Spatial distribution and factors associated with unmet need for family planning among women of reproductive age in Zambia: Evidence from the 2024 Zambia Demographic and Health Survey
Based on the 2024 Zambia Demographic and Health Survey, this study reveals that unmet need for family planning among Zambian women is high (27.0%) and geographically clustered in provinces like Lusaka and North-Western, with significant associations to marital status, parity, wealth, employment, and residence.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of a preprint that has not been peer-reviewed. It is not medical advice. Do not make health decisions based on this content. Read full disclaimer
In many parts of the world, the ability to decide when to have a child, or whether to have one at all, is not just a personal choice but a matter of health and stability. When women who want to delay or stop having children cannot access contraception, they face a situation known as an "unmet need" for family planning. This gap between desire and reality often leads to unintended pregnancies, which can strain families and increase risks for mothers and children. For decades, public health officials have tracked these numbers to see where help is needed most. However, national averages can sometimes hide the truth, smoothing over sharp differences between one town and the next. To truly understand where the need is greatest, researchers must look beyond the big picture and examine the specific geography of a country, mapping exactly where these struggles are concentrated and why.
A team of researchers in Zambia recently took a deep dive into this issue using data from the 2024 Zambia Demographic and Health Survey. They analyzed information from more than 12,000 women between the ages of 15 and 49 to create a detailed map of where unmet need for family planning exists. Instead of simply asking how many women across the whole country need help, they looked at the specific locations where these women live. Their work reveals that the need is not spread out evenly like a thin layer of dust; rather, it is clustered in specific areas, forming hotspots where the problem is significantly more intense than in surrounding regions.
The study found that nationally, about 27 percent of women of reproductive age in Zambia have an unmet need for family planning. While this number is an average, the reality on the ground varies wildly depending on where a woman lives. The researchers discovered that the highest levels of unmet need are concentrated in the North-Western, Southern, and Lusaka provinces. In fact, the city of Lusaka, often seen as a hub of opportunity and services, emerged as a primary hotspot. This finding is somewhat surprising because, generally, women living in cities have better access to health services than those in rural areas. The data suggests that within the city itself, there are pockets of deep inequality where women are just as isolated from family planning resources as those in remote villages, likely due to poverty or the specific nature of informal settlements.
Beyond location, the researchers identified clear patterns in the lives of the women who are most affected. The need for family planning is highest among younger women, those who are currently married or in a relationship, and those who have already given birth to five or more children. Wealth plays a major role as well; women from the poorest households are far more likely to lack access to contraception than those from wealthier families. Similarly, women who are employed and those with higher levels of education tend to have better access to the services they need. The study also noted that women who simply want more children face different challenges, as their desire for larger families interacts with their ability to plan those births.
To reach these conclusions, the researchers used a sophisticated approach that combined traditional survey questions with geographic mapping. They took the precise locations of the households surveyed and used statistical tools to see if the women with unmet needs were randomly scattered or if they were grouped together. The results showed a clear pattern: the women were indeed grouped together in specific clusters. One of the most significant clusters was found in Lusaka, where the number of women with unmet needs was nearly one and a half times higher than what would be expected by chance. Other significant clusters were found in the Southern and North-Western provinces. This spatial clustering tells a story that a simple national average cannot: the problem is localized, and the barriers to care are specific to these communities.
The researchers were careful to note that their study shows a connection between these factors and the lack of access, but it does not prove that one causes the other. For instance, while they found that distance to a health facility was a problem for many women in the initial analysis, this factor disappeared when they accounted for other issues like poverty and where the women lived. This suggests that the distance itself might not be the primary barrier; rather, it is the combination of being poor and living in a certain area that creates the obstacle. The study also highlighted that while some variables, like a partner's desire for children, were important, the researchers could not fully analyze them because too much of that data was missing from the survey.
Ultimately, this research offers a roadmap for action. The authors suggest that family planning programs in Zambia should stop treating the entire country as a single unit and instead focus their resources on the specific hotspots they have identified. They recommend targeting the Lusaka, Southern, and North-Western provinces with intensified outreach. Furthermore, they argue that services need to be tailored to the specific groups most at risk: young women, those with many children, and the poorest households. By understanding exactly where the need is clustered and who is most affected, health officials can move beyond broad, ineffective strategies and deliver help where it is needed most, ensuring that the promise of family planning reaches the women who are currently being left behind.
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