simply, the people having the most children are not the ones consuming the most resources.  When North American and European elites encourage women in developing countries to have fewer children – and generously provide them with the means to reduce their fertility – in the name of catastrophic climate change, it’s hard not to be a bit cynical.

The irony of this position was evident at the 2012 Women Deliver conference, where a group of experts were flown across the world to a developing country to hold court in a luxurious convention center.  During a lunch plenary session, the air conditioning was so efficient at keeping the outside tropical climate at bay that the audience shivered and several panelists expressed their discomfort – not only with the cold, but with the knowledge of how much energy was being expended to produce it.  Princeton ethics professor Peter Singer then tossed out the loaded hypothetical question of whether concerns about overpopulation could potentially end up trumping women’s right to have the number of children that they want (More description of the panel discussion here).

Feminist groups could get behind the “unmet need” concept as long as it was about giving women the means to achieve their goals.  Population alarmists were content to frame the push for contraceptive access in terms of women’s rights as long as the exercise of those rights resulted in fertility reduction.  But Singer’s hypothetical question – and the highly-charged discussion it triggered – demonstrates how shaky the “bridge” between the two groups really is.

And it’s about to get shakier, now that advocacy groups are losing “lack of access” as a compelling argument.  It’s not very hard to ask for money in the name of giving poor women something they allegedly want and don’t have.  It’s quite a bit harder to convince people to give you money to essentially reprogram women in the developing world to value having children less and ingest pharmaceuticals about which they have legitimate health concerns.

For twenty years, population control groups have taken refuge behind the “unmet need” label – a label that has been widely if incorrectly reworded as “lack of access” to great effect by activists.  In the words of Cleland and colleagues:

 “At the 1994 International Conference on Population and Development, addressing unmet need replaced fertility reduction as the central justification for investment in family planning. Its legitimacy was further strengthened in 2007 when it was added as an indicator to the Millennium Development Goals (MDGs) and again in 2012 at the London Summit on Family Planning.”

The relevant goal is MDG 5B, which is to “Achieve, by 2015, universal access to reproductive health.”  This target was a controversial late addition to the MDGs in 2005, and once again its focus is on access, with “unmet need” as one of its indicators.

The question now becomes: can the “unmet need” brand maintain its legitimacy as it attempts to pivot from a provision-of-access model to a behavior-change model, and will it lose support from feminists (especially those in developing countries) as it becomes harder to disguise the fertility reduction agenda that’s been lurking there along?

Reprinted with permission from TurtleBayandBeyond.org.