bearing are more knowledgeable about their past (and future) fertility behaviour than their male partners (Blood and Wolfe 1960).[84] Furthermore, since the woman is the child-bearer, her attitudes about proscriptive fertility-related events were felt to be more logical predictors of future behaviour (Mott and Mott 1985). The model implicitly assumes that women generally take decisions about childbearing alone without consideration of the cultural context of childbearing in Africa where children belong to lineages, and not individual couples, let alone individual women. Indeed the concept of an ‘unmet need’ (for contraception) generally still refers to the discrepancy between women’s expressed fertility goals and their contraceptive practice. Continued childbearing, in the face of reported desires to stop, led demographers to describe African women as inconsistent, irrational, or simply ignorant (see Casterline et al.’s critique, 1996), and yet when men’s preferences are included in analyses, many children cease to be ‘unwanted’ or ‘mistimed’ (Bankole and Ezeh 1997; Dodoo 1993).
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The concept of ‘unmet need’ was first explored in the 1960s when data from KAP surveys of contraceptive use showed a gap between women’s intentions and behaviour. The term that was used to describe this apparent discrepancy was ‘KAP-gap’ (Bogue 1974). In 1974 Freedman and Coombs used survey data from several countries for the first time to identify the size of the group of women who experienced such a gap; they found this gap to be considerable. Freedman and Coombs (1974) coined the term ‘discrepant’ behaviour to describe women in this group. One of the first published works to refer to ‘unmet need’ was by Stokes (1977), who, citing evidence from KAP studies in Third World countries, and from fertility surveys in the US, notes, “in disparate ways, the number of ill-timed pregnancies and widespread reliance on abortion among all social classes and groups signal an ‘unmet need’ for contraception” (Stokes 1977:4). Between 1972 and 1984 World Fertility Surveys (WFS) carried out in several countries were the first to report extensively on ‘unmet need’. Caldwell and Ruzicka (1978) note that ‘unmet need’ was so important that once such data became available to demographers this became the first variable to be analysed in any fertility-related study. Based on comparative estimates from five Asian countries in the WFS, Westoff published articles on ‘unmet need’ for limiting births (Tsui 1985; Westoff 1978).[85] Subsequently, Westoff and Pebley (1981) recommended that the concept of ‘unmet need’ be extended to include the desire to space births. Contraceptive Prevalence Surveys (CPS) carried out from the mid-1970s to 1984 added questions about women’s interests in postponing their next birth, thus making it possible to include measurements of the ‘unmet need’ for spacing births.[86] Other demographers, for example Boulier (1985), argued that if ‘unmet need’ measured the proportion of women who were supposed to be using modern contraceptives but
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Whose ‘Unmet Need’ Dis/Agreement about Childbearing among Ghanaian Couples
were not, then the concept should be extended to include users of traditional methods as having an ‘unmet need’. His argument was that traditional methods could not be considered to be reliable, hence women in this category had an ‘unmet need’ for more reliable contraception, or in Foreit et al.’s (1992) formulation ‘appropriate contraception’. Finally, the DHS that have been carried out in 44 countries since 1985, have allowed further refinements of the measure;[87] the DHS now also ask pregnant women whether their current pregnancy is “wanted then (planned or intentional), not wanted then (mistimed), or not wanted at all (unwanted)” and whether they were using contraception at the time of the pregnancy. This allows for the measurement of ‘unmet need’ among pregnant women as well. Clearly, the measurement of ‘unmet need’ has undergone a lot of refining since it was first conceptualised; however, limitations persist. In the next section I turn to an assumption that is implicit in the conceptualisation of ‘unmet need’— the assumption that a woman’s reproductive behaviour is a reflection of a couple’s intentions or preferences.