{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:58:42Z","timestamp":1791568722870,"version":"4.3.4"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Traditional binary frameworks tend to combine the various aspects of unmet family planning needs into one general category. This study evaluates unmet family planning needs by first using conventional multinomial logistic regression to determine baseline demographic risk profiles. It then applies machine learning methods such as Random Forest and XGBoost to see if they can provide further insights into non-linear patterns and complex interactions between features that standard regression might miss. Using data from the Bangladesh Demographic and Health Survey (BDHS 2022), we built a multivariable multinomial logistic regression model. Additionally, we applied sophisticated ensemble classifiers such as Random Forest and XGBoost, paired with a synthetic hybrid resampling technique (SMOTE) to address severe class imbalance. Feature selection was conducted using the Boruta algorithm, and we used Shapley Additive Explanations (SHAP) to visualize complex global patterns and interaction effects. Bivariate analysis showed significant associations between unmet needs and maternal age, parity, wealth, residence, and decision-making power (p\u2009&lt;\u20090.05). Multivariable logistic regression confirmed that having more children (4 or more) greatly increased the likelihood of unmet needs for spacing (aOR = 20.60) and limiting (aOR = 2.24). Wealth was notably protective against unmet needs for limiting, especially for the richest quintile (aOR = 0.48). Although SHAP analysis offered exploratory insights into complex, non-linear interactions between residence and factors such as parity and education, the predictive accuracy of tree-based models (Random Forest, XGBoost) was only moderate, with macro-averaged AUCs comparable to those of traditional regression. Therefore, population-level conclusions are most reliably drawn from the MLR model. The limitations of cross-sectional survey data as a diagnostic tool show that spacing needs are often fluid, transient, and shaped by relationships. Addressing the unmet need gap involves moving away from broad media campaigns toward localized counseling, ensuring stable rural spacing supplies, and involving husbands and mothers-in-law to turn reproductive healthcare into a shared household conversation.<\/jats:p>","DOI":"10.1371\/journal.pgph.0007412","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:38:03Z","timestamp":1791567483000},"page":"e0007412","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with the unmet need for spacing and limiting family planning: Evidence from a national survey"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4803-2648","authenticated-orcid":true,"given":"Muhammad Khairul","family":"Alam","sequence":"first","affiliation":[{"name":"Jahangirnagar University","place":["Savar, Dhaka, Bangladesh"],"department":["Department of Statistics and Data Science"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0751-7104","authenticated-orcid":true,"given":"Rumana","family":"Rois","sequence":"additional","affiliation":[{"name":"Jahangirnagar University","place":["Savar, Dhaka, Bangladesh"],"department":["Department of Statistics and Data Science"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"issue":"6","key":"pgph.0007412.ref001","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1080\/13625187.2016.1234034","article-title":"Factors affecting unmet need for contraception among currently married fecund young women in Bangladesh","volume":"21","author":"AZ Islam","year":"2016","journal-title":"Eur J Contracept Reprod Health Care"},{"issue":"2","key":"pgph.0007412.ref002","first-page":"1","article-title":"Unmet contraceptive need in Bangladesh: Evidence from the 1993\/94 and 1996\/97 demographic and health surveys","volume":"14","author":"Barkat-E-Khuda","year":"1999","journal-title":"Asia Pac Popul J"},{"issue":"1","key":"pgph.0007412.ref003","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1363\/4000414","article-title":"Unmet need, intention to use contraceptives and unwanted pregnancy in rural bangladesh","volume":"40","author":"R Callahan","year":"2014","journal-title":"Int Perspect Sex Reprod Health"},{"issue":"1","key":"pgph.0007412.ref004","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1363\/4000414","article-title":"Unmet need, intention to use contraceptives and unwanted pregnancy in rural bangladesh","volume":"40","author":"R Callahan","year":"2014","journal-title":"Int Perspect Sex Reprod Health"},{"issue":"1","key":"pgph.0007412.ref005","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s41256-023-00337-8","article-title":"Reimagining gendered community interventions: The case of family planning programs in rural Bangladesh","volume":"9","author":"B Bhatia","year":"2024","journal-title":"Glob Health Res Policy"},{"issue":"1","key":"pgph.0007412.ref006","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1186\/s12905-022-01752-8","article-title":"Link between unmet need and economic status in Bangladesh: Gap in urban and rural areas","volume":"22","author":"ZR Shabuz","year":"2022","journal-title":"BMC Womens Health"},{"issue":"28","key":"pgph.0007412.ref007","doi-asserted-by":"crossref","DOI":"10.1073\/pnas.2101160118","article-title":"Thirty-five years later: Long-term effects of the Matlab maternal and child health\/family planning program on older women\u2019s well-being","volume":"118","author":"T Barham","year":"2021","journal-title":"Proc Natl Acad Sci USA"},{"issue":"1","key":"pgph.0007412.ref008","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.contraception.2016.02.026","article-title":"Correlates of unmet need for contraception in Bangladesh: Does couples\u2019 concordance in household decision making matter?","volume":"94","author":"J Uddin","year":"2016","journal-title":"Contraception"},{"issue":"1","key":"pgph.0007412.ref009","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/s13524-012-0172-2","article-title":"Family planning and women\u2019s and children\u2019s health: long-term consequences of an outreach program in Matlab, Bangladesh","volume":"50","author":"S Joshi","year":"2013","journal-title":"Demography"},{"issue":"7","key":"pgph.0007412.ref010","article-title":"Association