and Roy, 1996)—showing that the associations are partly causal. Helping people implement their preference for fewer children should result in better schooling and health care for the wanted children. The ICPD Programme of Action emphasized the contribution that increased education of girls could make to lowering fertility rates, and, thus, population growth rates. A similar program of action with increased education of girls as its goal could reciprocally emphasize the contribution that family planning programs could make toward that end.

The effects of unintended births on siblings and parents can be mitigated by institutions and customs that share the economic burden with a wide circle of kin or fellow citizens. Child fosterage in West Africa, for example, "breaks down household economic boundaries and spreads the impact of additional children on family resources across a wider kin network" (Lloyd, 1994:188). However, when social institutions, whether traditional or modern, mitigate the impact of an unwanted birth on the immediate family, however, they are spreading costs of unintended pregnancy more widely within society, not eliminating them.


There is a large literature on the design, management, financing, and evaluation of family planning programs, and there have been some very useful recent reviews (Simmons and Lapham, 1987; Phillips and Ross, 1992; Buckner et al., 1995), so this report does not attempt to cover the field in a comprehensive fashion. Rather, we focus on some of the major challenges that face family planning programs in the next decade or two, with an emphasis on those that are shared with other aspects of comprehensive reproductive health services.

Unmet Need for Contraception

A measure of "unmet need" for contraception in developing countries can be formed by cross-classification of responses to survey items on the wantedness of current pregnancies, intentions for childbearing in the near future, and current contraceptive use. Westoff and Bankole (1995), using data from 1990-1994 DHS surveys in 27 countries, calculate unmet need as the sum of currently pregnant women who report that their pregnancy is unintended and nonpregnant currently married women who believe themselves fecund and want no more children (or none within the next 2 years), but are not currently practicing any contraceptive method. The proportions of unmet need vary greatly, from between 10 and 15 percent of women in Turkey, Colombia, and Indonesia (countries with

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