I thought the Foster article highlighted how international interest in fertility decline (outlined in Szreter's article last week) is still playing out today. Often, family planning programs and policies are focused on increasing the number of users (see Melinda French Gates's goal of 120 million new contraceptive users by 2020), rather than understanding decisions to use and not use contraception. I enjoyed the discussion in the Foster article that addressed the assumptions inherent in the measure of unmet need itself. Specifically, Foster highlighted that most of this unmet need may be choice not to use (demand-side) rather than lack of access or information (supply-side).
In addition to the cited Hussain article, other researchers have begun to contribute towards the development of improved contraceptive demand indicators. First is the issue of reclassifying individuals whose contraceptive needs are designated as "met" but who are dissatisfied with that method. Rominski and Stephenson suggested that women who are using a method but are dissatisfied with the method to having unmet need . Rothschild and colleagues tested this suggestion among women in Kenya and that this greatly increases measures of unmet need. On the other hand, there are individuals who are classified as having unmet need who choose not to use contraception, as Foster highlights. Senderowicz puts forth a new measure that overlays use with demand, which can elucidate both issues. I'm happy to see that measurement is beginning to catch up to the experiences of contraceptive users.
Rominski SD, Stephenson R. Toward a New Definition of Unmet Need for Contraception. Stud Fam Plann. 2019;50(2):195-198. doi:10.1111/sifp.12084
Rothschild CW, Brown W, Drake AL. Incorporating Method Dissatisfaction into Unmet Need for Contraception: Implications for Measurement and Impact. Stud Fam Plann. 2021;52(1):95-102. doi:10.1111/sifp.12146
Senderowicz L. Contraceptive Autonomy: Conceptions and Measurement of a Novel Family Planning Indicator. Stud Fam Plann. 2020;51(2):161-176. doi:10.1111/sifp.12114