A community-based cross sectional household survey was conducted to investigate unmet need for family planning, factors affecting unmet need and total demand for family planning in Kassala State, Eastern Sudan between 1st May and 31st July 2012. Random selection of three villages with different distance (not less than 10 km) from Kassala, the capital city of the State and two towns including Kassala itself was used.
Kassala is 600 killometer from Khartoum on Ethiopian –Eritrean border with 1.8 million inhabitants, 440491 out of them are women in the reproductive age . In Eastern Sudan there is a prominent diversity in culture, religion, language and ethnicity and some tribes are nomads. The maternal mortality is one of the highest in country. In Kassala there are 28 health centers and more than ten hospitals providing health services and there is an office of Sudanese family planning association providing different aspect of services like pills and intrauterine contraceptive device free of charge but the most recent methods such as implant and marina are not available. The family planning services are offered by different health personnel (doctors, nurses, midwives). After obtaining verbal consent structured questionnaires were used to gather data from all ever married women of childbearing age (15-49 years) to identify unmet need for family planning and associated factors (age, parity, education and husband education). Irrespective of its validity the age of the women defined as age completed in year at the time of interview using the recall method.
Concept of unmet need for family planning
Unmet need for family planning was defined as the percentage of all fecund married women who are not using an appropriate method of contraception even though they do not want to get pregnant also it included the pregnant and amenorrheic women whose the pregnancy or birth was unwanted or mistimed. Women who are not using an appropriate method of contraception and wanted to wait for at least two years or who wanted no more children were subcategorized as unmet need for spacing and limiting respectively. In this study the concept of unmet need was applied to ever married women in the union and it was estimated using Westoff model . Total demand for family planning was calculated as sum of the percent of unmet need plus percent using contraception.
The surveyed women were first divided into those using a contraceptive method and those not using a method. The nonusers were then subdivided into pregnant or amenorrheic women and nonusers who were neither pregnant nor amenorrheic category at the time of the survey. The pregnant or amenorrheic were further subdivided in to three categories: those their pregnancy was intended, mistimed and unwanted at the time of the survey. Those in the mistimed and unwanted pregnancy category were regarded as one component of the total unmet need. The other component consists of nonusers who were neither pregnant nor amenorrheic. These women were first divided into fecund or infecund women, with the fecund women then subdivided by their reproductive preference. Those who wanted another child soon were excluded from the unmet need category, while women who wanted to wait for at least two years or who wanted no more children were classified in unmet need group.
Data were entered into a computer database and SPSS software (SPSS Inc., Chicago, IL, USA, version 13.0, free version one) and double checked before analysis. Unmet need was the dependent variable and socio-demographic characteristics were independent variables. Confidence intervals of 95% were calculated and P<0.05 was considered significant. In case of discrepancy between the results of ANOVA and x2 test and the results of multivariate analyses, the later was taken as final. Means and proportions for the socio-demographic characteristics were compared between the unmet need for spacing and met-need catogery using student and x2 test, respectively and P<0.05 was considered significant.
The study received ethical clearance from the Research Board at Ministry of Health Kassala State, Eastern Sudan.