been the empowering effects of a woman’s structural resources (or a man’s lack of these) by reducing a woman’s sense of entitlement, in this case, to determine the couple’s fertility regime. These power differences govern the resolution of decision-making, especially in instances of disagreement, and yet this aspect of compromise is not captured in the concept of an ‘unmet need’.
Western epistemologies have largely failed to take into account local cultural realities in their explanations for phenomena which affect indigenous peoples. The concept of ‘unmet need’ in demography is one such example. In the foregoing analysis I have sought to show that an ‘unmet need’, where one exists, is often about power and gender relations. The measurement thereof also points to issues of methodology, linked to the broader questions about the relative importance of quantitative and qualitative data collection techniques and what sorts of evidence carry weight in development concerns. It also raises questions about the conceptualisation of fertility-related behaviour within traditional demography where women (and men) are seen as objects whose behaviour can be manipulated for larger development concerns.
For a KAP-based study on reproductive behaviour to have some usefulness it must be adapted to the particular social and cultural setting, and include questions on gender issues and power structures, building on the ethnography of that particular culture, society or group of people. Even though women are at the centre of the ‘unmet need’ concept, they are there without regard to the gender power relations that are always a part of women and men’s lives. The model was not conceived from women’s point of view but rather from a very instrumental, generally male-biased way of approaching development issues. Contraceptive behaviour is not only determined by the desire to space or limit births, nor even the motivation to use contraceptives, but also by the costs associated with their use (Easterlin and Crimmins 1985). Grace’s story shows how these costs include social, psychological and cultural factors that sometimes act as disincentives to individuals or couples who may otherwise feel motivated to use contraception. For women these costs may be included in their inability to refuse to acquiesce to their husband’s wishes. Thus the couples in the agreement category show that ‘agreement’ does not necessarily mean ‘egalitarianism’; indeed, Grace’s interview shows that ‘agreement’ can reflect acquiescence on the part of the wife rather than agreement between the spouses.
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A partner’s ‘unmet need’ can also be inadvertently measured as one’s own if the right questions are not asked. While Nana tries to subvert Nortey’s wishes to postpone childbearing by failing to use contraceptives she does eventually give in to his preference by having an abortion. Grace also tells her husband she will have no more children and that for all she cares he can have a child with whomever he wishes, but eventually she accedes and does become pregnant when she really wanted no more children. Thus it is certainly important to include the male part-
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Whose ‘Unmet Need’ Dis/Agreement about Childbearing among Ghanaian Couples
ner’s preferences in analytical models in order to arrive at a more realistic picture of fertility behaviour. Women’s ‘unmet need’ is not likely to be met without reference to men’s needs both conceptually and from a programme perspective.
On the other hand, men, who are rarely conceived of as having an ‘unmet need’ if their wives do not have an ‘unmet need’, are generally left out of the picture. Yet, some wives, like Delali, are able to effect preferences for a child based on more egalitarian gender relations. Unwanted (or mistimed) births are rarely simply indirect indicators of the extent of imperfect control over reproductive processes (Adetunji 1998), including social control. Thus, the ‘unmet need’ for family planning must be attributed to more than inadequate supply factors or ignorance about methods, and include the role of gender relations. More useful than simply examining women’s stated family size preferences in relation to achieved fertility, then, is an examination of the relative preferences of individual spouses, and the ultimate reproductive behaviour of the couple. There are critics of ‘male-inclusion’ efforts who argue that ‘male motivation’ (family planning) campaigns simply reconfirm that men have control over women’s bodies and their reproductive capacities (see Win 1998). I take the position that increasing male involvement should not, and need not, detract from efforts to improve the status of women, but should foster mutual respect and shared responsibility. Thankfully, some scholars have begun to look at developing a broader definition of ‘unmet need’.[101]
However, there are limits to the extent to which surveys can capture these nuances and processes. Spouses may under or over ascribe their own reproductive preferences to their spouses, or they may ascribe more or less agreement than actually exists, though women are more likely to do so than men given the general trend of male dominance. The increasing acceptance of including qualitative and triangulation techniques in surveys, though more costly and time consuming, needs to make greater inroads in the population establishment. There are so many underlying concerns which individuals simply cannot, or will not reveal in a questionnaire survey. For example in the story of Grace and Akwasi, the latter’s mother was an important player in questioning her daughter-in-law’s (and son’s) inability to bear a son. This had significant implications for Akwasi’s gender identity, and his dominance over Grace (see Adomako Ampofo 2000). Yet, the role of the extended family in creating a ‘need’ for children does not feature in population discourse. Fertility and infertility are such important aspects of people’s lives in Africa that examining people’s decisions (or non-decisions) to have (or not have) children needs to be carried out, as with all research, in a careful, sensitive and, culturally-relevant manner, both in the design of concepts as well as in the field methodology.