Population growth and the high levels of fertility in sub-Saharan Africa remain a significant impediment to development in the region. After nearly three decades of family planning programming in the region, fertility levels remain, for the most part, unchanged although substantial numbers of women continue to indicate a preference toward lowering their levels of childbearing. Some estimates indicate that almost 30 percent of married women in sub-Saharan Africa do not use family planning although they express a desire to stop, or delay, having children (Bongaarts 1994; Westoff and Bankole 1995).
Most African countries now have explicit population targets, a response to the exacerbating effect population growth has had on social, economic, and environmental resources. Population should not be held solely responsible for the economic quagmire in which many developing countries find themselves, although it is widely acknowledged that lower rates of population growth would ease the development burden in these societies.
Beyond the concern with sheer numbers and rates of growth, another perspective on population as a problem in the region relates to the gap between reproductive preferences and actual fertility, alluded to earlier, which affects one-half of the population's (the female half) inability to determine what happens to, or issues from, their own bodies.
This gap, referred to variously as the KAP-gap, or unmet need (Westoff 1988; Bongaarts 1991) has constituted the cornerstone of, or basis for, family planning programming. After all, if women say they want no more children, but are not using contraception (the fundamental conditions for inclusion in the KAP-gap/unmet need measure), then providing family planning services should serve to satisfy this apparent unmet need for contraception. Conceptually, then, unmet need can be represented as a demand for contraception which can be “met” by family planning programs.