There were several studies that explore the proportion and determinants of unmet need for FP in Bangladesh (for example, Islam et al, 2013; Pradhan and Dwivedi, 2015; Khatun and Mallick, 2020). This study examined the effect of wealth index on unmet need for FP in Bangladesh and how this effect varies between rural and urban areas. In determining the required adjusted effect few selected covariates were used as control covariates. The data used in this study have been extracted from the BDHS 2017-18 data. We have considered the strict definition of infecundity in defining unmet need for FP and only the number of currently married women of reproductive age who have demand for FP were used in the denominator to calculate the proportion of unmet need for FP. However, the NIPORT 2020 used all currently married women of reproductive age as a denomination when calculating the percentage of unmet need for FP.
The proportion of unmet need for FP among currently married women of reproductive age was 15.48% in Bangladesh. This proportion was approximately equal to the figure of Nigeria (16.1%) and was less than the figure of Malawi (21.0%) (Fagbamigbe et al, 2018; Nkoka et al, 2020). However, both Nigeria and Malawi's studies considered all sexually active women (married or unmarried) of reproductive age. It is expected that figures of those two studies should be higher than the figure of Bangladesh as young unmarried people face great barriers to access FP services and hence may have higher unmet need for FP than the married people (Westoff, 2006; Islam et al., 2013; Pradhan and Dwivedi, 2015).
Using BDHS 2014 data, Khatun and Mallick (2020) found that women from rich families had significantly higher odds of having unmet need for FP than women from poor families (OR=1.25, CI: 1.08-1.46). In other studies, wealth index had no significant effect on unmet need for FP (Pradhan and Dwivedi, 2015). However, studies in other countries reported that poor women were more likely to have unmet need for FP (Fagbamigbe et al, 2018; Nkoka et al, 2020). Huda et al. (2017) extensively reviewed literature from ten articles on contraceptive use in Bangladesh and observed that rural women had significantly higher odds of having unmet need for FP than urban women. A similar finding was found in Ethiopia (Hailemariam and Haddis, 2011). In this study, using the composite factor place-wealth we have found that women from rural areas and rich families had the highest likelihoods of having unmet need for FP (OR=2.222, p<0.001) compared to women of urban areas and not rich families. However, women of urban areas and rich families reduced unmet need for FP.
The present study demonstrated that higher educated spouses were less likely to have unmet need for FP than the below higher educated spouses. Note that an earlier study in Nigeria (Fagbamigbe et al, 2018) had also found a similar effect of education of women on unmet need for FP. However, Islam et al. (2013) reported that in Bangladesh higher educated women had more odds of having unmet for FP to space compared to illiterate women. In Kenya and Eastern Sudan, educational attainment (at least secondary level) of the respondent significantly reduce the unmet need for FP (Wafula and Ikamari, 2007; Ali and Okud, 2013).
As expected, working married women had less odds of unmet need for FP than those women who are not working at the time of the survey. This is consistent with studies from Ghana and Malawi (Wulifan et al, 2019; Nkoka et al, 2020) and a study in Bangladesh (Islam et al., 2013). Working women may have easy access to quality health services and have better autonomy in using contraceptive (Nkoka et al, 2020). However, a contrary findings was found in rural areas of Burkina Faso (Adebowale and Palamuleni, 2014).
In a study in the rural areas of Burkina Faso, it is observed that with living children (\(\ge 1\)) were much more likely (more than five times) to have unmet need for modern contraceptive than women with no living children (Adebowale and Palamuleni, 2014). But our study discovered that women with more living children were less likely to have unmet need for FP than women with no living children and is consistent with another Bangladeshi study (Khatun and Mallick, 2020) in which unmet need were likely to reduce in families having more children.
Our findings provide evidence that migrant women were less likely to have unmet need for FP than non-migrant women in Bangladesh. This is consistent with studies in Ethiopia and Cotonou of Benin Republic (Groene and Kristiansen, 2020; Banougnin et al., 2018). Migration can delay childbearing due to time taken to adjust at the new environment (Ochako et at., 2016). If migration is particularly to search for opportunity, migration provides easy access and better exposure to contraceptive methods (Groene and Kristiansen, 2020).
As expected, the likelihood of unmet need for FP was less for the women who are visited by FP workers in the last six months of the survey that corroborates with the figure obtained in Ethiopia and rural areas of Burkina Faso (Hailemariam and Haddis, 2011; Adebowale and Palamuleni, 2014). However, study in Burkina Faso considered whether respondents recently visited a health facility with or without discussing FP issues. Discussion with FP workers improve the knowledge and hence they are eagerly using FP methods (Adebowale and Palamuleni, 2014). Women whose movement were monitored or cannot discuss FP services were more likely to have unmet need for FP (Fagbamigbe et al, 2018).
Consistent with studies from Bangladesh, Nepal and Nigeria (Islam et al., 2013; Bhanderi and Kannan, 2010; Fagbamigbe et al, 2018), in this study it was found that women form Muslim families were more likely to have unmet need for FP compared to non-Muslim women. Religious beliefs reduce the use of contraceptive and hence increase the fertility. In a study among young Muslim couples in Iran revealed that participants having strong religious beliefs desire more children (Khadivzade and Arghavani, 2014). Muslim women who live in the Northern part of Nigeria usually desire larger families and hence have less demand of contraceptive (Fagbamigbe et al, 2018).
The likelihood of having unmet need for FP varies across geographical region and that agree with the results of two studies in Bangladesh (Pradhan and Dwivedi, 2015; Khatun and Mallick, 2020) and a study in Nigeria (Fagbamigbe et al, 2018). However, unmet need for FP in Sylhet division was significantly higher than that in Barishal division in previous two studies which is not significantly higher in our study.