between socioeconomic factors and unmet need for modern contraception among the young married women: A comparative study across the low- and lower-middle-income countries of Asia and Sub-Saharan Africa","volume":"2","author":"AI Anik","year":"2022","journal-title":"PLOS Glob Public Health"},{"issue":"1","key":"pgph.0007412.ref011","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s12889-023-17414-9","article-title":"Experiences with family planning and abortion services during the Covid-19 pandemic: A qualitative study in Bangladesh, Iran and Netherlands","volume":"24","author":"K Asadisarvestani","year":"2024","journal-title":"BMC Public Health"},{"issue":"1","key":"pgph.0007412.ref012","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1186\/s12978-022-01410-0","article-title":"Family planning knowledge, attitude and practice among Rohingya women living in refugee camps in Bangladesh: A cross-sectional study","volume":"19","author":"Md Abul Kalam Azad","year":"2022","journal-title":"Reprod Health"},{"issue":"3","key":"pgph.0007412.ref013","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1177\/1010539511399118","article-title":"Interspousal communication on family planning and its effect on contraceptive adoption in Bangladesh","volume":"24","author":"SMM Kamal","year":"2012","journal-title":"Asia Pac J Public Health"},{"issue":"3","key":"pgph.0007412.ref014","doi-asserted-by":"crossref","first-page":"157","DOI":"10.2307\/1966810","article-title":"Oral contraception in Bangladesh: Social marketing and the importance of husbands","volume":"18","author":"J Davies","year":"1987","journal-title":"Stud Fam Plann"},{"key":"pgph.0007412.ref015","unstructured":"Bradley SEK, Croft TN, Fishel JD. DHS analytical studies 25 revising unmet need for family planning [Internet]. 2012. Available from: www.measuredhs.com"},{"issue":"1","key":"pgph.0007412.ref016","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1186\/s12905-023-02587-7","article-title":"Examining the influence of mother-in-law on family planning use in South Asia: Insights from Bangladesh, India, Nepal, and Pakistan","volume":"23","author":"MR Pradhan","year":"2023","journal-title":"BMC Womens Health"},{"issue":"9","key":"pgph.0007412.ref017","article-title":"Prevalence and factors associated with family planning during COVID-19 pandemic in Bangladesh: A cross-sectional study","volume":"16","author":"N Roy","year":"2021","journal-title":"PLoS One"},{"issue":"1","key":"pgph.0007412.ref018","doi-asserted-by":"crossref","first-page":"16","DOI":"10.2307\/3088271","article-title":"Spousal communication and family planning adoption: Effects of a radio drama serial in Nepal","volume":"28","author":"M Sharan","year":"2002","journal-title":"Int Fam Plan Perspect"},{"issue":"12","key":"pgph.0007412.ref019","doi-asserted-by":"crossref","first-page":"6099","DOI":"10.3390\/ijerph20126099","article-title":"Adolescent pregnancy in South Asia: A pooled analysis of demographic and health surveys","volume":"20","author":"S Poudel","year":"2023","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pgph.0007412.ref020","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.contraception.2016.02.026","article-title":"Correlates of unmet need for contraception in Bangladesh: Does couples\u2019 concordance in household decision making matter?","volume":"94","author":"J Uddin","year":"2016","journal-title":"Contraception"},{"issue":"7","key":"pgph.0007412.ref021","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1016\/j.socscimed.2009.01.025","article-title":"Understanding gendered influences on women\u2019s reproductive health in Pakistan: Moving beyond the autonomy paradigm","volume":"68","author":"Z Mumtaz","year":"2009","journal-title":"Soc Sci Med"},{"key":"pgph.0007412.ref022","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/1742-4755-7-15","article-title":"Women\u2019s autonomy in household decision-making: A demographic study in Nepal","volume":"7","author":"DR Acharya","year":"2010","journal-title":"Reprod Health"},{"issue":"2","key":"pgph.0007412.ref023","doi-asserted-by":"crossref","first-page":"2097044","DOI":"10.1080\/26410397.2022.2097044","article-title":"Intermittent needs for family planning among women with an internal migrant husband in Bangladesh: A qualitative study","volume":"29","author":"R Khan","year":"2022","journal-title":"Sex Reprod Health Matters"},{"issue":"9287","key":"pgph.0007412.ref024","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1016\/S0140-6736(01)06182-7","article-title":"Do better family planning services reduce abortion in Bangladesh?","volume":"358","author":"M Rahman","year":"2001","journal-title":"Lancet"},{"key":"pgph.0007412.ref025","doi-asserted-by":"crossref","first-page":"313","DOI":"10.2307\/1966627","article-title":"Determinants of reproductive change in a traditional society: Evidence from Matlab, Bangladesh","volume":"19","author":"JF Phillips","year":"1988","journal-title":"Stud Fam Plann"},{"issue":"1","key":"pgph.0007412.ref026","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1186\/s12978-022-01410-0","article-title":"Family planning knowledge, attitude and practice among Rohingya women living in refugee camps in Bangladesh: A cross-sectional study","volume":"19","author":"Md Abul Kalam Azad","year":"2022","journal-title":"Reprod Health"},{"issue":"3","key":"pgph.0007412.ref027","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1111\/j.1728-4465.1999.00183.x","article-title":"The effects of family planning workers\u2019 contact on fertility preferences: Evidence from Bangladesh","volume":"30","author":"M Arends-Kuenning","year":"1999","journal-title":"Stud Fam Plann"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0007412","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:38:09Z","timestamp":1791567489000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0007412"}},"subtitle":[],"editor":[{"given":"Anushka","family":"Ataullahjan","sequence":"first","affiliation":[{"name":"Western University of Health Sciences","place":["CANADA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,9]]},"references-count":27,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0007412","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,9]]}}}