ready market for contraceptives.[79] The basis of this conceptualisation was the fact that women interviewed in the DHS indicated, in response to standard questions on fertility preferences, that they had ‘unwanted’, ‘unplanned’ or ‘mistimed’ births. The standard formulation of ‘unmet need’ includes all fecund (not pregnant or amenorrhoeic)[80] women who are currently married or living in a union, who either want to postpone their next birth for two or more years (have an ‘unmet need’ for spacing births), or want to cease childbearing altogether (have an ‘unmet need’ for limiting births), but who are not using contraception. For example, the 1998 DHS for Ghana puts the total ‘unmet need’ for all women aged 15— 49 in the country at 16.5 per cent and puts it at 23 per cent for married women in the same age group (Ghana Statistical Service and the Institute for Resource Development 1999).
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In this chapter I take a critical look at this concept of ‘unmet need’ commonly used in population discourse and development efforts in the Third World. In the process I also address the underlying assumptions about ‘agreement’ between couples regarding reproductive issues that are implicit in the concept. For me it is important to take a closer look at the concept of ‘unmet need’ because my own research interests include the areas of population, and gender and reproductive decision-making. More importantly, the concept of ‘unmet need’ and concerns about African women’s fertility remain at the heart of population and reproductive health discourse and programs in Ghana, and within the discipline of demography more generally. Within theoretical frameworks that continue to view ‘rapid’ population growth per se as a problem, the concept of ‘unmet need’ remains a very attractive one because it presents a practical approach to solving the ‘population problem’ by providing contraceptives for women and their partners (Bon — gaarts and Bruce 1995). The concept assumes that the reason women have an ‘unmet need’ is because they do not know about ways to meet this need, and/or do not have access to the services required to effect their fertility preferences, or, if they do have access to services, that these are inefficient (Bongaarts 1991).[81] While we can expect that better access to, and efficiency of programs and services will enhance contraceptive use, the important cultural and ideological aspects of fer-
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Whose ‘Unmet Need’ Dis/Agreement about Childbearing among Ghanaian Couples
tility behaviour in Africa have been neglected. The quote cited at the head of this chapter comes from a woman whose story I return to later. She was not, as might appear to be the case, anxious to have a son. On the contrary, she did not want to have any more children; however, her husband was insistent that she would continue childbearing until she had a son. And yet her ‘unmet need’ is not exposed in the survey I conducted prior to the subsequent interview. Broadening the understanding of the relevance of the social context for demographic processes will bring to the discipline issues of gender inequality, which should enhance our understanding of fertility behaviour generally.
I will argue that in its theoretical and methodological approach the concept of ‘unmet need’ is at best overly simplistic, and, at worst, neglectful of the dominant role of males in human reproduction. Thus the concept fails to take into account the gendered social context of reproductive decision-making and behaviour. I also question the (over) reliance on traditional KAP-style survey questions in the measurement of ‘unmet need’ by pointing to some of the inherent methodological limitations of this approach. Specifically, I will show how the survey method overstates the level of ‘agreement’ between couples about past fertility behaviour, and also, fails to take into account the outcome of potential past childbearing that did not occur (i. e. in the case of induced abortions).[82] This approach of measuring ‘unmet need’ may account for the failure, over three decades, of family planning programs to have significantly reduced the high level of ‘unmet need’ in Africa (see Dodoo 1993; Dodoo and van Landewijk 1996). I base my arguments on available literature, the DHS, as well as data from my fieldwork among Ghanaian couples with reference to the last born child.